Andy Burnham’s plan to integrate health and social care is the boldest idea to emerge from Labour’s policy review so far. If he can convince his shadow cabinet colleagues to back it, can he convince the country in 2015? “The Labour party is going to have to decide how ambitious it wants to be,” he tells Mary Riddell
Some offers are impossible to refuse. And so, when Andy Burnham was asked by a constituent to skydive from a Red Arrows jet to raise money for an exemplary charity, the shadow health secretary agreed. We meet some time before the stunt, but Burnham – a vertigo sufferer – is already gripped by trepidation. “My mum’s in meltdown about it. I couldn’t say no, but I’m not brilliant with heights.”
In politics, as in aerobatics, Burnham tends to close his eyes and jump. A candidate in the Labour leadership election, he has now embarked on the most ambitious policy advanced by any shadow minister. So radical is his idea that Ed Balls is rumoured to have reacted with some dismay when he first learnt of Burnham’s plan to integrate health and social care.
“I don’t think he was dead against it. The truth is that the implications went well beyond my brief,” Burnham says. “You always have to be a little careful because obviously I can’t just write everybody else’s policy for them. But, with those concerns, the shadow cabinet endorsed it, Ed B endorsed, so we’re really motoring.”
According to the Burnham preference, health and social care would be fully merged, with the additional cost of decent provision for elderly people met either by a levy on all estates or by payments made by older people. The notion of ‘whole person care’ is now being floated, at meetings up and down the country, as an alternative to the proposals by the economist, Andrew Dilnot, whose recommendations of a cap on personal contribution and a voluntary insurance scheme have been embraced, in a diluted form, in George Osborne’s budget.
Although Burnham says that straw polls show an overwhelming preference for his approach, he regards better social care as a continuum. “Even the government’s move [which offers a cap of £72,000] is a tiny, tiny step forward, and I give them credit for that. To do Dilnot properly [Dilnot initially suggested a maximum lifetime limit of £50,000] would be much more significant. The all-in approach would go one further.”
Burnham’s enthusiasm for gradualism runs out, it seems, in 2015. If Labour wins, he hopes to move fast. “It would have a very clear timetable…Integration could be done quickly [through] a bill early in the next parliament. A new way of paying for social care would have to be phased in over a period of time.”
In the short run, he plans to elaborate on his plan at this year’s conference and, assuming he gets endorsement, to develop the detail for a policy that would be signed off in 2014. “The Labour party is going to have to decide how ambitious it wants to be,” he says.
Despite the Tory campaign against a “death tax” that derailed his previous reform plans in the closing stages of the Brown administration, he remains an evangelist for a 10 per cent tax on all estates, great and small, to fund social care. “There’s a simplicity, and it does need clarity. The more options you give people, the more potentially complex the whole thing gets. But there are other options – such as payments at 65 or an annual payment over [people’s] retirement years. All these questions are on the table.”
Stephen Dorrell, the Tory chairman of the health select committee, has argued the need for integration, and Liz Kendall, Burnham’s deputy, has also done much groundwork for a revolution long favoured by Burnham, a onetime health secretary who says he is the only member of Ed Miliband’s top table to be “a shadow of my former self”.
Assuming that he succeeds in allaying colleagues’ anxieties, his all-in health system may end up as one of Labour’s big ticket pledges for 2015, along with a major housebuilding programme and a move towards universal childcare. Given Labour’s coyness about what it might cut, could Ed Miliband afford even one of these flagship policies, let alone all three? “Partly what I’d cut to pay for my policy are hospital beds. I’m very clear that we could get much better results for the current £120bn we put into health and adult social care if we were to treat it as one budget. Some social care could be met for free from a much more preventative, home-based system.”
The logical consequence of such a shift is fewer hospitals. “We’re definitely saying that none of this is sacrosanct. We’re not going to be on every picket line opposing every closure.” The exemptions seem less clear. On planned retrenchment at Lewisham hospital and the Whittington, in north London, Burnham appears to be on the side of the anti-cuts lobby. “If there isn’t a clinical case behind the changes, then we won’t support them.”
In the shorter term, Labour has modulated some aspects of government reforms, most recently seeing off regulations favouring private providers. None the less, Burnham says the NHS “feels as if it’s on a knife edge”, principally because elderly patients unable to get care at home due to council cuts are ending up in hospital.
“Just to say we’re going to protect the NHS budget can be pretty meaningless. You shouldn’t give a rise over and above inflation, because [more money] should go to councils. You can’t have this mismatch between health and local government spending.” Although Burnham opposes any notion that Labour should prune one of its untouchable budgets, such as healthcare, he claims his words have been twisted.
“Because I was saying we should give the NHS inflation but not real terms increases, the Tories have mutated that into me wanting to cut the NHS, which isn’t true. It has to be protected, but at the moment it’s [failing to] use money as efficiently as it might. I’m working on the basis of no new money [though] I’m hoping that means inflation. But the way I shall get the improvements that we want is by full integration.”
Given that others in the shadow cabinet are reported to be keener on simply promising to protect the NHS, Burnham must have struggled to get his plan even to the consultation stage. “I have made a strong argument. I’ve had to because I’m proposing something quite big. Where Ed B and I completely agree is that health will be a very big issue at the next election…I’ve got to convince not just Ed B but Ed Miliband too that I’m giving them the right policy.
“It’s right that I should be tested. Ed B has set a number of efficiency drives going, assuming there will be no more money, so this kind of came from a Treasury request anyway. The economic necessity is that we have to think about combining these budgets, because local government will be completely overwhelmed if we don’t. The financial imperative is probably as important as the quality imperative in all of this.”
