Andy has a hard-won reputation for
championing the underdog, and challenging inequalities of every kind. For
example, tackling the issue of rough sleepers. It was a policy ambition he
announced just before he walked in through the front door of No 10 for the
first time as Prime Minister. His vision of health and wellbeing is fundamentally
about prevention and dealing with the social determinants that so often cause
ill-health.
Personally, I think he made a
great choice for the new Secretary of State for Health and Social Care, Yvette
Cooper. In a previous regime, Yvette was an under-secretary of state for
health. In this role she implemented the Sure Start programme – a brilliant bit
of health and social care policy that really did make a difference to families and
children’s lives. So, we have someone who is an experienced minister of state, and
knows something about health care and if anyone can sort out social care,
Yvette can.
Andy is also a committed
devolutionist. He passionately believes power (political and professional)
should be devolved close to where actions and decisions are required. We don’t
yet know what this might mean for health and care services in England. There is,
however, the little matter of Yvette’s predecessor’s policy legacy. As I write
this blog, Wes Streeting’s NHS Modernisation Bill (Health Bill) is slowly
working its way through parliament. The Health Bill was meant to become law in
March 2027. I do wonder if it will complete its journey through parliament on
time, and remain unchanged in its intent.
Briefly, the Health Bill aims to
move power, decision-making and functions from NHS England (NHSE) to the
Department of Health and Social Care (DHSC). This includes transferring some
powers directly to the Secretary of State. The NHSE Regional Offices and Integrated
Care Boards (ICBs) will take on new roles around performance oversight and
strategic commissioning. The abolition of the consumer groups Healthwatch, and
Councils of Governors within NHS Trusts, will be replaced by a new patient
voice department within DHSC. All of these changes move power and decision-making
away from local government and communities.
For many people, getting to this
point has been brutal. The DHSC, NHSE, Regional Offices and ICBs have all had
to reduce their costs by 50%. This has meant people losing their jobs. Whilst
it is difficult to get accurate figures, the original estimates were said to be
around 18,000 job losses. Likewise, it is estimated that the cost of these redundancies
has been in the region of £1 billion.
I suspect for many, the personal
costs, in terms of the negative impact on their mental and physical health and
wellbeing, will be immeasurable. Whilst many of the people who have lost their jobs
won’t have been frontline care providers, the loss of knowledge, experience and
skills arising from these redundancies will undoubtedly have an impact on the quality
of future health care provision. Likewise, there are hidden costs associated
with these reforms, as leadership and organisational energy are diverted from
tackling everyday issues of service provision.
Don’t get me wrong. In any
organisation, there will always be a need to review what might be required in
terms of numbers, skills and so on in the workforce. It’s probably also true
that part of the work undertaken by some of these people can now be better done
by new technologies and transformed service models. But there will still be a
lot of functions and jobs that will still need to be done by someone, and I do
wonder if we may have thrown the proverbial baby out with the bath water. I
hope not.
Wes Streeting was reported as
saying to parliament that these reforms could save the NHS £500 million to £1
billion each year. This may be true; it’s difficult to get an accurate figure.
Whatever the eventual saving turns out to be, I sincerely hope it is given to
Yvette to help reform our social care services. Andy Burnham has already demonstrated
his commitment to tackling the social determinates of health that lead to
health inequalities. I wish him well as he pursues this commitment on a much more
complex and bigger stage than the Greater Manchester region.
*Today’s blog title draws on a
quote from the historian and writer Thomas Carlye. I wonder what Thomas would
have made of Andy Burnham? Thomas Carlye was famous for his ‘great man’ theory –
an interesting theory and worth looking up.