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


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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