In June 2007 then Conservative shadow health secretary Andrew Lansley revealed his plans for NHS reform. His NHS Autonomy and Accountability “white paper” marked the more or less natural culmination of the reforms that began under Kenneth Clarke in the late 1980s and continued under New Labour.
Five years later, Mr Lansley’s blueprint formed the heart of 2012’s Health Act.
Today, Labour shadow health secretary Andy Burnham is due to make a speech which may signal an end to this period of health reform by proposing a system that places local democratic, not clinical, control in a “pre-eminent” position and replaces a competitive/contestable market with the idea of the NHS as the “preferred provider”.
He is cautious about saying the proposals bring an end to the purchaser/provider split, especially as he wants local authorities to become health commissioners. However, the impression he gives is of a much less transactional relationship between healthcare planners and providers.
Mr Burnham has, of course, floated some of these ideas before. He championed the “preferred provider” idea while health secretary. He was also openly talking about the idea of full scale health and social care integration at last year’s Labour party conference, at least until − according to press reports − Ed Miliband asked him to use more cautious language.
‘Recreating hospitals as accountable care organisations is an exciting idea but it must not be simply a ruse to avoid reconfigurations’
But Mr Burnham did not abandon his ideas − indeed he now describes integration as a goal which he will need a lot of persuading not to pursue. It is in effect his bottom line; the path taken to reach that destination is the area open to consultation.
Most significantly, he appears ready to address the £90bn integration question. Namely, that a local authority could − if it did not mean contravening nationally set standards - move funds from financing NHS services to housing if it believed this would have a more positive impact on its local population’s health.
Mr Burnham has done the right and brave thing, as Mr Lansley did, by consulting on such radical ideas. It is was hardly the Tory politician’s fault if few noticed quite how far-reaching his ideas were. Mr Burnham’s plans are likely to receive a lot more attention.
The shadow health secretary sees the current commissioning reforms as “provider led”, something he − and many other policy makers − believe is an inherently bad idea. However, Mr Burnham’s desire to remove provider interest from healthcare planning is somewhat undermined by the idea the local hospital will become the default care supplier.
The idea of recreating hospitals as accountable care organisations is an exciting and interesting one − but it must not be simply a clever ruse to avoid necessary hospital reconfigurations.
‘Burnham will do the service a favour by stressing areas of continuity, as well as change’
It seems as if the integration bandwagon is now picking up speed. Back in November, HSJ suggested − only slightly tongue in cheek - that the integration “experiments” being proposed by Liberal Democrat health minister Norman Lamb marked “a turning point” in the direction of health policy.
It is interesting to note that Mr Lamb also appears to favour a “prime contractor” model. He has not said this should be the local hospital, but in most cases it will obviously be the frontrunner.
The next general election is still two years away and its outcome is very uncertain. Mr Burnham’s ideas are also likely to be subject to revision, amendment and clarification, something he readily admits.
One thing is for sure however − and this is an inevitable outcome of a proper policy debate − that those helping to construct the new system, especially in clinical commissioning groups, Monitor and the NHS Commissioning Board, must now be wondering how long it will last. Mr Burnham will do the service a favour by stressing areas of continuity, as well as change.