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The Politics Interview - Andy Burnham

Yes, the Lansley plans are unpopular. But what would Labour do differently? Rafael Behr meets Andy Burnham.

A veteran civil servant at the Department of Health once described the experience of working with Andy Burnham to me as disconcerting - in a good way. "You half expected him any minute to say, 'Actually, shall we just go and have a game of football instead?'" That wasn't meant as an aspersion on Burnham's commitment to the job. It was praise for the boyish eagerness and informal manner that stood out in the tense and sullen atmosphere around Gordon Brown's government.

Burnham is now shadowing the job he held in government. He got the portfolio back in a reshuffle last month, after a year as shadow education secretary in which he failed to disrupt the coalition's plans. His satisfaction at the return to Health is palpable. "I did enjoy Education for a year, but it's like coming home. It's where my heart lies."

We are drinking tea in his parliamentary den, a gloomy and unadorned cubicle to which he retreats from a more spacious office round the corner. The absence of decor feels like a kind of mourning for the Whitehall suite now occupied by Andrew Lansley. Several times, Burnham recalls his ministerial days to support an argument against his successor. "As health secretary, I was told the financial challenge would be all-consuming for the NHS - that it would require every bit [of funding] to get through this thing safely and fairly." Labour's main practical objection to Lansley's reform plan is that a huge reorganisation is being pushed through just as the NHS is struggling to find £20bn of "efficiency savings". The result, says Burnham, is “a complete loss of grip at local level . . . people making random cuts and haphazard changes".

There is also a theoretical attack, which is that by significantly increasing the exposure of state health care to private competition, the reforms undermine the founding ethos of the NHS. In government, Labour supported private-sector involvement and competition in the health service, but never on the scale that Lansley envisages. Since last year's general election, it has been unclear whether the party still believes in market-oriented reform. Burnham's view?

“There's this implication that if you introduce more competition it makes things more efficient. I don't think, if you look at health-care systems around the world, that is borne out by the evidence. The most efficient health-care systems in the world are the ones that are planned and managed . . . the argument that the market is cheaper just doesn't wash."

Does that mean Labour will fight the next election pledging to reverse Lansley's reforms, regardless of how far these have gone? "As things stand, we would have to put the NHS back together again." So Labour would reinstate primary care trusts - the commissioning bodies being dismantled to make way for GP-led commissioning? "Definitely."

The political advantage in promising to reverse an unloved policy is obvious enough, but that doesn't deal with the long-term budget constraints on the NHS. It would test voter credulity for Labour to fight the next election promising to rebuild services as they were at the peak of the high-spending years. Even without Lansley's plans, there would be a need to rationalise provision. That entails unpopular changes - hospital closures, for instance. Is that a message Labour is prepared to give the public?

“There's a nettle that has to be grasped by all politicians here," Burnham says. "The difficult thing is where one side starts saying 'we'll keep them open'. It builds a kind of arms race. It is going to require some cross-party discipline."

Recent history shows how implausible a prospect that is. Under the last government, there was an attempt to reach cross-party agreement on another difficult question of health reform - long-term funding of adult social care. Talks ended acrimoniously when the Tories attacked Labour's proposals as a "death tax" on elderly patients. Now Burnham wants to turn the tables, attacking the effect of local authority cuts on social care, which result in higher charges for all but the most acutely ill patients, as "Lansley and Cameron's dementia tax".

An attack is also planned on lobbying by the private health-care industry, the scale of which Burnham describes as "quite alarming". Parliamentary questions are being tabled to find out about ministerial meetings with Care UK, the private health group whose old chairman donated cash to Lansley's office in opposition. And he is scathing about some of the Tory peers backing Lansley's reforms in the Lords: "We're talking about people who have barely turned up for years and now have 100 per cent attendance record on the Health and Social Care Bill - and they've got major links with private health-care organisations."

It isn't the most positive agenda: attack, protest, attack again. There are, he insists, other things Labour can say about health. Next year he plans a "major policy shift" to focus on mental health and the effects of stress and anxiety on well-being. But, for now, it's all about the bill that is now bogged down in parliament. Labour is mobilising for a "final push" to kill it off. What is the plan, I wonder, if the push fails and the reforms go ahead? "We expose the effects . . . the extent of the postcode lottery that develops around the country."

That is a prospect that has made many Tories anxious. In private, most accept that Lansley's reforms are a mess. Few voters understand the changes; most NHS staff despise them. The Conservatives will have to fight the next election explaining how David Cameron's two headline promises - to protect health budgets and avoid top-down reorganisations - became the biggest reorganisation and harshest budget settlement in NHS history. It is, says Burnham, with a glint of eager satisfaction, "the almightiest of political migraines known to man".

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

This article first appeared in the 14 November 2011 issue of the New Statesman, The NHS 1948-2011, so what comes next?