Transcript of speech by Andy Burnham MP
Afternoon, everybody.
It's really an honour actually
to be invited to speak to
the first family gathering,
as people are referring to it,
first annual Healthwatch conference.
There are lots of gatherings,
annual gatherings
for clinicians, managers, unions...
There are too few for patients,
for the public, the public voice.
So I hope that this is the first of
what will become
an annual high-profile fixture
in the health calendar.
It isn't my first visit here
as David has just said.
I think we've actually won here
twice in 25 years
so I'm hoping my performance today
is a bit better
than my team normally manage.
To get straight into it.
We're two weeks away from the 65th
birthday of the National Health Service.
I think the time is coming for
some big decisions about its future
and I want to set out to you today
what I think they are.
But first,
let's take a moment to celebrate
the great strengths of the NHS.
It is the country's
most valued institution.
Perhaps the last remaining part
of our society
where we can say that, still today,
people come before profits.
It's a system that provides
comprehensive universal cover
to everybody, of a good standard
for less than ten per cent of GDP.
But true friends of the NHS need
to be honest about its weaknesses, too.
When things go wrong, as they will
in any healthcare system,
the NHS has a terrible tendency to push
people away and pull down the shutters.
I'm sure you will all have experiences
of that in your own communities.
And as was revealed yesterday,
shockingly,
that tendency extends right to
the very top and even to regulators.
But even beyond that, I believe there's
a more fundamental structural weakness
that is now being exposed by
the challenges of the 21st century,
and in particular, the ageing society.
In 1948,
the year the NHS came into being,
the World Health Organisation
set out a definition of health
that still stands to this day.
This is it.
"Health is a complete state of physical,
mental and social well-being,
not merely
the absence of disease or infirmity."
A complete state of physical, mental
and social well-being.
The argument I want to make to you today
is that for all of its great strengths,
and there are many, the NHS was
never set up to deliver this vision.
Principally because of
the exclusion of the social.
For that simple reason, the NHS has
never been able to see the whole person,
all of one person's needs.
Social care is prevention.
It's the human side of care,
the help with daily living,
it's what happens in the home.
It's what keeps us active,
keeps us going,
delays the day we might need
more extensive support
from the healthcare system.
But in the NHS's eyes,
social care is what the council does.
And this explains, I think,
more than anything,
why for all of the talk about prevention
from people like me down the years,
prevention has never truly been
in the DNA of the NHS.
It explains why it remains
a treatment or sickness service
picking up the pieces
when people can no longer cope
with daily living on their own at home.
And it's that culture
that we have to change.
That idea that
the home is where the council is
and we all pick up the pieces
when things go wrong.
It has to change because councils
simply are not properly funded
to provide universal
good-quality home-based support.
As people are living longer,
that problem gets bigger and bigger
as the demographic pressure increases.
Councils are having to spread
their budget ever more thinly.
That means that support
is being withdrawn from people.
Increasingly,
people are gravitating towards
the most expensive end of the system
that we've got here in England,
the hospital system.
Our hospitals are becoming
increasingly full of older people.
In many cases, very frail people
for whom there is no better alternative.
It's the last resort.
It's where people are ending up.
That's just not acceptable.
I came across a statistic last week...
In our job, and I'm sure in yours too,
there's a blizzard of statistics that
are coming past you all of the time,
But one, sometimes you just stop
on one, don't you?
It really catches your attention.
I had that last week.
It's this.
Between 2009/10, and 2011/12,
in those two years,
there was a 66% increase,
66% increase,
in the number of people aged 90 and over
coming into A&E
via blue light ambulance.
And that increase relates to more than
100,000 very frail, frightened,
elderly people
in the back of ambulances.
Now, that has to make us all say,
"Something here is not right
with the way we're trying to care
for older people
and deal with the effects of
the ageing society."
And because our hospitals
are becoming so full,
they are increasingly struggling
to provide decent care
to everybody within those hospitals.
Quite frankly,
they are simply not geared up
to deal with all of the needs of those
very frail people that are coming in.
