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Michael White: Burnham's big leap

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A veteran public sector manager reports her family’s experience with the NHS over Christmas.

Health reporting HSJ and LGC logo

Mum emerged from hospital after surgery to find neither she nor her ailing husband had any support waiting from primary care services. My friend’s doctor son had another problem, a family plotting to keep their own mum in his hospital ward rather than spoil their festive plans.

‘Burnham said his “penny drop” moment came talking to a ward sister at the Royal Derby Hospital’

Everyone has such stories and shadow health secretary Andy Burnham told a painful one as part of his “whole-person care” speech at the King’s Fund the other day. Back in 2007, the then health minister’s sister-in-law was dying of cancer in the mighty Royal Marsden and asked him to get her home to die among her family. To his surprise he found that even a health minister couldn’t fix it. How must others feel? Ouch.

What goes wrong? Poor regulation? Callous staff? Partly so. But what Burnham called his “penny drop” moment came talking to a ward sister at the Royal Derby Hospital.

Modern hospitals simply aren’t equipped to deal with wards full of the post-operative elderly whose needs − physical, mental, social − are great, she explained. Having spent time lately with a 90-year-old, still active and delightful but in need of much attention, I can follow that.

Set-piece speeches

Burnham’s big leap is thus from Bevan’s National Illness Service of 1948 to one which finally embraces social care and its implications. What happens in the home and the community, diet and lifestyle choices − preventive as well as curative − is an unavoidable component of the “whole-person” challenge in a health system with flatlining budgets. “Person-centred, not patient-centred,” as he puts it. It’s cheaper and often safer too.

It’s easy to be cynical about such talk, as some were. After all, Labour is still only two years away from 13 years in power. It did good things, but also got snared in reorganisations, competition models, grandiose PFI hospitals (no mention of them in his speech) and left end-of-life care policy to 2009, too late to resolve.

Myself, I dread big set-piece political speeches, but as a glass half-full man would give Burnham a beta-plus for effort.

His “green paper” offers a constructive way of thinking the future − “the start of a conversation, not the end”. That’s more than can be said for David Cameron’s high-risk promise of a European referendum in that speech the day before. If he wins in 2015, the PM promises a vote on an outcome he cannot control, a dangerous move.

Handy Andy

If Labour wins Burnham is less committed. No point in making up your mind before the promised consultations (about which voters have become cynical), so he consciously ducks issues like compulsion versus the voluntary model to fund elderly care.

‘The biggest sleight of hand is surely the promise that a Miliband cabinet would allow “no top-down reorganisation” of the NHS’

It’s also clear he walks a party political tightrope, both condemning market solutions a few words before praising integrated US systems and reviving his own “NHS preferred provider” formula while also remembering to condemn uncaring “monopoly”.

Markets equal fragmentation, he says, as if over 60 NHS monopoly years produced integration. And “choice is not the same as competition”. Oh really? It’s pretty damn close.

Yet the biggest sleight of handy Andy’s hand is surely his promise that a Miliband cabinet would allow “no top-down reorganisation” of the NHS. Instead it would repeal market chunks of the 2012 act while putting its council-led health and wellbeing boards in charge of commissioning budgets, leaving medic-led CCGs to provide mere “technical support”.

Wow! I’d call that pretty sweeping and disruptive, Andy. Thank goodness for the promised consultation.

Michael White writes about politics for The Guardian

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