Not many Liberal Democrat ministers have a more difficult job than Paul Burstow this week in Birmingham. Faced with activists who are disgruntled at being denied a chance to vote (again) on health policy, he must explain a set of policies which many in his own party now describe simply as being “Lansley’s reforms,” almost denying that the Liberal Democrats have had anything to do with them.
This denial is of course as untrue as it is untenable within a coalition. It is also unhelpful for the Liberal Democrats, seemingly conveying the idea that the leadership of the party is somehow being buffeted between Andrew Lansley’s belief in markets on the one hand and Evan Harris’ strong desire to move further away from competition on the other, lacking the protection of their own ideological bulwark. So, if I was advising Paul Burstow, this is how I would suggest he sets about having a successful conference season.
The next few days should be about showing how his philosophy – and his strong track record on advocating for better services, particularly in social care – has made its mark on the reforms. Paul Burstow has always believed that NHS and social care services should be brought closer together and that the power over services should be moved closer to patients. He can claim an influence over the reforms on both counts. The role that local health and wellbeing boards will play in coordinating care (which continues to evolve and grow in significance) and the post-pause focus on integration support the former and the work on personal budgets, reablement and choice in community services supports the latter.
Paul Burstow needs to demonstrate how his own experience, perspective and position in the Department of Health has placed these principles centre stage. In addition to policy benefits, he needs to demonstrate the practical gains that have been achieved over the past year, moving the focus on from often sterile debates about the Health and Social Care Bill. Given his portfolio – which, from cancer to mental health or dementia, contains many of the issues people care about most – he is well placed to do this. He can point to new clinical strategies on issues such as mental health, greater prioritisation for dementia research, new awareness campaigns for bowel cancer, all things which people care about and will engage with far more than technocratic reforms. Now would be a good time to begin canvassing opinion on the conditions which require similar attention in the coming year, translating the reforms into practical action.
There is also, of course, the need to address ongoing activist concerns with the Bill. Here he is somewhat hamstrung by his leadership’s rather premature claims of total victory at the end of the listening exercise. The trouble with such a claim is that anything less seems like a failure. Burstow shouldn’t claim that the reforms meet the expectations of all activists (this would be impossible), but he should show how a partnership between ministers and activists has created opportunities to improve the reforms, opening up the process to people and groups far beyond either the Conservatives or the Liberal Democrats. “In government on your side” should be a message to voters and civil society, not just activists.
Paul Burstow should also make the point that the Liberal Democrats’ record on health will not be made or broken by debates in Birmingham, but instead by the improvements in outcomes which are delivered (or not) as a result of change. Now is the time to shift Liberal Democrat attention to ensuring that the Coalition actually delivers on health, as well as talking endlessly about it.
This will not be the easiest few days of Paul Burstow’s political career and he will not be the most popular minister on the fringe circuit. However, there is a job to be done and, whatever, you think of them, it is not about disowning the reforms.