The physical, mental and social needs
of those very frail,
very elderly people.
When we reach our late eighties
and our nineties,
our needs become much more complex.
A blur of the physical,
the mental and the social.
It's just not possible to say any more
in my view, as everyone lives longer,
that to break down one person
into different systems,
this bit of you is done over here
by the council
and that bit is done over there
by the NHS.
You can't provide the standard of care
the public are crying out for
when you have
such a fractured system as that.
But it is what we're still trying to do.
Our acute hospitals really
I think are really struggling
and bearing the brunt of
this huge social change
that has happened
since the NHS was created.
As I say, they're not staffed
to look after the whole person.
So the minute that a very frail elderly
person walks... goes through the door,
not necessarily walks,
some of their needs
will be being addressed, but not all.
Some of their needs
are not being addressed
the minute they are in
that acute hospital environment.
Namely, their social and mental needs
are likely to be being neglected
when they're in that
acute hospital environment.
That explains why
very frail elderly people
often drop like a stone
when they go into hospital
and go downhill quickly
into a downward spiral.
While we do hear recurrent stories
of older people lost on the acute ward,
disoriented, dehydrated,
most appallingly at Stafford,
but elsewhere too.
If we're honest, those stories are
coming from around the country.
So what do we do?
What we do with that analysis
if you accept my analysis?
What do we do about it?
I think there are fundamental
societal and structural issues
that lie behind the issues
exposed by the Francis report.
And indeed now, our present,
in the growing debate about the NHS.
They can't simply be solved
by ever tougher regulation.
A chief inspector of this,
that or the other.
Something much more fundamental
is needed.
I think the time has come
for political parties
to offer solutions that are equal to
the scale of this enormous challenge,
rather than dealing in micro policies
designed to change a day's headlines
but not much else.
That's what I'm doing now.
I'm developing a Labour answer
to the challenges of this century.
As an alternative to the path
on which the NHS is currently set,
which I believe takes us in
the wrong direction.
The Health and Social Care Act of 2012,
and indeed the government's response
to the Francis report,
together show where
their thinking is going
and I believe that is towards
market-based provision.
A health service of autonomous,
competitive providers,
balanced by stronger
central regulation.
And that is a model, obviously we've
seen elsewhere in the utilities,
that it was said when the bill was going
through that they were drawing from.
I am absolutely clear that this is
the wrong prescription for the NHS.
We've been through a period in politics
where, to be honest,
both main political parties
have appeared to accept
the inexorable advance of
the market into the NHS
as though it's an inevitability.
And while I look back on
our time in government,
and I am proud of many of the things
we did to restore the NHS,
which quite frankly was seriously
struggling in 1997, I will say this.
I think we let the market in too far.
The time has come to say that and to
draw a line and make a break with it.
If you let this market in too far,
I believe, in the end,
you will destroy the whole,
what is so fantastic about the NHS,
that ethos that Danny Boyle captured
so memorably
at the opening ceremony of
the Olympic Games.
What did he say? "For everyone."
That was the... tag line of
the opening ceremony.
But it absolutely is
what the NHS is all about.
So why do I say markets
are the wrong answer
to 21st-century health challenges?
Three reasons. The first, cost.
All of the evidence
from around the world
says market-based health care systems
cost more, not less,
than planned systems.
If we look across Europe,
all of our neighbours spend more than
ten per cent of GDP on health.
The US close to 20%.
In the century of the ageing society,
when rising demand and controlling cost
is the big challenge,
why would we throw away a system
that has an inherent efficiency
through national planning
and decision making?
The second reason
why I think we shouldn't embraced
the inexorable advance of the market
is that I don't think it will
deliver what people want.
People want integration of care.
Markets deliver fragmentation.
The logical conclusion of
any qualified provider
is to deliver an ever increasing number
of providers on to the pitch
dealing with ever smaller elements
of one person's care.
It intensifies the frustration
that families already feel
in having to tell the same story
to every professional
who walks through the door.
