The Choice on the NHS – read the full text of Andy Burnham’s speech

29th July, 2014 10:54 am


When people look back, this could turn out to be no ordinary summer for the NHS.

In just over two weeks, a group of mums from Darlington will set out from the North East, retracing the steps of the Jarrow marchers.

The People’s March for the NHS aims to raise awareness about, in their words, “the Government’s assault on our most prized possession”.

It remains to be seen whether it catches the public mood.

But I think it might.

There is growing anxiety about where the NHS is heading – and anger that people have never voted for such changes.

Four years ago this month, Andrew Lansley published his ‘Liberating the NHS’ White Paper.

I can remember the shock I felt when I turned through its pages.

Just weeks before, I had spoken alongside Lansley at many hustings events and heard him promise no top-down re-organisation.

And then this – the biggest bombshell ever to land on the NHS.

He had clearly been drawing up these plans in Opposition, with the help of the private health care company which funded his office, but chose not to tell the voters.

When they hit the light of day, the problem wasn’t just the danger of a distracting reorganisation when the NHS should have been focusing on the financial challenge – and all the inherent risks to patient care.

What was more breathtaking was the sheer audacity of the plan to treat the NHS as another utility to be broken up and privatised.

Who had voted for this?

Today I want to show what has happened to the NHS in the four years since the biggest reorganisation in its history began.

Not with assertions, but evidence.

I will then go on to show how that analysis of where the NHS is heading frames the huge choice before the country at next year’s election.

At this election, unlike the last, there will need to be a proper debate about what kind of health and care service the country wants going forward.

The NHS has arrived at a major crossroads. The 21st century is asking some difficult questions of our 20th century service and, in truth, it is struggling to answer them.

Such is the scale of the challenges looming over the NHS in the next Parliament that the decisions taken will determine its future – or indeed whether it has one.

So all the main parties will need to make their plans for the NHS plain: there can be no repeat of last time. People need to be presented with a real choice.

Today, and over the weeks to come, I will set out Labour’s plan.

The time has come for the Party which created the NHS in the last century to reset it for this – as a national health and care service able to see the whole person and all of their needs.

That is the only way, in this the century of the ageing society, that it will be able to plot a course to financial sustainability.

But it is also the way that we can dramatically improve the way we care for older people – now an urgent national priority.

People need to be able to judge our plan against the current course on which the NHS is set.

To do that, we need to look at what has happened to the NHS in the four years since the reorganisation began.

I said it then – and I say it again today: this was the wrong policy at the wrong time.

We said the reorganisation would drag down the NHS – and so it has proved.

The NHS has gone downhill under David Cameron.

Today we publish new analysis charting the change over four years on the main patient care measures.

Across the board, standards have got worse.

Let’s start with A&E – the classic barometer of the NHS.

Problems anywhere in the wider system will in the end show up as extra pressure in A&E.

Back in July 2010, 98 per cent of patients were treated within four hours in A&E.

Last week, that had dropped to 94.8 per cent – with the NHS as a whole missing the Government’s lowered target of treating 95% of patients within four hours.

In the middle of summer, the NHS is performing like it does in winter. This month, hospitals across England are reporting that records are being broken on a daily basis as more people attend than ever before.

Something has gone seriously wrong.

But that doesn’t tell the whole story.

Hospital A&Es in England have now gone one whole year since they last met this Government’s A&E target – and this sustained slump is having a knock-on effect on the rest of the NHS.

Look at ambulance response times.

Ambulances are taking on average over a minute longer to reach patients in a life-threatening condition, compared to three years ago.


Because of pressure in A&E, patients are being held in the backs of ambulances as they queue outside.

This in turn is leaving large swathes of the country, particularly rural areas, without adequate ambulance cover.

In places, police cars and even fire engines are doubling up as ambulances.

This is no way to run a health service.

As A&E is overwhelmed, other hospital services are being hit.

Back in July 2010, when the Government first published their plans for the NHS, there were 12,991 cancelled operations the most recent figures show there are now 17,865.

