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Editor's blog Thursday 16 June 2011: Dr Milburn, Or How I Learned To Stop Worrying And Love The J-Turn

I occasionally think, 'I quite miss Alan Milburn'.

Perhaps it was the character-forming near-vomiting-on-him experience at my very first NHS Confederation conference; or maybe it was just The Gravity-Averse Quiff Of Doom.


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Whichever: Milly had an impact.

He also had a very, very tired joke for the start of every speech he gave about getting up each morning and being so depressed about what was in the Daily Mail. This revealed a view of human nature that (depending on your point of view)  was either charmingly optimistic or profoundly incapable of learning from experience.

There were various uninteresting conspiracy theories about his exit form the job as Health Secretary. I like to think that his Mail joke got diagnosed with Chronic Fatigue Syndrome, and so an Employment Tribunal ordered it to take an indefinite leave of absence - and he was so attached to it that he went, too.

Whatever: Milly is back, and handing in his notice (as I see it) as social mobility advisor to the Coalition Government by way of this article for The Daily Telegraph arguing that 'This NHS debacle sets us back a generation'.

This is a statement which (as no supporter of either the original reforms nor of the reformed reforms) I suggest is total bullshit, from soup to nuts.

Milburn has lost none of his ability with the demotic, calling the Governments' NHS reforms "the biggest car crash in NHS history ... the stench of a sharp U-turn has become overpowering. It leaves both health policy and British politics in a very different place".

Well, no, it doesn't. It really doesn't.

It leaves 'competition' rebadged as 'patient choice', and it leaves the economic and competition regulator role formerly promised to Monitor as a gift for the NHS Co-Operation and Competition panel, hosted in - guess who? - yep, Monitor.

Milly's next suggestion is that "the temptation to elevate short-term politics above long-term policy proved too much for both David Cameron and Nick Clegg. Cameron has returned to his original strategy of playing safe on the NHS in order to decontaminate the Tory brand. A combination of his own neglect and his Health Secretary’s foolish bout of policy-wonking had put that at risk.".

Riiight. Oooo-kay.

The clear assumption here is that these reforms, pre-alteration, represented good long-term policy, which is a view held by probably only two people: Andrew Lansley and James Kingsland.

Oh! Look - here's a bit that isn't wrong! "Everyone knows the NHS cannot stand still in the face of demographic change and medical advance. Reform is a constant necessity".

Then we canter through the slower pace of change, and the potential damage done to required reconfigurations.

It is on the latter point that the WTF signal starts flashing bright red with noisy klaxons.

The need for reconfiguration of the NHS's acute estate has been well-known for some time. New Labour, post-2000, had the economy's 1997 electoral expenditure leash loosened, and an economic boom.

It could spend its way out of trouble on the NHS, and guess what? It did.

When Patricia Hewitt made a courageous attempt to have a go at shutting things in 2007, many of her fellow cabinet ministers ware out on picket lines to stop it.

Milburn also writes that "GP consortiums that were supposed to be in place by 2013 now have no deadline for their creation" - where it is quite clear that the new clinical commissioning groups will have to exist once PCTs stop, even if only in shadow form. This just isn't a strong point.

Milburn goes on to assert that "the NHS books (will) be balanced by the usual device which policy-makers have deployed every decade or so in the NHS. A very large cheque ... sorry, George, but the cash you were saving in your pre-election Budget for tax cuts will now have to be spent on a bail-out for the health service".

Safer ground is reached in Realityland, when Milly writes, "the Government’s U-turn places real power in the hands of the national NHS Commissioning Board – the daddy of all quangos. The board will control how £60 billion of NHS money is spent in local communities from Darlington to Dartmouth. It is the biggest nationalisation since Nye Bevan created the NHS in 1948. I’m not sure whether he would be laughing or turning in his grave at the prospect of the Conservative Party championing such a policy".

Quite so. The Nicholson Health Service.

Milly returns to the New Labour reformist argument with his concept that "the debacle has set back for a generation the cause of market-based NHS reform ... reform of the public services in Britain won’t be achieved from the Right: it has to come from the Left.

"So there is an open goal for Ed Miliband’s Labour Party. The temptation, of course, is for Labour to retreat to the comfort zone of public sector producer-interest protectionism – and there were signs of that in the party’s response to the Government’s U-turn this week. It would be unwise, in my view, for Labour to concede rather than contest the reform territory. It now has an opportunity to restake its claim to be the party of progressive, radical reform. It is only when we are that we win".

Interesting analysis, this.

Milburn's paean to "market-based NHS reform" ignores the widespread concern underpinning much of the criticism and opposition over the White Paper and the Bill about the potential effects of marketisation.