Burnham regards each small move as hopeful. “Getting permission to do the speech [in which he launched the idea at the King’s Fund] was quite a big step,” he says. Underlying any deference to doubters is a steeliness instilled by the blow of watching his last reform moves wither before the 2010 election. “I’ve really learnt from the last parliament and started early. The NHS is on a fast track to the fragmentation of the market when the future demands integration.”
Much as he might wish to look ahead, the failures of the past continue to haunt Burnham. He has rejected suggestions that he did not do enough to investigate supposedly avoidable deaths in NHS trusts, saying he acted “firmly” and “immediately” on the information at his disposal. In addition, he remains supportive of David Nicholson, the beleaguered head of the NHS who has been implicated in the scandal of appalling care at Mid-Staffordshire NHS Trust. “I wouldn’t just put this at David’s door. Our policy was a bit hospital-focused, and I don’t too much blame people internally. We set that direction. I don’t think I’ve seen David since I left the department, but I found him to be someone genuinely committed to the NHS and all it stands for.
“There have been failings in the NHS. It can’t be perfection because of human error. But the overall context was an NHS which made huge strides forward.” While that may not satisfy those who argue that he, along with his Labour predecessors, have more questions to answer, few would argue with his diagnosis of a crisis in which “people really are fearing hospital…People are beginning to worry about mum or dad going into hospital, and that’s a real change. What’s really sad is that older people drop like a stone because hospitals are not geared to deal with all their needs.”
Burnham has more personal experience than he would wish of the services he hopes to revolutionise. “My gran went through the care system just over a decade ago, and it was thoroughly depressing. We walked in one day, and her knuckle was red raw because someone had ripped off her engagement ring and stolen it. I wasn’t even a candidate at the time, but I remember my mum saying to me: ‘If you ever get into parliament, you had better do something about this.’”
More recently, Burnham’s wife, Marie-France, had a double mastectomy after tests showed that she had the gene for the breast cancer that killed her sister at the age of 39. “What the NHS did for my wife was incredible. Her family were living in Belgium, and the care there is not as good as what is provided here. Of the three sisters, Claire died, and Louise, the eldest, had breast cancer but has seen it off.
“I remember being lobbied as a health minister to speed up genetic testing. I did a lot of work, never knowing that one day we would have to use those tests, and it does bring it home to you how [progress] can save lives.” Marie-France’s operation took place during the Labour leadership race in which Burnham overcame family trauma to fight a valiant campaign. “I’ve no regrets at all. I knew David [Miliband] would stand, and I thought Ed B would stand, but I didn’t think Ed M would stand against David. So although I was the rank outsider, I also knew there was a real space for somebody to come through the hole [of the] Blair/Brown dynamic.
“Then shortly after the [general] election, Ed M rang me and said: ‘I’m thinking of standing, and I wondered if you might support me.’ I knew at that moment that the ground I was aiming for had gone, because Ed M was more prominent than me.” And so it proved, even though Burnham, whose views are perceived to place him towards the right of the party, was never an ideological replica for the eventual winner.
Burnham, for example, was a strong believer in restricting new migrants’ access to benefits long before the possibility was publicly floated by Yvette Cooper. “I’ve long argued within the shadow cabinet around the issue of benefits and the EU. I just found it indefensible on the doorstep at the last election that people should be able to repatriate child benefit. I couldn’t and I can’t defend it.”
His restrictions would not stop there. For the first time, Burnham says that, if he becomes health secretary, he would wish to restrict migrants’ access to the NHS. “There have to be pretty clear rules about entitlement. It can’t be an open…system. People do try and take advantage of it, and we have to protect it [the NHS] from that.”
So would he say, for example, that people had to spend a year here before they had any access to free healthcare and that they would have to carry cards to prove their entitlement? “I do take a pretty tough line on these things,” he says, citing only one exception. “If someone is in this country, I think they should get emergency care without checking up. If something’s life-threatening or could seriously impair them, I think care should be given without checking their credit card details. To go down an American system [for emergencies] would be antithetical to me.
“Essential emergency care should be provided free. Whether you can recover the cost later is a different question. But I believe on being tough on entitlements to care, because the NHS doesn’t do well at chasing these bills … Around [all] planned care, I would want a pretty tough entitlement.”
Both on healthcare and benefits, he is “happy to look at” existing rules, with a view to toughening them considerably. “We’ve got to move away from saying that it’s too hard to change so we shouldn’t mention it, because that’s not going to wash with people. When we left government, we had started to look like people who didn’t want to do the right thing, or people who wanted something for nothing.
“Winning again is critically linked to our ability to show we want to reward people who are doing the right thing – to show we’re on the side of common sense and people who are making a contribution. We need to regain that ground absolutely.”
If that standpoint is anathema to some in his party, Burnham is inured to their disapproval. The leadership contest was, for him, a liberation. “When you go over a line and speak for yourself and no one else, you just think: Who am I, what do I really believe, what’s my purpose in all this?” He doubts if he will ever run again but cannot be quite certain. “I don’t know. But I don’t think so. It took a hell of a lot out of me.
“And I’ve seen the pressures Ed has had to deal with. I think he’s done fantastically well, to be honest. I’ve had my go, and my mission now is to build a health and care service for the 21st century.” Vertigo sufferer and reluctant skydiver he may be, but there are few bolder or more ambitious politicians than Andy Burnham. He will soon find out whether he can aspire to be a Beveridge for our times or whether the law of political gravity will ordain that he instead becomes the man who fell to earth.