The third reason why I think markets
are the wrong answer is culture.
The debate we're having around
openness and transparency.
Competition works
by not telling your competitors
what you're up to, what you're doing,
by keeping it to yourself,
not sharing data.
As we all know, the NHS has a long way
to go in building the right culture
around openness and transparency
but I believe the market-based model
that the Health and Social Care Act
takes us towards
drags it in
the wrong direction altogether.
Our attempts as a front bench team
to find out more
about the contracts signed under
any qualified provider
have been blocked
under that old get-out clause,
"commercial confidentiality".
Now, how can we do our job
or indeed, how can you do your job
in holding the local health service
to account if that is in place?
I don't see how that is possible.
It just won't do.
Jeremy Hunt is right to place
great emphasis on transparency.
But he also wants more private providers
and I believe that he's got to address
that anomaly
that is at the heart of
government policy.
It seems to me essential
that if they want to bring
more private providers into the NHS
that full disclosure applies.
Those providers work on
an open data basis,
sharing information with others
and that the full provisions of
the Freedom of Information Act
should apply to
the holders of NHS contracts.
That will allow those providers
to be properly held to account
both locally and nationally.
Given the revelations of yesterday,
I'm clear that the only way to ensure
safe services people can trust
is through full openness
and transparency.
It's the only way to go.
Really the only the way to go.
It's time to embrace it fully
and get on with it.
I would argue the government
should stop dithering.
It should get on and implement
Robert Francis's recommendations.
Particularly the key recommendations.
For instance,
a duty of candour on individuals.
That, for me, is a good antidote to
the organisational secrecy that we see.
They should also implement
the benchmarks on
minimum patient-to-staff ratios.
I think that would help you
do your job.
At the moment, how do we know
whether a hospital has got
enough staff on every ward?
How do you know when you're trying to
hold those organisations to account?
We need a guide so that
people can say to a trust,
"You're getting too close to the bone,
sailing too close to the wind here,
you need to increase the staff."
If we don't have those benchmarks,
how can we make those judgments?
Also I think we need to proceed on
the regulation of healthcare assistants.
Instead, it seems to me that
the government is ignoring
the recommendations of
its three year public inquiry
and writing its own
based on central regulation.
So we have the proposal for
a chief inspector of hospitals,
a chief inspector of general practice,
a chief inspector of social care.
I'm not necessarily
against these things
and yes, we do need
better central regulation,
but we're putting our faith
in the wrong place
if we think that it will solve
all of the problems that the NHS faces.
Instead, we need full transparency
so locally, people can challenge,
ask the right questions
and stop problems
developing into scandals.
We do need better systems
for complaints as well.
I'm pleased to see Healthwatch
making that call
as part of its conference this week.
I believe the organisations gathered
here are essential in this work.
I think all politicians need to
support you on a cross-party basis
to be the strong and effective
patient voice the NHS needs.
I would also go on to say that
I think you all need to be
properly funded on an agreed formula,
a national basis,
rather than having that left to
the whims of local discretion.
And you need to have the powers
that you need to do the job.
You need to have the funding that you
need, the information to challenge
and the powers to act if you need.
That seems to me to be essential.
I commit to you today to provide
all of those things as well,
as you might be pleased to hear,
not reorganise you again.
(applause)
You've got to be here for the long term.
I make that commitment.
We don't want any reinvention now of
the patient voice or public involvement.
Let's make this system work.
You will have my full backing
in doing just that.
But I will repeal
the Health and Social Care Act 2012.
(applause)
Because, as I said earlier,
it's the wrong answer,
it's the wrong answer to the future.
But that doesn't mean
I have to create new organisations.
I will carry over the provisions
that create CCGs,
health and well-being boards,
Healthwatch.
I don't need new organisations.
I can work with the ones
I will inherit in 2015.
Just as actually Andrew Lansley
should have worked with
the ones that we left behind.
He should have put doctors
in charge of PCTs, slimmed them down.
