A Labour government would “not mandate” organisational change to drive through its plans for a fully integrated national health and care service but would like “fewer players on the pitch”.
This was the pledge made by shadow health secretary Andy Burnham during an exclusive interview at the Labour party conference in Manchester.
The former health secretary’s comments came amid concerns the NHS would face another structural reorganisation if Labour wins the general election in May 2015.
He told the Labour party conference he wanted to bring social care into the NHS as part of a 10 year plan and to develop a system focused on “whole person care”, which pushed provision out of the hospitals and into communities.
He told HSJ: “The way I would describe it, [is that] everyone in the system needs to think differently.
“Being loyal to a part of the system is not going to work anymore….The divides have got to go.
“We have to develop a shared loyalty to the public and people working as one team.
“I would say the fewer organisations you have on the pitch, the more likely it is that you will develop that sense of team spirit.
“But I am not going to mandate that. I am saying organisations should evolve into integrated care organisations but how it’s done, the speed with which it is done is a devolved matter [for] health and wellbeing boards [to oversee].”
Asked if this constituted a top down reorganisation, a charge Mr Burnham has repeatedly rejected, he said: “I have always said there needs to be service reorganisation [but not a structural reorganisation.
“Actually, by focuses on structures we’ve avoided the main issue.
“[The quality innovation productivity and prevention programme] was about remodeling services to address these issues but it got put on hold because everything went to jobs and structures and organisations and that’s the point.”
Mr Burnham said he understood that non-acute trusts would fear “hospital takeover” but said new financing mechanisms would push work away from hospitals and into communities.
“For those who fear hospital takeover, as they might, my message to them is that the funding changes that come with this, protect the community.
“In fact, it becomes the place where care is delivered. So alongside the calls for integrated organisations, you must look at the ‘year of care’ proposal.
“That, in many ways, is the most important change of all here. I think that is my engine of integration. I would want to triple underline that as the most important thing.
“[The financial tide] drags [money] towards the hospital at the moment. The year of care turns the tide in precisely the opposite direction.
“So for non-acute trusts, I would hope that they would see much of what they have always called for and a massive opportunity. But I would also ask them not to fight their organisation’s cause. Let’s fight the cause of better care for vulnerable people.”
Under the year of care tariffs, NHS providers are paid for caring for a patient for a year, rather than per episode of care such as a hospital admission.
The system is designed to encourage trusts to deliver the best care for patients and keep them out of hospital, rather than incentivise maximum hospital activity, as is the case under payment by results tariffs.
He said his “preferred option” would be for GPs to be salaried employees of integrated care organisations.
“I think there is a problem with younger people coming through training and thinking ‘is that the career for me?’
“I think there is some evidence that people are not choosing [to be GPs] so you have to rethink general practice and generalism.
“The new generation of GPs that have been announced, I would imagine that many of them will be salaried.”
He said he envisaged “the GP at the centre of a multidisciplinary team that includes the social care staff too… quite empowering that, I would think”.
Andy Burnham on:
The £2.5bn funding boost for the NHS
The £2.5bn of extra NHS funding pledged by Labour leader Ed Miliband will be available in every year of the next parliament from 2015-16 – in addition to whatever allocation was agreed for the NHS during the spending review.
Mr Burnham said: “A full spending review has not been done yet, so that’s the first thing to do. It starts with Ed Balls’ statement that we will do whatever it takes to protect the NHS.
“This is recurrent funding. So the money starts to come in and it’s there and this becomes part of the NHS budget. It’s great news for me… This is money over the five years of the parliament that we can bank on basically.”
Mr Burnham said while he wanted to devolve decision making to health and wellbeing boards, a Labour government would impose more “top-down” grip on the system which he said had been “lacking” under the coalition government.
He said “we lost a sense of clarity about the numbers and who was responsible” for the total number of nurses in the NHS that this “has given us a major headache now because now the agency bill is quite literally out of control”.
Mr Miliband’s pledge for 20,000 new nurses was based on the current government’s target to recruit around 12,000 new nurses and a further 8,000 to fill unfilled vacancies in the system..
Proposed union strike action
Mr Burnham said it was not for him to “support or condemn” a potential strike action proposed by Unison members this month but he said he “understands why they feel the way they do”.
He said: “What [health secretary] Jeremy Hunt has done to nurses, midwives and other staff is nothing short of disgraceful. An independent pay review body set up to consider affordability, that was told by the government that 1 per cent would be acceptable; recommended it; to have that thrown back is, I think, appalling.
“I know Unison, I know the [Royal College of Nursing] and the [Royal College of Midwives]. The fact they’ve never done anything like this is an indication of how they feel. I am not supporting [strike action]. I am not opposing. It’s not for me to do that. But I understand why they feel the way they do.”