NHS waiting lists have now hit a six year high, with over three million people waiting for treatment. And people are now waiting longer.

Back in July 2010, average waiting times were 8.3 weeks. Today they are 9.1 weeks.

But perhaps the most worrying problem of all is the decline in standards of cancer care.

In July 2010, 87.1% of people were able to start their treatment within 62 days. Now it has dropped to 84.4% – meaning that the NHS recently missed the national cancer treatment target for the first time ever.

In human terms, this means added anxiety and distress for thousands of families and, in some cases, survival chances reduced.

For some cancer patients, things are worse than others.

One in four people with lung cancer are now waiting longer than 62 days for treatment to start, with things having got steadily worse over the last three years.

This deterioration must be stopped. It is putting lives at risk and threatens to undo all of the progress on cancer in the last decade.

It flatly contradicts Mr Cameron’s claim that his reorganisation would improve cancer care.

So the question follows: why are hospitals struggling so much?

If anything illustrates the failure of Mr Cameron’s reorganisation then surely it is what has happened to GP services.

Four years on from promises to put GPs at the heart of the NHS, the Royal College of GPs said this week that the profession had “been brought to its knees”.

A reorganisation which promised to empower GPs has proved an abject failure on its own terms.

GP morale is at its lowest ever level, many are retiring early from the profession in despair, and services are in crisis.

All the while, it is getting harder and harder to get a GP appointment.

The slump in service standards is more marked in general practice than anywhere else in the NHS: in 2009/10, four out of five people said they saw a GP within 48 hours; now it is just two in five.

So the jury’s in: four years on from the reorganisation, patient care has got worse.

But the same is true of NHS finances.

At the time of the last election, 1 in 10 trusts were in deficit. Today, 1 in 3 are in the red and the financial position is getting worse.

The truth is that Cameron chose the worst possible moment to reorganise the NHS.

All of the focus should have been on saving money. Instead, at a stroke, it shifted to structures and saving jobs.

This weekend, we learned that the bill for redundancies has now gone up to £1.6 billion.

The reorganisation that Mr Cameron promised would not happen is on course to cost double what he said it would.

Is it any wonder no one trusts what he says on the NHS?

But worse, it degraded NHS financial planning to the point where, despite being supposedly ring-fenced, it is alone amongst public services in not being able to afford a 1% rise for its front-line staff.

No surprise that morale is so low when nurses and midwives denied a modest pay increase have seen thousands walk away with six-figure pay-offs only to be re-hired.

When the reorganisation was going through, there was huge disinvestment from front-line staffing with around 6000 nursing posts lost and training places cut.

Following the Francis Report, the short-sightedness of these policies has come home to roost with trusts having to turn to turn to agency staff. The bill for agency staff has spiralled upwards by 20%.

It all amounts to the mismanagement of the country’s most valued asset on a grand scale.

The NHS can’t carry on like this. It is heading for the rocks and we urgently need a plan to turn things around.

What has been the Government’s response?

So far, complete denial.

Only days ago, Cameron stood at the Despatch Box and said “The NHS is improving”.

The gap between the Prime Minister’s rhetoric and the reality is one of the greatest dangers facing the NHS today.

But the biggest of all is the true ideological purpose of his reforms, kept well hidden at the time of the election, but now beginning to assert itself.

Deadly to the NHS because it corrodes the core values of the service.

In July 2010, I described the White Paper as an attack on the N in NHS, threatening a growing postcode lottery in care and more privatisation.

Four years on, there is clear evidence to show this is precisely what has happened.

Since 2010, hundreds of new restrictions have been introduced on operations and treatments – in contradiction of national guidelines.

In places, hip operations are now only available to people in severe pain – as the Royal College of Surgeons recently revealed.

In North Staffordshire, there is a proposal to take the NHS into new territory by denying hearing aids to people with moderate hearing problems.

Slowly but surely, we are moving away from a national health service with clear entitlements and towards a series of local health markets where unaccountable commissioners decide what people can have.

I ask again – who voted for this?

People are facing charges for services or treatments that are free to others elsewhere.