If he'd done that,
by God, he would have saved
a lot of people a lot of heartache.
I will, though, give them a new job
to do, those organisations.
And let me just explain
what that job will be.
This is my alternative to the direction
the government have placed the NHS on.
The job that I will give the system
is simply this.
Whole person care.
Whole person care.
I believe the time has come
to unite physical, mental and social
in a single service.
A national health and care service,
if you like.
That means the full integration of
health and social care.
One service, one budget, able to look
after all of one person's needs,
the whole person.
By giving the NHS responsibility
for providing social care,
perhaps with
an annual year of care tariff,
it would immediately have an incentive
to support people at home
with good-quality integrated support.
It would have the incentive
to become the prevention service
keeping people out of hospital.
That's what we all want it to be.
And it can help lift standards
in social care
which currently are far, far too low.
It would be balanced by
and held to account by
a more extensive role for the NHS,
by a strong health watch
and a leading role for local government
in commissioning
through the health and well-being board.
Because I think greater local
democratic oversight of the system
will also help to bring
the change in culture
and the greater accountability
we need.
In conclusion, it may sound like I do,
but I don't have all of the answers.
I know what I believe,
I know what I think about the NHS.
But I'm open to build this with you.
That's why we're consulting now.
I don't want to do
the old politician think of saying,
"Here's one we made earlier,"
five minutes before a general election
taking everybody by surprise.
I know actually that
people in the system are feeling
bruised and battered, demoralised.
If they're going to go with this vision,
they need to be involved in it.
They need a chance to shape it
and so do you.
That's the offer I make today.
If you connect with anything that
I've said,
please get involved with us
and let's build a policy together
that is the right one for
the future of this country.
So, I need your help.
I don't have all the answers.
But I tell you what I do have,
I have a passion for
the National Health Service.
I have a vision for its future
and I'm on a mission
to deliver that vision.
That is because I think we now have to
fundamentally rethink
how we care for
older people in England.
We will never, ever get
the standards of care we aspire to
for our own parents
or indeed, anyone's parents,
from a malnourished, minimum-wage,
social care system
delivering care in ten-minute slots
where there is barely enough time
to make a cup of tea,
let alone exchange a meaningful word.
How will we get the quality
in this system
when the message we're sending out
to young people
who seek to work in care
that they're only worth
the minimum wage?
Looking after somebody else's parents
is the highest calling
that a young person can answer,
not the lowest
as society is telling them today.
So this is a vision that is about
Labour renewing a vision,
a consensus for the NHS
in the 21st century
based on integration over
fragmentation,
collaboration over competition,
people before profits.
I can't think of
any more appropriate way
to mark the 65th anniversary of
the NHS
than to commit to making
that vision a reality.
- Thank you very much for listening.
- (applause)
So, a spirited finish to the day
and he came bearing gifts.
A commitment to your continuation,
no more upheavals.
"Proper funding on an agreed formula"
were the words I heard.
And the powers you need to do your job.
- Commitments.
- Absolutely.
You heard it here.
As much as
a politician's commitments are worth.
Absolutely right.
Certainty, clarity, stability.
That's what you need
to do your job properly.
I think all parties should back you
to the hilt and let's get on with it.
(David) Which you presumably
will welcome, Katherine.
Enormously. I think one of the things,
coming into this new,
was the history of people saying,
"We went through change after change,"
and one of the critical things for us
is around community engagement.
None of that community engagement
do you do overnight.
I know there has been
a huge piece of work
to make sure the community engagement
is taken from the history
into the present.
But it's really critical for people,
as they spend
all of that really detailed time
reaching out to those people
that rarely have their voices heard.
that we know we can build on that.
Actually, that is
a really key marker of our success
is that we reach
those vulnerable communities
and voice their concerns very loudly.
None of that happens overnight.
You can't do that engagement
without lots of hard labour.
(David) We have just
a few minutes for questions.
There's one right here.
Can we get the mic
very swiftly to this gentleman?
(man) Thank you.
