How Burnham got it wrong

Andy Burnham wrote a piece in yesterday’s Guardian in which he tries to make some political ground out of this week’s mini row over the NHS.

Burnham sets out what he sees as clear dividing lines for the next election.

“Our commitment to national standards and structures in health remains strong. We know that, without them, the poorest areas tend to get the poorest services. By contrast, the Tories are ambivalent about the role of the centre, preferring localism in health as in other areas.”

I can only hope these aren’t the real dividing lines because they are all wrong.

It’s depressing to see repeated the old canard that opposes national standards, fairness and quality to a post code lottery. We should know by now that this is a false dichotomy.

It’s entirely coherent to think that government can set minimum standards (not the same thing as targets) but that how these standards are prioritised, procured and provided can be determined at local level. At the LGiU we would argue, indeed we often have argued, that not only does this have a democratic premium, but that it creates better outcomes and drives efficiencies by ensuring that services are tailored to local contexts.

Elsewhere the government seems to recognise this and, for all its faults, John Denham’s Strengthening local democracy consultation is based on these assumptions. It’s hard to see how Burnham’s thinking squares with the consultation’s proposal to give councils “greater scrutiny and oversight” of the “billions of pounds spent every year by a wide range of service providers, including the National Health Service.”

Aside from the fact that it does a beleaguered government no favours to be sending out mixed messages, Burnham’s article obscures the real issues. We know that public services such as the NHS face real long term pressures associated with demographic change, increasing rates of chronic illness etc. If we want to make real progress towards meeting these challenges we need to do a lot better than a false binary between inconsistent localism and equitable centralism.

    1. kevin dykes says:

      agree with your argument about this being a false binary, and then the next step in the argument will be to say how local democratric control of nhs services can be achieved, somebody could be asked to do a participatory exploration of how Links is doing.

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