Another worrying warning sign about how our NHS is changing can be found in Warrington.

There, treatment for varicose veins was restricted by local commissioners.

This of course created spare capacity at the local hospital as NHS patients were no longer arriving in the same numbers.

So what happened? The trust launched a private treatment service for varicose veins – using NHS facilities – as they were permitted to do under the new freedom to earn up to half of their income from treating private patients.

The Trust’s website says “…we have developed the MyChoice service. This allows you to pay (self-fund) to have these procedures with us …”

This example shows how all the pieces fit together and where the NHS is heading under this Government – a two-tier service where priority is given to those who will pay.

The reason why people love and trust the NHS is because, for all its faults, it is a service that is based on people not profits.

That principle sets our health service apart and was famously celebrated at the Opening Ceremony of our Olympic Games.

But it is under real threat.

NHS privatisation is now proceeding at pace and scale as commissioners are forced to put services out to the market.

For the first time, NHS spending on private and other providers has just broken through the £10 billion barrier.

Here in Greater Manchester, patient transport services were handed to a bus company without patients being consulted.

It is indefensible for the character of the country’s most valued institution to be changed in this way without the public being given a say.

But the speed of change is about to increase.

Labour publishes new analysis today which shows that NHS privatisation is entering new territory and becoming harder to reverse.

In Cambridgeshire, one of the single biggest privatisations of services ever seen could be signed off in the months before the next election.

This £800 million contract covers services for older people and will run for the five years of the next Parliament from 2015 to 2020.

This is not acceptable. Contracts like this will tie the hands of the next Government in a crucial area of public policy.

But, even worse, they are being signed without a mandate from the public.

The Prime Minister was not up front about these plans at the last election and he now needs to be reminded that he has never been given the permission of the public to put the NHS up for sale in this way.

Further privatisation of services should not proceed until the public has had a proper say.

So today I have written to the Chief Executive of NHS England to ask that no further contracts for NHS clinical services are signed until after the next election except where there are issues of patient safety or threats to service provision that need to be addressed urgently.

This will give the country the chance to have a proper debate at the 2015 election and to decide what kind of health service it wants in the 21st century.

And it will reserve the rights of the next Government to decide how best to take the NHS forward.

So the evidence is clear: this Government’s reorganisation has prompted a sustained fall in standards of patient’s care, an accelerating postcode lottery and privatisation.

There is no evidence that these policies hold the answer to the huge challenges awaiting the NHS in the next Parliament.

If things stay as they are, the competition framework foisted on the NHS will in the end break it up. It won’t survive five more years of this.

I am clear: the market is not the answer to 21st century care.

When the future demands integration of services, markets deliver the opposite: fragmentation.

It results in more providers dealing with one person – increasing the cost and complexity of care and intensifying the frustration they feel from telling the same story to everyone who comes through the door.

All the evidence from around the world tells us that market-based health systems cost more, not less than the NHS. We are one of a handful of countries in the world that provide a comprehensive health service of a good standard to all people for less than 10% of GDP. In a century when controlling cost and demand will be the big challenge we face, we should be extending the NHS principle not whittling it away.

And there is one final reason why the market is not the answer – it is holding back the sensible changes that the NHS needs to get on and make if it is to plot a course to sustainability.

Last year, under the auspices of the Cameron Health Act, the Competition Commission intervened for the very first time in the NHS to block collaboration between two NHS hospitals on the grounds that it was “anti-competitive”.

What a nonsense.

And we have the former Chief Executive complaining of the NHS “bogged down in a morass of competition law”, frustrating professionals who want to make integration a reality.

The truth is this Government’s competition regime is a roadblock to reform – a barrier in the way of the radical service reforms that the NHS urgently needs to get on and make.

That is why it has got to go.

Instead, the NHS needs full permission to collaborate and integrate – to work across traditional service divides and break them down.

That’s why, as Ed Miliband has said, the next Labour Government will repeal the Health & Social Care Act and restore an NHS based on care over competition, people before profits.

