Who said what to whom? Andy Burnham, Shadow Health Secretary, has written to the Chief Executive of NHS England to ask that no further contracts for NHS clinical services are signed until after the next election, except where there are issues of patient safety or threats to services that need to be addressed urgently.
What does it mean? Burnham is speaking out against what he regards as the privatisation—or "sell-off"—of the NHS. He argues that the next election is the time for politicians to debate whether contracts should go to non-NHS providers. There is, at present, no popular mandate for doing so, and yet contracts awarded now will restrict the ability of a future Parliament to row back.
Burnham has written to NHS England rather than the Health Secretary because, as a consequence of the Coalition reforms, NHS England is more independent of ministers. But Burnham’s claim is nevertheless that it is the Tory agenda for privatisation that is leading to more contracts being awarded to private providers. These have a total value of £10bn, according to the latest figures. In the same week that Labour has announced plans to allow mutual and cooperatives to bid for rail franchises, there is a clear attempt here to show the difference between Labour and Conservative views of the role of the state.
What could go wrong? There may be two problems with the commitment Labour is seeking. The first is that some of the contracts in the scope of Burnham’s criticism meet many of the objectives he himself has been talking about for healthcare. Take the example of cancer services in Staffordshire. Four clinical commissioning groups in the area are getting together to buy over £1bn of cancer services over ten years. The care will be better "integrated," to use a phrase which Burnham has employed in the past, and the needs of the patient are at the core of the exercise. For example, the bid takes the guidance of Macmillan Cancer Support in defining the patient outcomes for the contract. This may be an example of what Burnham has previously called "Whole-Person Care."
The second problem is that the contracts being criticised by Labour are partly so large in value because they run over a number of years. Many clinicians take the view that health spending needs to be planned on a longer term basis to help with service reform. Short contracts, whether awarded to NHS providers or others, mean that changes are hard to make. The risk of Labour’s approach—which hinges on the claim that long-term contracts bind the hands of a future parliament—is that service transformation, even when it benefits patients, may not happen.
When will we know? It is unlikely that the commissioning exercises Labour names will be stopped in response to this criticism. This means Labour will have more campaign material on the "secret privatisation" of the NHS. But the key test of their future policy will be what their manifesto says about how healthcare—including the integration of services—is going to be delivered.
Would Labour cut out patient charities like Macmillan from being involved in the commissioning process? Probably not. Would they be opposed to long-term contracts that coordinate across different areas? Certainly not, if they’re to deliver Whole-Person Care. Burnham has said previously that he would treat the NHS as the preferred provider of services, which suggests it will not be the exclusive provider.
In the end, the difference between the parties may be much harder to spy than this week’s commitment suggests.