My name is Tarsem Sidhu
and I'm an independent from
Dudley in the West Midlands.
This particular question is for Andy.
Andy, if you were to come
into power in 2015,
how would you sort out
the systemic institutional failures
that have been occurring
within our health services?
Particularly from the very top down.
And, looking at it, you spoke about
the secretiveness within the NHS,
parts of it are almost like
the intelligence services,
in allowing information to get out.
How would you deal with that?
(Andy) They're good questions.
As I say, there is only one way
for the NHS to go in this century.
That is to embrace
full openness and transparency.
I experienced it as a constituency MP,
as a backbench MP,
and every other member of
the House of Commons will too,
that pulling down the shutters.
It isn't just the top
but it permeates, goes all the way up
because often the issues that arise
when things go wrong are very difficult.
People often want to kind of
not face up to those things
but it is essential that they do.
Families left in difficult situations
are pushed away by the system
and that just isn't good enough.
So the duty of candour I think
is important
to bring about what you describe.
If, as the government are proposing,
it only applies to those institutions,
how, if that culture is wrong
in those institutions,
how is that going to change that?
If individuals have got
that responsibility,
that is their protection.
They've got that duty to speak
and therefore, nobody can do anything
then if they do choose to speak
so I think Francis was right on this.
We should just get on and embrace it.
But the thing
I want you to think about,
I am worried, though, at the moment
there is a growing thing of,
it's all about top-down regulation
and leadership and all of that.
I actually believe
it's partly about that
but it's something
much more fundamental at play here.
And that is that the system is allowing
too many older people
to gravitate towards hospital
and those hospitals are not set up
to deal with the needs of those
very frail, very vulnerable people.
As I say,
the minute an old person is in hospital,
their social and mental needs
are being neglected
and that explains why they don't thrive
in that environment.
That is a much more profound thing.
It's happening to the NHS
all over the country.
It's why staff are finding it,
on the front line,
increasingly hard
to provide proper care.
A member of staff said to me,
not far from here, at the Royal Derby,
"When I trained, I never saw somebody
in their late seventies or eighties
on the ward after major surgery."
"Now we're full of people in
their late eighties and nineties."
The job is totally different.
I don't think we've properly...
We've got a 20th-century system
that's in danger of being overwhelmed
by the challenges of the 21st.
That structural issue is
what I'm trying to address
through whole person care.
(David) I'm going to take
two more questions.
A hand there and one at the back.
(woman) Hello, there.
Ursula Hussain from Healthwatch Oldham.
How would you go about transforming
the current social care system
into a respected profession
in a way that the NHS
and clinicians have the status of,
rather than what is more often than not
the default position for
Jobcentre Plus advisers
to advise people to go into care work
when they can't get any other job?
Yeah, honestly,
I think so much about this.
The reason that social care is
a real motivator for me
is because I saw my own grandmother
go through the system.
Proud, working-class Scouser
that she was,
it was the most soul-destroying journey
imaginable for us
as she went through firstly homecare,
residential care, nurse...
It was truly awful.
And the day...
We went in to see her
and her knuckle was red raw
because somebody had ripped off
her engagement ring
as older people's knuckles grow over.
My mum said to me,
"If you ever become an MP, you will
have to do something about this."
Anyone who's got a Scouse mum,
you know you've got to listen to them
and I always do, and I did.
I have been on that thing ever since
that this can't be right.
This won't ever deliver
what we're all looking for.
I don't necessarily blame
the people who did that
or the people that work in that system
because you're right,
that's the message.
The message we're sending is that
it's the lowest of the low.
It's a dead-end career.
If you're a young person
joining the social care system,
there isn't any opportunity to advance
to other parts of the care system,
into clinical roles,
you're basically in a dead-end.
Because social care is cut off,
it's a cul-de-sac, so...
(Ursula) How do we actually bring about
a change to that?
Good question,
you're right to get me back on to the...
(laughter)
One last fact
before I come on to the change.