But we also know that the threat to the NHS is real – and that it can’t wait for an Election.

That is why Labour is supporting a Private Member’s Bill – promoted by Clive Efford MP – to repeal the most noxious elements of the Cameron Health Act in this Parliament.

As part of Labour’s summer campaign on the NHS, we will work to build support behind this.

Before they face the public next year, Conservative and Lib Dem MPs have a chance to correct their mistake.

The threat to the NHS is urgent and it shouldn’t have to wait for an election.

I appeal to MPs on all sides to help us form a cross-Party alliance in favour of the NHS and, in doing so, restore some trust in politics.

Repealing the Cameron Health Act is just our starting point.

It will lay the foundations for the National Health and Care Service that Labour intends to build to meet the challenges of the ageing society.

The truth is that we need radical reform of the way the NHS cares for older and vulnerable people.

Alongside the reorganisation, the other main reason why the NHS is now trapped in a downward spiral is the collapse of social care.

Delayed discharges from hospital have hit record levels – up from 55,332 in August 2010 to 80,012 today.

Why? Because of unsustainably severe cuts to social care.

This has disrupted discharge planning but the failure to support people properly at home has created a hidden human tragedy.

In recent years, there has been an appalling 48% increase in people aged over 90 coming in to A&E via blue-light ambulance. That is an extra 100,000 very frail and frightened people in the backs of ambulances speeding through our towns and cities.

It has got to stop.

The ever-increasing hospitalisation of older people is no answer to the ageing society.

Nor is the neglect of vulnerable people in their own homes or care homes.

By starting to bring social care into the NHS, we will build a health service for the whole person.

A service that starts in people’s home and builds from there, keeping them supported where they want to be, surrounded by the people they love.

A service that doesn’t see family carers as invisible – as too often happens today – but places them at the very centre.

A service that gives patients and families a single point of contact and the right to a personalised care plan.

A service with prevention at its heart, that has incentives to keep people out of hospital, and thereby a path towards financial sustainability.

Whole Person Care – a Labour vision for a 21st century NHS.

I believe passionately in the public NHS and what it represents.

And I am clear that David Cameron’s ‘race-to-the-bottom’ approach to health and social care won’t build the 21st century service that people want.

That’s the make-or-break choice on the NHS that this election brings.

We can no longer take the NHS for granted. If the advance of the market is not stopped, it will devour everything that is precious about it.

Five more years of the same would push the NHS off the cliff-edge where it now finds itself.

The choice is clear: a part-privatised, two-tier health market under David Cameron; a public, integrated national health and care service under Labour.

So my message today is simple: If, like me, you still have faith in it, the NHS needs you, more than ever before, to vote for it.

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  • tim

    I really hope this gets some coverage. I have trained and worked in the NHS for tge past 8 years, at the coalface. Changes r obvious. A&E is busier, patients r referred into hospital from a&e to ‘avoid 4 hour breach targets’, even if not thought to be necessary. In terms of privatisation, I see more people wearing 2 logos (nhs alongside g4s etc), and lab services seem less cooperative with clinicians. Services r more fragmented. Money is an issue, and wasnt helped by ignorant/naive PFI deals from 1990s on, but the health&social care bill has been th biggest & worst top down reorganisation, driving clinicans away from decisions on the healthservice (ironic hey). Indeed, drs decisions can be over-ruled by management policies….the most influential people in hospitals are no longer consultants acting on their patients’ behalf. Morale is naturally plummeting, and new drs (many of my colleagues) openly discuss leaving, maybe 10-25% of my colleagues said this last year. Another waste of nhs resources, having spent around 250000 to train each one of them.
    The importance of the 2015 election for NHS is not to be underestimated. It should be a key issue, just as the economy was last time. There should be mandates and accountability, and lets not forget if we do live in asupposed democracy then the electorate should be allowed to decide what happens to our (not the govt’s) nhs

    • Dave Postles


      stop the exploitation of the health service by Boots:

      Stop Boots

  • Mukkinese

    Excellent, message and ideas.

