Since Labour came to power nearly 10 years ago, junior ministers have not tended to advance their careers by thinking for themselves and coming out with big ideas that stray beyond the limits of current government policy. So Andy Burnham, the health minister, is entering uncharted water by setting out for Society Guardian a wide-ranging agenda for NHS reform that cannot be implemented until long after Tony Blair has departed Downing Street. Few are privy to the shape and tone of health policies that might be adopted by Gordon Brown, the most likely successor, and it is hard to judge whether Burnham's ideas mesh well with them. "It's not easy to go off and freelance in this way," he says. "The structure of government doesn't cater for off-road biking."
Burnham's off-road agenda includes proposals for an NHS constitution, which he will try to persuade the government to unveil on the health service's 60th birthday in July next year. Its purpose would be to reassure patients and staff about the enduring values of the NHS in a period of rapid change.
Other ideas are more abrasive. He is arguing for clearer rules to allow paramedics in England to refuse to take a patient to hospital if they think the medical condition does not require an emergency response. He thinks that the 18-week maximum patient wait should be the last top-down target imposed on the NHS by a Labour government. He wants to inform the public about the cost of NHS services that they are using for free - perhaps even sending out statements after a course of treatment, or reminders of appointments that would let people know how much public money they would waste by not turning up. And he has ideas to change the working lives of staff, ranging from hospital porters to chief executives.
Burnham, 37, is widely regarded as a rising political star. He is one of only half a dozen Labour MPs who were elected for the first time in 2001 and have already reached minister of state rank, one rung below the cabinet. After a reshuffle of portfolios at the Department of Health last month, he took on the wide-ranging responsibilities that John Hutton had before his promotion to the cabinet in 2005. As a recent entrant to the Westminster bear pit, he is relatively unencumbered by the political baggage that burdens some of the Blairite and Brownite camp followers.
Blair gave Burnham licence to think for himself when he switched him from the Home Office to health last year. He asked the young minister to develop a strategy for winning over staff who were loyal to the NHS, but anxious about the pace and direction of reform. Burnham decided the best way to proceed was to take a few days away from the normal schedule of meetings and official visits to spend in one-to-one contact on the shop floor.
Fresh perspective
His workshadowing diary - published under the title Days Out in the NHS on the department's website - may sound a trifle gimmicky, but the exercise seems to have given him a fresh perspective on why morale in the NHS is so low when spending on better wages and staffing levels is so unprecedentedly high.
In a report to Hewitt, he said: "The irony is that the process of change necessary to secure long-term public support for the NHS risks driving a wedge between the coalition of its strongest supporters ... There is a feeling of nervousness among NHS staff about being on a journey without knowing where the end point is ... Some are concerned that the values of the NHS are in some way up for grabs."
That observation forms the basis for Burnham's proposal for an NHS constitution. We may all think we know that the NHS is meant to be a comprehensive service, free at the point of use, provided on the basis of need not ability to pay. But these core values were never set down in legislation. Burnham thinks that they need enshrining now as power passes from central Whitehall control to a variety of local healthcare commissioners and providers. "We have to have the N in NHS spelled out in a binding set of principles. The NHS will be 60 years old on July 1 next year. I think that is the right point to settle a new consensus around the NHS as the right model for Britain's healthcare needs for at least the medium term, if not for the longer term."
He thinks the constitution could be reviewed every 10 years after extensive debate among patients and staff. But writing such a document might not be as easy as it sounds. For example, some serious players in the Labour party believe the NHS may soon be unable to afford to provide a free service to everyone. They want a system of co-payment, requiring a contribution towards the cost of treatment from those who can afford to pay. For them, a constitution promising a free universal service for at least the next 10 years would be a hostage to fortune. But for most NHS staff and patients, failure to promise a free service would spread alarm - defeating the object of the exercise.
Cost-effective
Burnham does not recognise this as a difficulty because he is against co-payments being introduced at any point over the next 10 years. He says a free service, funded by taxpayers, remains "the fairest and most cost-effective way of delivering a comprehensive health service to the whole population".
Admittedly, the NHS already charges those who can afford to pay for dentistry and prescriptions, but Burnham does not support extending this list. He also rules out fines on patients who do not attend appointments.
If Blair's successor agrees, the process of drawing up the constitution could test the Conservatives' commitment to a free NHS. Would David Cameron agree to a set of principles "written on Labour's terms"?
Burnham thinks the case for a constitution is separate from any debate about whether the NHS should be run at national level by an independent board - and at local level with more democratic accountability. He is still open-minded about whether the constitution should be enshrined in legislation or model contracts for use by all NHS organisations.
Burnham may come over as a smooth-talking minister who is lavish in his praise of Blair's leadership and backs Brown for the succession. But his commitment to Labour is more old-fashioned and tribal. He says: "The Burnham family are a close-knit mob and there are three organisations that matter to us: Everton football club, the Labour party and the Catholic church - in that order." Until recently, the ringtone on his mobile phone was his son's rendition of the Everton terrace chant against supporters of Liverpool FC: "If you hate all Koppites, clap your hands." He says this used to raise eyebrows when he was a minister at the Home Office, where mishearing officials thought the target of hatred was coppers.
Burnham's workshadowing visits have taught him that support for the NHS among its professional and blue-collar staff is no less tribal. One image that sticks with him is the north-west hospital porter on £5.88 an hour, who volunteered for the job of putting a wristband on a man whose decomposing body had been undiscovered for three weeks. "We do all the shitty jobs that no one else will touch ... But I don't mind. Someone has to do it. I like working for the NHS," the porter said.
Another enduring image was the paramedic in the West Midlands, who told Burnham about the difference between the older generation's reluctance to summon an ambulance except in the direst emergency and the impatience of younger people to be rushed to hospital for the most trivial reasons. Burnham's cuddly message of reassurance about maintaining NHS values will now be laced with references to the responsibility of patients to avoid abusing the service. Of course, if NHS staff and patients want to put him right about a thing or two they can email him.
· Contact the minister at andyburnham.workshadowing@dh.gsi.gov.uk
Curriculum Vitae
Age 37.
Status Married, one son, two daughters.
Lives Golborne, Greater Manchester.
Education St Aelred's RC comprehensive school, Merseyside; Fitzwilliam College, Cambridge (MA Hons English.)
Career 2006-present: minister of state, Department of Health; 2005-06: parliamentary undersecretary, Home Office; 2003-05 parliamentary private secretary to David Blunkett when home secretary; 2001-present: Labour MP for Leigh; 1998-2001 special adviser to Chris Smith when culture secretary; 1997-98: adviser, Football Taskforce; 1997: parliamentary officer, NHS Confederation; 1994-97: researcher for Tessa Jowell when in Labour opposition health team.
Interests Everton FC, the Labour party and the Catholic church - "in that order"; Leigh Centurions rugby; prefers watching Sky Sports to reading.
