The shadow health secretary is working hard to demonstrate causation between the NHS’s problems and the use of the private sector, and his speech will have a significant impact on local decisions
Andy Burnham’s powerful speech launching Labour’s summer offensive on the NHS is undoubtedly good politics. Even the Tory supporting media has decided there is a “crisis” in the NHS and HSJ’s recent polling shows Mr Burnham’s chosen target - the use of private sector suppliers - makes the public feel decidedly uneasy.
Whether it is good policy making is another matter. Michael White picks up on HSJ’s warning that such broad attacks can paint future ministers into tight corners.
Time will tell on both points.
Politicising the position
What is more interesting is to examine how Mr Burnham’s tactics will affect the approach of commissioners over the next 10 months.
By formally asking NHS England chief executive Simon Stevens to place a moratorium on the tendering of “clinical contracts”, Mr Burnham is doing two things: he is attempting to politicise the position of the erstwhile commissioning board, and he is putting a shot across the bows both of commissioners keen on using competition and their potential private sector suppliers.
‘Burnham is working hard to demonstrate causation between the NHS’s problems and the use of the private sector’
The shadow health secretary is working hard to demonstrate causation between the NHS’s problems and the use of the private sector, though he will know most of his “evidence” is actually correlation.
NHS England, of course, has embarked on a major piece of evidence collection itself - which will result in the publication of a medium-to-long term vision for the NHS this autumn.
As HSJ has suggested before, this will be the most important health policy intervention for over a decade. Mr Burnham knows Mr Stevens can only respond to the moratorium call by stating he will do what is best for patients, but the Labour front-bencher wants to highlight the potential risk NHS England would be taking should its plans favour the greater use of non-NHS providers.
The impact Mr Burnham’s speech will have on local decisions being considered today will be significant. It will fire up local opposition - but more importantly it will embolden those resisting use of competition from within.
Across the country, and especially in the north, clinical commissioning groups and, indeed, the leadership of some NHS England area teams will start making noises about how delaying contract tenders constitutes “sensible risk management in the light of political uncertainty”.
Elsewhere, where competition is being more readily embraced, there will be understandable nervousness. Labour will admit privately that, should it come into government, it would not immediately be able to start ripping up private sector contracts. However, the kind of major tenders being envisaged by Cambridgeshire and Peterborough CCG for example, require a reasonably clear view of long term development to work well.
‘Andy Burnham has already, though perhaps only temporarily, put the brakes on the NHS’s use of the private sector’
The double impact of Mr Burnham’s move will be that: these major contracts are likely (as admittedly they always were) to be won by NHS providers; and that private sector suppliers will withdraw from competition of their own volition or, as result, of the inability to raise funds from concerned investors. So, Mr Burnham has already, though perhaps only temporarily, put the brakes on the NHS’s use of the private sector long before the election result is known.
Some CCGs, of course, will not be discouraged from employing non-NHS suppliers and will back their ability to show any incoming government that they have made the right call. For Labour, the next step must be to better define what it means by “clinical services”. Many, for example, would have been surprised by Mr Burnham’s mention of “patient transport”.
They also need to consider how this policy affects the party’s desire to allow smaller businesses more access to state funded work - much recent growth in the health sector has come from NHS community services contracts being won by locally based private suppliers.