    Will it be reported? I never see a newspaper report on Labour and the NHS without a sidebar on Mid-Staffs and the supposedly thousands of deaths, which apparently has been “exposed” by this government. Even though the inquiry was initiated by Andy Burnham.

    The Tory press pretend to support the NHS, all the while hiding the fracturing and privatisation of Cameron’s reforms…

    • Dave Postles

      The newspapers are reporting an exodus of A&E medics to Australia where the conditions are superior and because the conditions here are becoming, it is reported, intolerable.

  • markmyword49

    Whole Person Care – Where’s the money coming from to fund this policy?

    A&E – There are proposals by the various trusts in West Yorkshire to centralise certain emergencies by taking patients direct to regional trauma centres. It would mean downgrading facilities at various hospitals. Will Labour support this?

    Specialities – Again there are proposals to further centralise certain specialities in regional centres on the grounds that it will improve the outcome for the patients. Are Labour in favour?

    Privatisation – Do the patients really care who provides the various services so long as they are free at the point of access? I spent some time in November and December last year attending a Leeds hospital for radiotherapy. I noticed quite a number of people walking round the centre who were wearing uniforms other than NHS. It didn’t detract from the expertise shown by the people who dealt with me.

    • Steve Stubbs

      Your third point is the significant one for me. Who cares who provides the free at point of use NHS service provided that:-

      a. It is in fact provided free to the user.

      b. It is timely.

      The outcomes are compatible with the best elsewhere.

      I don’t believe that the founders of the NHS specified it was to be provided specifically by state employees. In fact family doctors have always been self employed, or grouped into private practices, and continue to be.

      Anyway, we no longer have a national health service. We have one each in England, Wales, Scotland and Northern Ireland.

      • RegisteredHere

        I agree, although I’d much prefer suppliers to conform with government rules on transparency and FOI, and suppliers that happen to sponsor MPs, donate to political parties or place SpAds in Westminster should be viewed with caution.

        • Steve Stubbs

          No issue with that, but those requirements can be taken care of in the bidding process for contracts with specific disclosure requirements.

          • Dave Postles

            They’ll all plead commercial confidentiality on many financial aspects. Some of them will have complex structures to avoid tax and financial accounting. If corporate organizations obtain control, it’s goodbye to transparency, hello obfuscation. Some superior being help us if the likes of G4S, Serco, etc (let alone US conglomerates) get control.

          • Steve Stubbs

            So you make it a condition of bidding that full disclosure is a pre-requisite including tax structures to be used if awarded and absolute disclosure of ultimate benefit ownership, with break clauses with penalties for subsequent failure to comply.

            It is not rocket science, for goodness sake.

          • Dave Postles

            It may not be rocket science, but there is recent experience of refusals to comply with the Information Commissioner’s requests for access to information on such grounds and it is moot whether private equity companies would comply or just take the fine which is likely to be minimal in relation to their profits.

      • Dave Postles

        I do not want my healthcare to be for profit, thank you, and I hope that many others share my concern.

        • Steve Stubbs

          All private companies providing services to the public sector do so for profit. I could also argue that the employees of the N H S are doing it for their profit, except we call it salaries.

          NHS doctors are doing it for profit for themselves or their joint practices. They are contracted to by but not employed by the NHS. I can see no logical reason why public sector staff in any service provision generally should be direct employees. There is nothing sacrosanct in health services.

          • Doug Smith

            The corporate sector is more concerned with profit than anything else.

            My wife recently attended a privately run treatment centre that only takes NHS patients.

            Of the three letters sent to her from the centre only one had the correct address. One didn’t arrive at all, the other incorrectly addressed letter arrived three weeks late, opened, and re-addressed by someone else. My wife had to chase-up the hopelessly inadequate, non-functioning private sector administrators.

            The situation in the waiting area of the ‘hospital’ was chaotic. People were herded around, from area to area for no apparent reason. And they had been waiting so long they were cracking jokes as to the availability of bed and breakfast.

            We only found that it was privately run afterwards, when I began my investigations. Set up under the authority of a Tory named Blair.

