Why Andy Burnham will never be health secretary (again)

Labour has built its electoral strategy for the May election around the NHS. That made sense given it polls strongly on the NHS. Yet, its NHS policy boils down to only two components: a robust rebuttal of the so-called 'privatisation' of the NHS and a proposal to integrate health and social care provision. Both are looking increasingly too weak to function as the main pillar of a general election strategy and here is why.

'Privatisation' is a serious concern for many people in the UK. Labour has read the polls carefully and consistently identified the Health and Social Care Act 2012 as being widely discredited. Andy Burnham, the Labour's shadow health secretary, built his health care policy around the repeal of the Act. This has brought him plaudits from people who dislike tampering with the NHS. However, the agreement around the rejection of the Act is brittle and insufficient to act as long term policy. And the electoral appeal of 'anti-privitisation' rhetoric does not extend much further than Labour's core supporters. In addition, repealing the Act may also quickly emerge as disruptive to the fabric of the NHS. The 'anti-privatisation' agenda could thus become tarnished with exactly the same brush as the Act itself: endless re-organisation of the health care service.

Going nowhere - Labour's Shadow Health Secretary Andy Burnham (Foto: EPA)

To offer something positive, Burnham suggested to integrate health and social care. Yet, his proposal, three years in the making, still remains obscure. Health care through the NHS is free, whilst social care is means tested. Burnham's proposal was riddled with contradictions and he knew it. So, with only slightly more than 2 months to go to the general election, he has still not spelled out how the integration of the NHS and social care is to be achieved. The policy remains a shell at best.

Cue George Osborne. On Thursday, the Chancellor announced that Greater Manchester will have direct control over the entire NHS budget for its area. In 2017, the elected Mayor of Manchester will assume full responsibility for social care and health care provision for almost 3 million people. It's hard not to see this as a preemptive stroke of genius by the Chancellor (and a snub to Burnham by the local Labour councillors who did not even bother to inform him about the imminent agreement). Without having to fill in the detail of HOW to integrate health and social care, Osborne has given local authorities the powers to embark on integration as a local response to local problems.

The consequences are devastating for Burnham. As the consensus around his 'anti-privatisation' rhetoric becomes increasingly fragile and reveals its ideological thrust, his other main policy proposal is stuck in the mud of detail. In the meantime, Osborne devolves health care budgets to local authorities, strengthening the narrative around local accountability without having to provide any detailed health care policy on the complexities of integration.

The upshot is that Labour's health policy hangs by a thread and so does Burnham's political career. During his tenure as shadow health secretary he has failed to develop any significant and substantive policy proposals and the Labour leadership knows this. Their entire electoral strategy was built around the NHS and Burnham has left their flank undefended and open to attack. He is likely to pay the price for this blunder.

Scotland and the devolution trap

As the No Campaign scrambles to counter the late surge in support for Scottish independence, Westminster politicians appear to throw a last trump: constitutional reform. For anyone who observed the dithering of UK politicians on this issue for the last decade, this late constitutional twist is ironic to say the least.

For a start, there is the consistent inability (or unwillingness) of Westminster to conduct a radical overhaul of the British constitution. Labour embarked on devolution with great fanfare, only to shelve plans for parliamentary and tax distribution reforms (i.e. the infamous Barnett formula). After 2010, the coalition government strafed the issue with ignorance right from the start.

The paradoxical result of this is that Britain, for all intents and purposes, is a federal country without the necessary institutions. It remains suspended in a constitutional limbo, where Westminster keeps operating as if this was a centralised state, whereas devolved governments in Edinburgh, Cardiff and Belfast are allowed to keep their grudges against 'imposition from London'.

In a way, the Scottish referendum is the child of devolution, and it may just be the reason for devolution's inglorious end. On one hand, devolution allowed parliaments and governments in Edinburgh and Cardiff to be the training ground for potential independence, boosting the confidence and competences of their politicians. On the other hand, however, devolution is still too fresh to even blip on the radar of many Scottish or Welsh voters to recognise that the assemblies in Edinburgh and Cardiff already have powers at their disposal to freely decide on health, education or housing.

Devolution thus is too young and too advanced at the same time. Timely radical constitutional reforms could have strengthened the hand of the opponents of independence, but now, all that's left to them is to clobber together a package that may just sway sufficient votes against an independent Scotland. There can only be one lesson: delaying constitutional reforms leads to freewheeling thinking of headless chickens. Lets hope for the best.

Delay the Lords Reform!

As the coalition government is stumbling from one mistake to another, it is hard to dispel the impression that most of its wounds are self-inflicted. To add to the list of problems, the government has opened the can of worms again that is the reform of the House of Lords. 

As many observers of constitutional affairs have noted only half-jokingly, House of Lords reform has been imminent since 1911. In that year, parliament approved the Parliament Act which established the supremacy of the House of Commons. Ever since, politicians and the British public have wondered what the role and purpose of the Lords could be in the legislative process. 

Much ink has been spilled on possible reforms for the House of Lords and many a commission’s report has come and gone. But now, the government is determined this long protracted issue should enter its final phase. In fact, it is so determined to solve the House of Lord issue, ministers will move other legislation out of the way in the House of Commons schedule to make place for reform legislation. Why the haste? 

One reason may be the desire of the Liberal Democrats to secure their legacy before the next general election. Putting in place some of the changes they promised in their election manifesto in 2010 may provide a critical stepping stone for their electoral survival. However the timing of this round of reforms of the House of Lords appears deeply flawed. While few would argue that making the Lords an elected parliamentary body would increase their legitimacy, it is the timing that is ill conceived. 

Scotland’s First Minister has announced a referendum on Scottish independence for 2014. Whether or not Scotland may secede from the Union in 2014, Britain will need a fundamental transformation of its constitutional structure as devolution for the three smaller home nations gathers pace. The obvious means for re-jigging the British constitution would be a federal upper chamber that could ensure regional and national representation and balances the power of central government.

Any precipitate House of Lords reforms however forecloses this option. Once the upper chamber is a fully elected body with the main political parties dominating its composition, any federal solution become unfeasible. Since not much has changed in the last 100 years, chances are we would have to wait another century for a federalisation of the upper chamber. The forces set in motion by devolution may not wait that long.