This week: Andy Burnham, mayor of Greater Manchester
Why he matters? Mr Burnham was a Labour Cabinet minister from 2007 to 2010, including serving as health secretary for one year in Gordon Brown’s government, from 2009 to 2010. He served as a shadow Cabinet minister until 2017, and twice ran for the Labour leadership, finishing second to Jeremy Corbyn in 2015. Two years ago, he became mayor of Greater Manchester, a position which has an expanded range of delegated powers over health services.
The second report from Sir Robert Francis on the Mid Staffs scandal arrived in 2013 like manna from heaven for, then, newish health secretary Jeremy Hunt.
The result of the public inquiry provided a genuine – but also fortuitous – opportunity to move the debate on from the disastrous Lansley reforms.
Mr Hunt took aim at the New Labour NHS regime, which Sir Robert said had fuelled many of the problems at the hospital, often personalising his attacks by targeting the health secretary in place at the time, Labour’s Andy Burnham.
It is an episode that still rankles with the man who has swapped Westminster for the biggest job in local government.
“I don’t think people realise that I brought in Robert Francis in July , against civil service advice.
“The previous reviews [of care failures at Mid Staffs] obviously hadn’t really uncovered the full scale of it, but the advice said there should be no inquiry of any kind. They said definitely not a public inquiry, because it would be so destructive for a trust that was still quite troubled – and I actually bought the argument, to be fair. So, in the end, I said, ‘Let’s get as close to a public inquiry as we can.’
“When I appointed Robert Francis, my letter of appointment, said something like, ‘If you feel people are not complying with your inquiry, you have the right to come back to me at any time and I will upgrade this to one where witnesses can be compelled to give evidence… effectively a public inquiry.’
“Midway through it, he wrote back, and I remember him saying he had the level of cooperation he needed. No one can tell me that the first Francis report was pulling back from anything, and actually the coalition [government] didn’t repeat that first stage of [examining] what happened in the hospital. They went straight to what was the regulatory failure to allow it to happen and why it wasn’t picked up sooner.
“I’m not saying I did everything right. Looking back, I wish I’d known fully what was going on. I didn’t understand how the department was trying to push away the patient group called Cure the NHS. I didn’t know the extent to which that group were asking for meetings and so on.
“When I went up to Stafford in July 2009, I was told to have a generic family forum, [and that] ‘you can’t just meet one group’. And I didn’t realise that Cure the NHS then just completely boycotted it for that reason. But I think what happened was a polarisation was created there that never came back together, which was my fault in hindsight.
“We perhaps should have really thought through the handling of that and bringing the Stafford community more in with why we were doing what we were doing. That was the mistake and that rift was never healed.
“The NHS does, at national level and often at trust level or even individual complaint level, sometimes have the tendency to pull the shutters down. It used to do it with individual complaints, and it wasn’t an attractive side of the NHS mentality. I understand why that instinct is there and they often don’t do it wilfully.
“But actually, the NHS needs to be a learning organisation and always needs to have a mirror held up to it because you can always learn from everything. It needs to be constantly challenged, and to be fair to him Jeremy Hunt, I think, did do quite a bit to bring that sort of culture.
“But some of the more politicising of that stuff I think was not so fair.”
Modern government couldn’t create the NHS
The other big issue that still irks Mr Burnham about his time in government was New Labour’s failure to reform social care.
His bold proposals in the 2010 election campaign led to the Conservatives commissioning a now infamous response.
“The minute that poster landed with the gravestones, [claiming] ‘Now Gordon wants a death tax’, that was it. My reforms were dead.”
Nine years on, the need for reform is even more pressing, but politicians remain just as fearful of bringing forward new policies in this area.
Mr Burnham spent two stints at the Department of Health – between May 2006 and June 2007 as a minister of state, and between June 2009 and the May 2010 general election as health secretary.
“My deepest frustration in my time at the Department of Health was that it was all about incremental, marginal, micromanaging type change.
“It felt to me that the Whitehall system of politicians, ministers and civil servants couldn’t, in its modern way of working, have ever created the NHS. It just didn’t have that scale of ambition or boldness within it anymore.
“In 2009, I had come to the view, partly informed by my time in the Treasury, that having spent a decade of building up NHS resource and NHS capability, the biggest threat to the service in the next decade was going to be social care.
“I knew you needed a major reform (to make social care free at the point of delivery – paid for through a form of wealth tax) and I kind of battled a bit on my own to try and persuade the system of that.
“They all said it would be called a death tax and I said, ‘Yeah, maybe it will’, but I kept saying we should explain to people properly about the problems with the current system, where you have the chance of losing everything.”
Mr Burnham says he argued that just as “the British public came to see the NHS was the right thing to do in 1948, they’ll come to see the nationalisation of social care is the right thing to do.
“But God yeah, it was a deep frustration to me that that point was not understood. How the Whitehall and Westminster worlds were so timid about embracing major change, and politicians were so fearful of the newspapers.
“I think they’ve kind of had this unholy alliance where they’ve pulled away from the scale of change that we need to see on social care… and I’m not convinced it’s going to change anytime soon.”
Pork barrel politics
Mr Burnham’s answer to the lack of policy ambition in Whitehall has been to move into regional politics, which he still believes will benefit from substantial devolution of power over the coming years.
“I think what has really now become clear in this post-EU referendum debate is that we’ve all been very much living in a London-centric country. The referendum result in 2016 was as much an instruction from the British public for Westminster to rethink its relationship with England as it was to rethink its relationship with Brussels.
“That issue is now openly spoken about and recognised. If I go back to my time in Parliament, I used to say it, but no one else did. No one really was acknowledging it in quite the same way, it wasn’t really a big political issue.
“The north-south divide is an issue that is now very much something that has to be addressed, not just in terms of levels of investment but also levels of autonomy and freedom. Obviously, Scotland’s got devolution. Wales, Northern Ireland, and London as well. What about the rest of England?
“This question is going to come up especially in places that voted leave. The devolution genie is definitely out of the bottle and it’s not going back in. I’m certain of that.”
Mr Burnham says that agenda could benefit from the current disruption to the traditional party system in Parliament caused by Brexit.
“The Westminster system hasn’t really allowed local geographies to punch their way because MPs generally only group along party lines. In the US system, people can argue for their area more, be more independent. They call it ‘pork barrel politics’, don’t they?
“But the whip system in Parliament prevents certain geographical areas getting what they could get if the MPs in those places could use that leverage differently.
“I think the North can use its political muscle differently to build a more equal country. In all my time in Parliament, the North never punched its political weight, the MPs never kind of coalesced and worked as a team for the North, it was always fractured along all the different lines.
“But I can see that now starting to happen more, with things like the Stronger Towns Fund.”
So, would he ever want to return to Westminster?
“I wouldn’t rule it out, but I’m not sitting here biding my time. I genuinely believe this country needs major political reform and part of that is a huge devolution of power to functioning localities like Greater Manchester.
“Westminster shouldn’t be the only game in town.”
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