What would be the impact of Andy Burnham’s proposals?

Politics

Red rosette

Labour needs to develop a distinct health policy before the 2015 election. It is likely to seek a course between committing to repeal in some way the coalition’s Health Act, and avoiding another huge NHS reorganisation.

Andy Burnham’s intention to all but abolish the current 211 clinical commissioning groups does not appear to meet the latter requirement, so could cause problems.

It is possible the coming months and years of discussion on the proposals may see them refined and reworked to ease any disruption.

Social care funding is politically sensitive and Labour has sought to avoid making large spending commitments. But if social care was paid for and healthcare free, the complexity of two funding systems would weaken the arguments for passing NHS funds to councils.

Integration

Interlinking arrows

Mr Burnham’s aim to promote integration and prevention is likely to be welcomed by many leaders in health and social care.

The need to provide affordable and high quality care for the growing population of frail elderly and people with long-term conditions is accepted as the NHS’s central challenge.

However, some are likely to argue that a nationally mandated transfer is not necessary − or sufficient − to deliver seamless services.

The type of provider landscape Mr Burnham envisages is unclear but there could be a positive response to an apparent move towards accountable integrated providers.

That said, the prospect of leaving single NHS trusts entrenched and unchallenged will be unpopular with many, including within Labour.

Funding controversy

Pund sign

Outside of local government, the prospect of councillors making decisions about NHS services will be hugely controversial.

Whether a council decides to divert NHS funds to social care or housing, or conversely prop up its local district general hospital at all costs, the process would be divisive.

The changes may take national politics out of hospital reconfiguration, but would replace it with extra local politics. Power would move from GPs’ surgeries to councillors’ surgeries.

NHS commissioning

NHS logo

The proposals may cause rapid shifts in behaviour on the ground.

CCGs’ success depends on the confidence and participation of GPs. For some, the news they may become an advisory body to councils within three years will dampen enthusiasm.

Conversely, many CCG leaders have shown significant interest in integration, and may see Mr Burnham’s ideas as an opportunity.

The NHS national leadership and commissioning board staff may see the potential benefits of a focus on integration and community care, but will be wary of the idea of another major reorganisation just as they attempt to fill posts in time for April.

Local government

Buildings

Councils are likely to welcome the freedom to spend NHS money on services such as housing if they believe this will improve health and reduce demand for acute services. A focus on prevention, rather than treatment, could sit well alongside the public health responsibilities they take on in April.

They will welcome the prospect of relieving the pressure on social care budgets − the Local Government Association has reported this to be councils’ biggest area of concern.

However, where health and wellbeing boards are working well and there are good relationships with CCGs, councils may ask whether the major shift in funding is necessary. It could make more sense, they might suggest, to transfer their social care budget to their CCG.

A further concern is that dealing with the NHS could become a big reputational problem for councils. Key questions include whether troubled councils such as Doncaster and Tower Hamlets could be handed such significant responsibility, how councils might be accountable for NHS failings, and how many staff they would be expected to take on.

Burnham plans £60bn NHS cash handover to councils