We are living through a sea-change of health policy. This much you will have noticed. This much has been forced on UK PLC by the recession.

An ebb-tide of the unprecedented NHS economic growth since 2000 had been planned after 2010-11 in the last comprehensive spending review anyway - but the global credit crunch has given those plans short shrift.

Economic swine flu
The past weeks have seen profoundly unedifying conversations about ‘cuts’. They have seen the fiction being maintained that the NHS has got a political vaccination against economic swine flu from both the major Westminster parties.

Not many people I’m talking with seem to believe that the NHS’s suggested immunity from public spending cuts is true.

It is emerging that the political battle lines between the Labour incumbents (with what will, come election time, be 13 years in office to throw stones at) and the Conservative opposition will be around two main points of public sector policy: the timing and timescale of the move back towards lower national debt; and surgical skill and savior-faire in deciding what should be cut.

In this context, Andy Burnham’s policy speech today (which effectively hijacked todays’ Kings Fund seminar on quality and efficiency) is an important one.

Some of it was simply repetition of the Jim Phillips ‘moving from good to great’ stuff he spouted at the NHS Confederation conference in June. The ‘No Shit, Sherlock’ award of the week goes to Burnham’s solemn statement that the big growth of the last decade was over. Really, it would have taken a heart of stone not to laugh.

No mini-service reviews locally
A fascinating theme, that he emphasised repeatedly, was that NHS organisations locally should not conduct mini-service reviews, “second-guessing” potential settlements in years to come.

Burnham told us, “I don’t want people to think of the glass as half-empty”, observing that PCTs are still receiving 5.5% growth in funding this financial year and next. That glass he’s talking about must be half-full of the tears that Jesus wept.

Some good bits
Like the curate’s egg, there were some good bits. He did mention the importance of exercise and prevention for the next decade. He was also frank about the fact that despite the NHS’s significant successes on reducing waiting times and healthcare-associated infections, progress has been insufficient to be content with quality.

Burnham also said that he realised that further reform was contingent on successfully engaging staff in the need to change ways of working. He quoted Sir Michael Barber’s line on public service reform that “You can mandate ‘awful’ to ‘adequate’ but you cannot mandate greatness. Greatness must be unleashed.”

Importantly, he also described the importance of patients in driving reform, repeatedly mentioning patient satisfaction (although in debate, this was modulated to the more useful ‘patient experience’).

Likewise, his concept of a “smarter centre” that would not “measure everything” is grubbing around the right general area.

He also made an aside that casts a flattering reflection on ex-Health Secretary Patricia Hewitt, in describing the importance of staff engagement in reform and morale. Describing a session he had done with staff at the infamous Maidstone and Tunbridge Wells acute trust, and reflecting that the extremely low morale he encountered had made him ask DH staff to look further into the trust, Burnham observed that Hewitt had advised him that, to learn about how the organisation feels, “do a session just with the staff only”. Those were wise words.

Reservations
However, a native American politician would have been struck by the number of reservations that arise from various statements. Burnham suggested that the waiting time rights for elective and cancer care were enshrined in he NHS Constitution – which is not legally enforceable.

He also suggested that the Conservative plan for the NHS to be run by an independent board, “creating the world’s biggest QUANGO”, would harm the NHS’s accountability. Surprisingly few people laughed out loud at the notion that the NHS is particularly accountable, but there were giggles.

The unions’ pound of flesh
It looked very much as if the trades unions have exacted their pound of flesh with Burnham’s equivocal comments on a new stage of reform, as he criticised the assumption of recent years that there had been “unintentional messages at ward level that private equals good and public equals bad”.

But the really interesting one was his repeated comment that the NHS should be regarded as the “preferred provider” of services. It could well be that Lord Carter’s Co-operation and Competition Panel might have something to say about that.

Multi-year tariff and quality consultation
There were substantive announcements in the speech, apart from the silly bollocks about dual GP registration.

There is to be (another?) consultation on quality accounts, as part of a move to make the quality accounts a significant new factor affecting the payment of trusts under the national tariff.

Moreover, Burnham wants to see the tariff announced in advance for a four-year period, to better enable trusts to prepare for and cope with the change in their income over forthcoming years. Again, it is in itself a Good Thing. The unintended consequences, of course, are another matter.

There is also to be a move next (financial) year to a “best practice tariff for stroke, gallbladder, hip fracture and cateracts” – detail will presumably follow on this.

The return of ‘Yes, Minister’?
The drift towards de-authorisation of FTs, which he mentioned, will give cause for concern to those who believe that independence for FTs is an important matter. It will get Monitor’s lawyers reaching for their copies of the 2004 NHS Act - again.

And finally one for the conspiracy theorists
The timing with the launch of the new Dan Brown book is impeccable. Burnham’s concluding line - “we have a common purpose to make our NHS great again” – will fuel those conspiracy theorists who worry that Common Purpose has a malign intent.

Sense also spoken
The responses from John Adler, CE of Sandwell and West Birmingham acute and the Fund’s own economics maestro Professor John Appleby, had much to commend them. Adler’s reality sense-checks were smart and short (as the little time permitted).

Appleby took the opportunity to light into the absurd removal from the NHS staff survey of the question ‘would you be content to be treated by your own organisation?’, noting that in one acute trusts, the ‘no responses reached 50%. This apt challenge to rhetoric about the importance of staff involvement and engagement will long hang in the air. (John may also be off the Christmas card list at Richmond House, but knowing him, I suspect he will cope.)

He also pointed out the dire financial situation, as revealed in the Fund’s recent report (scroll down about half-way) with the IFS (whose director Robert Chote wrote for today’s Times that economically speaking, things are worse than the IFS’s previous assumptions).