In our region, I don't know if
you saw this last week, the north-west,
information was released that says
there are 37,000 care assistants in
the north-west on zero hours contracts.
Now, how do you get proper care
when people...
You cannot provide care for people
on a here today, gone tomorrow basis.
You can't do it in the NHS
or in social care.
So yes, we have to fundamentally rethink
it. So how?
My idea is not that social care
drags the NHS down to its level,
it's the reverse.
The NHS will have to lift social care
from the enfeebled, impoverished state
it's in at the moment.
One direct example is if you do have
a fully integrated system
in the way I've described,
the Agenda for Change system
could be extended into social care
so that staff coming into social care
are part of that integrated workforce
where there is opportunity to progress,
where you can access training
to update your skills.
And yes, properly rewarded.
A living wage.
Get decent reward for the job they're
doing on all of our behalfs,
looking after our mums and dads
and grans and granddads.
That has to change or we'll never
get the care we want from the system.
(David) In case Ed Balls is listening,
you've said could be a solution.
Well, I'm consulting at the moment.
I wish I could...
We're not at the point where
we've finalised our policy proposals
but you get a bit of a picture of
where I'm coming from.
(David) Of course.
Finally, the question from the back.
(woman) Hello, I'm Frances Hasler
from Healthwatch Camden.
I wanted to come back to this point
you're making about the one system
and your thoughts on the market
because one of the things we know
the things that people do value
in local services are, in fact,
those very local services
that are provided through
usually the voluntary sector.
It is at the moment very difficult
for the voluntary sector
sometimes to get in on the act,
to be providing services because of
the way that things are commissioned.
We heard recently, not just in health
but in the work programme for example,
that some of the most effective things
are just not getting into the system.
In your new vision for
how it would work in health,
have you given thought to
how you actually, in one system,
don't sort of make it too difficult
for those very local
and highly valued services
in people's localities?
I'm glad you've asked that because
it's a really important question.
I think...
I'm sure what you might have heard,
maybe you took this from
what I was saying,
it can sound monopolistic
and it can sound as though
it's pushing others off.
There absolutely must be a continuing
role for the voluntary sector
and indeed the private sector.
But I see that role in
a supporting capacity
rather than a replacement capacity.
Adding that value,
bringing the innovation,
doing those things that
the NHS can struggle to do
at, let's say, the margins.
Really, what is at heart of
this vision that you're hearing about
is the desire to move to
a more social model of commissioning
and not have a narrow medical model.
That does imply...
I'm talking about...
I don't use
the word "patient-centred" any more.
Person-centred.
That is a big difference,
going from patient-centred
to person-centred
and that does mean
you need those organisations
to provide that help with
daily living.
But there is a "but".
When we were in government,
we spoke a lot about choice.
That is obviously a fundamental
concept and principle in healthcare.
But the realisation I've come to
is that you actually get more advanced
notions of choice and control
in a more integrated system
than in a competitive system.
We were saying to people at times,
"Where do you want to go to
for your hip operation?"
But we weren't giving people choice over
the really fundamental things,
"Do you want to have
your baby at home?"
"Do you want your dialysis at home?"
Or even, "Do you want to
end your life at home?"
That is proper choice and control.
And yet we weren't...
Through the way we were...
Even now, the way we configure services,
we don't make that a possibility.
so in this model, there absolutely
will be a continuing role.
In the end, to ensure it isn't done too
monopolistic or anything like that,
perhaps the way to do it is to
enshrine in the NHS constitution
fundamental rights of people.
Rights to treatment at home
or treatment in a place you want it.
Rights to organisations
providing services that you want
or use of personal budgets.
All of those things remain
part of my thinking.
But I do believe that
it's that integrated system,
when you have organisations that
have got the range of services.
If you have that,
you can offer much more sophisticated
notions of choice to people.
It is a scandal actually that so many
older people die in hospital in England.
That's because the system isn't geared
to provide
that most fundamental of choice.
If we go in the way that
I'm describing,
I think a more integrated system
in the end delivers
better notions of choice and control.