            You can be sure Tory and Labour MPs will avoid receiving treatment in these privately run sh*tholes.

          • Steve Stubbs

            Well I have only used a private supplier to the NHS once, when they told me I had to wait six weeks for an MRI scan or I could travel somev25 miles to another town and have one quicker. Having agreed to that I was phoned about an hour later by a BUPA unit who scanned me the next day. It was clean, organised, tidy; Unlike the absolute shambolic hell hole of the NHS spinal clinic who were in theory treating me.

            I won’t bore you with the appalling treatment I received from the NHS over that spinal problem, suffice to say they were doing their best to keep me off the operating list for a problem they agreed could only be treated by surgery, as they had not filled a replacement for a bone surgeon who had left to save money, whist spending significant cash on artwork to decorate the hospital instead. It would have paid for three years salary for a replacement surgeon.

            Box ticking at its worst and it left me with a very poor opinion of our local hospital and PCT.

            So there is two sides to opinions of private provision by the NHS.

          • Dave Postles

            ‘It would have paid for three years salary for a replacement surgeon.’
            would support even more

          • Dave Postles

            Life is sacrosanct. Regardless of the anomaly of private GP practices, which could not be incorporated into the NHS at the time of the inception of the NHS, despite stuffing the mouths of the GPs with gold, the NHS is a public service and should, IMHO, remain in the hands of dedicated public servants ultimately responsible to the public, not shareholders. Public service ethos is alive and well and politicians meddle with it at our peril. Salaries are not ‘profit’; they are remuneration for labour, since the factors of production are land, labour and capital.

          • Steve Stubbs

            “…the NHS is a public service and should, IMHO, remain in the hands of
            dedicated public servants ultimately responsible to the public, not

            And the NHS contracting out private treatment does not mitigate that provided that the commissioning staff are competent and do their job properly.

            This debate reminds me a bit of Orwell’s Animal Farm, except it is “Public Good, Private Bad” as an ideology. So very old labour in its thinking.

          • Dave Postles

            Private affluence, public poverty of J. K. Galbraith seems more appropriate in this context. The private sector has quite demonstrably revealed itself as ‘bad’ in recent decades. The effectiveness of any service depends on the commitment of the staff at all levels. The recent form of outsourcing of services has not been a remarkably good demonstration. I take no offence at being labelled as old Labour and a protagonist of public service ethos. I’ve seen enough of the public and private sectors to make my own judgment.

  • David Lewis

    “I put that forward before the last election to support a national care service….My personal view is I still think the best way to do it is to go for the solution that you discussed (tax on estates) but there is a debate to be had on whether that is acceptable the public. I think it is….it’s only where you create a system where everyone is in and everyone is then covered, that I think you’ll be able to help people protect their own homes. If you have that system, people would pay 10/15%….you can see where I’m coming from, these are big changes, we’re going to have start with integrating the NHS first but in time I would also like to see the system you describe, I will hope that what we come up with Labour will embrace the full version.”

    Is it just that he is a complete idiot? It is not that hard to reach a conclusion for those who have any attachment to rationality.

    Is it because he has never had a job?

    • Danny

      You’ve had a job, it doesn’t appear to have helped you.

      • Steve Stubbs

        Care to address the issue, rather than just slinging abuse about?

  • jaime taurosangastre candelas

    The Daily Telegraph are tonight reporting that Andy Burnham wants a 15% Death Tax on estates to fund social care. Maybe he is right: social care is not cheap.

    • Steve Stubbs

      So we can now expect the tory posters in the run up to the election about secret labour tax plans?

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  • David Pavett

    Andy Burnham makes many good points and it is refreshing to hear a Shadow Cabinet member being so specfic about undoing the damage done by the Coalition. That’s rather different from the Hunt/Blunkett commitment not to change the educational “landscape” created by Gove.

    I have a nagging doubt though. Privatising measures were well under way under Labour (including under Burnham) . Doesn’t political honesty require at least a few words about this? Or is it a case of Labour privatisation good, Coalition privatisation bad?

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