Labour’s shadow health secretary said yesterday that politicians should never again surprise the public with election time “rabbit from the hat” policy shifts on the NHS.

Andy Burnham was speaking at a conference on NHS leadership, where he also conceded that the payment by results system introduced under Labour had “caused a problem” and indicated support for a care model in which acute trusts employed GPs and social care staff.

He told delegates: “Given what’s happened in recent years… the old way of doing things certainly won’t work now, and it shouldn’t have happened anyway.

Andy Burnham

Andy Burnham said Labour’s payment by results policy had created ‘problems’

“What I mean by that is someone like me producing a rabbit from the hat near an election, or in the case of this current government after an election, which takes you by surprise.

“That can’t happen again ever, particularly now given that the NHS is in such a fragile moment in my view.”

Mr Burnham went on to indicate support for a model of integration in which acute trusts took a lead role in providing services across secondary, primary, community and social care.

He said that while the route taken to integration should be a local decision, he could “see a solution that is about the acute trust receiving the year of care budget, starting to employ staff in different disciplines – [occupational therapists], [physiotherapists], social care staff, GPs – and then evolving over time into an integrated or accountable care organisation, working from home to hospital covering physical, mental and social needs”.

However, he said he was “open minded” about whether leadership could be provided by other areas of the NHS. He said: “It might be a GP or a community solution that emerges rather than a hospital growing into the community… I’m open minded about all those things.”

Mr Burnham admitted the tariff payment system, introduced by a Labour government, had created “problems”.

He said: “While I could make a very strong argument today for the tariff… and what it did in terms of improving productivity in the acute sector, in the end it has caused a problem.

“It has cemented a system that gets paid by activity and [is] hooked on people coming through the door. Hospitals can’t at the moment, without very strong cover from their commissioners, take big decisions about remodelling care in the community because that’s how their organisation makes ends meet and it’s not possible for them to break out of a system that they didn’t create, but we created for them.”

He also suggested he would like the National Institute for Health and Care Excellence to take into account the implications for public finances beyond health spending when considering the value of new treatments.

“I would want NICE to take a view about all public spending when considering recommendations for treatment or technologies,” he said.

“So if young people aren’t properly supported in their early years there can possibly be a very major cost to the criminal justice system later down the line… There are horrendous figures about the number of young people in the criminal justice system with untreated or undiagnosed mental health problems.

“It seems that NICE just looking at the health budget when making decisions is a medical model. We need to start thinking more broadly than that, so if you support a young person at this point in their life you can save tens of thousands of pounds in terms of costs to other public services later down the line.”