Exclusive: Forward view leaves ‘big questions unanswered’, says Burnham

In an exclusive interview with HSJ and its sister title Local Government Chronicle today, the shadow health secretary said the forward view’s assumptions were based in part on current government policies, which a Labour administration would change.

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His comments came after the Nuffield Trust raised concerns about the absence in Labour’s health manifesto of any reference to the forward view, which documented the shared view of national NHS bodies on the care reforms and funding the service will need in the next parliament.

Mr Burnham said he supported the principles set out by the NHS leadership, but if Labour were to adopt the forward view “without making some other fundamental changes then we don’t believe we would put the NHS on the right path”.

He told HSJ: “While the principles of the [forward view] are good ones and while I would restate my support for it, we are starting from a very different place than this government, therefore there are other things we need to set out in our manifesto.

“The [forward view] is fine as far as it goes but in and of itself it leaves many big questions unanswered. I reiterate my commitment to it but it isn’t of itself… a detailed plan for the NHS.” 

Mr Burnham suggested the “big questions” unanswered by the document were around the present competition regime in the NHS, and the integration of health and social care.

His comments came after Nuffield Trust chief executive Nigel Edwards said this weekend it was “regrettable [that] Labour are now the only party” not to have committed to the £8bn spending pledge required by the forward view.

The document, published last autumn, suggested that the NHS could potentially make up to £22bn in efficiency savings over the next half decade, but would still be left with an £8bn gap that would need to be covered with real terms increases in funding.

The shadow health secretary stood by the party’s decision not to “get drawn into a bidding war” with the Conservatives and Liberal Democrats, who he accused of trying to “shift goal posts” in the argument around how much more money the NHS needs.

“The £8bn [funding issue] arises in five years’ time and it’s not the issue now. The issue is what happens to the NHS now, this year, immediately, that’s the issue, especially when we have a growing financial deficit in the NHS and a growing sense that financial control is being lost,” he argued.

Labour, he added, was “the only party with a costed, fully funded proposal”. Labour has committed to a £2.5bn “time to care fund”, paid for through taxes on properties over £2m, a levy on tobacco companies, and a crackdown on tax avoidance by hedge funds.

He said he would not rule out funding injections over the next five years above the promised £2.5bn.

He also claimed the £8bn funding gap by 2020 projected in the forward view could be smaller if Labour’s integration plans were fully implemented.

“The five year forward view is high level isn’t it?” he said. “But I think it takes into some of its assumptions current government policy. What we are saying is that we would make fundamental changes to that. We will repeal the competition regime and secondly we will be setting out towards a single [health and social care] service.

“We are setting out towards some pretty fundamental changes and therefore the trajectory changes in my view. I believe the funding gap that arises in a fully integrated scenario may be smaller than the gap that arises in a scenario where you are maintaining two separate systems.” 

However, Anita Charlesworth, chief economist at the Health Foundation, said there was “very little evidence” that integrated care reduced costs in the short term. “The evidence on integrated care which [business economist] Kate Barker looked at as well in her commission for the King’s Fund is it certainly doesn’t deliver short term savings, because a lot of what it might do is reveal need as well as reduce need,” she told HSJ.

Chris Ham, chief executive of think tank the King’s Fund, said he thought it was Labour’s decision not to commit to the £8bn of real terms increases by 2020-21 which “stood behind its silence on the forward view”, rather than disagreements over policy substance.