Your questions to Andy Burnham

20 March 2007

Thanks for all your questions about Mr Burnham's work shadowing and the NHS in general. We had over 300 in the end and the Minister stayed for an extra 25 minutes to try and get through as many as he could. You can read the unedited transcript below.

• Read more about his work shadowing (opens in new window)
• See our health section

Read the transcript

Andy says: Hello. This is Andy Burnham. Thanks very much for your questions. Our NHS is very much in the news at the moment and it's good to have the chance to engage in the debate directly with you.   

Raymond Robinson: So then, any chance we'll see you giving up the Westminster lifestyle and becoming a paramedic/cleaner/doctor any time soon?

Andy replies: Well, it was nice to be out in the real world for a change. It's certainly something that we should all politicians should do more of as you can learn far more on one day out of the office than you can in many days of Westminster meetings. I'm not sure I could do the jobs you list. In one of my earlier incarnations, I used to a Government special adviser and was fond of the saying 'Trust me, I'm a spin doctor!'  

Lisa Thomas: Can we see some one doing this in mental health? so ministers will have a REAL understanding of mental health in this country and not make decisions about us without seeing and feeling what this is like?

Andy replies: 

I did spend some time with an assertive outreach team in the North East and, as I say in my report, it was the best day I had out on the road. It was certainly the day when I had less idea in advance of what it would mean. Mental health services have been neglected too much in the past and I agree entirely that Ministers all all health decision-makers should see these vital services first hand. But it's also worth saying that the area where I spent time had seen a major improvement in preventative mental health services in recent years. We need to build on that.

John Mallaby: What is the one most important thing he gained from his experience?

Andy replies: That's hard to say. It was a great experience in so many ways but what came through more strongly than anything else was the depth of commitment to the NHS and its values on the part of all the staff I shadowed. In changing times, we must never lose sight of that. It is why I proposed the idea of an NHS Constitution in time for the service's 60th anniversary.

Bruno: Did you see any evidence of waste or mis-management on the frontline or was all the bad stuff hidden from you?

Andy replies: I don't think it was hidden from me. There were many times when staff said to me that simple changes could be made to save time and money. But the NHS is overall an efficient healthcare system and sometimes too much of this point is made by its detractors. What I have taken from this exercise is that we need to create a culture in the NHS where front-line staff are empowered to lead change. There is still too much of a top-down culture in the NHS. Staff have got loads of good ideas but need to be given the support to implement them. Dare I say it, I think Gerry Robinson came to a similar conclusion.

Mr Henry Knox: Did you spend any time with NHS security staff?
Wh is it that our hospitals still have to put up with poor security? They are doctors and nurses not police. People who are abusive or violent should be isolated and refused treatment until they stop, even if their life is at stake. We have a grandaughter who is due to start working in the A&E at Hartlands Hospital, Birmingham (as featured on TV) and we fear for her safety.

Andy replies: I have to say I didn't spend any time directly with security staff, although I did hear from A&E porters about the challenges they face. I can appreciate your concerns about the working environment that your granddaughter will face but I hope you will be reassured by the fact that we continue to work towards a zero tolerance of abuse and attacks on staff. We recently brought in new measures to deal with this and the NHS can remove trouble-makers from the premises. 

Helen Flight: Mr Burnham, 32,300 junior doctors recently applied for only 23,000 training posts available to start in August this year. As the wife of a junior doctor I am very concerned that we will lose our income in August. In the House of Commons yesterday Patricia Hewitt claimed there would not be mass unemployment for doctors because 29,000 of the 32,300 applicants already have jobs in the NHS- she completely missed the point that those jobs are all fixed-term contracts due to end in early August, the numbers don't add up. My husband is an excellent doctor who is dedicated to working for the NHS but we are now considering moving to New Zealand, why should we have confidence to stay in the UK and the NHS?

Andy replies: 

It is clear that there have been a number of problems with the MTAS system and I understand fully the concerns you raise. It's important to say again why we worked with the professions to bring in a new system of recruitment. It was to create a fair and transparent recruitment process and a level playing field for all. That wasn't what existed before. I can assure you we are listening to junior doctors and are working to get the system right. 

Tracey J Samuels: Now that you have shadowed key workers within the NHS, how do you feel about the 2.5% pay rise that the nurses have been given? And what would you consider to be a fair pay rise?

Andy replies: 

I understand people's concerns about the staging of the award. But the Government does have to take the wider economic picture into account which, at the end of the day, affects us all and the needs of the NHS.

Overall, I'm very proud of the Government's record on rewarding our key staff in the NHS. It is a fact that nurses' pay has increased significantly and the successful negotiation of the incremental pay structure of Agenda for Change with the trade unions means some staff will receive a bigger increase than the baseline award in the coming year.    

Julia Toft: I know that you favour a constitution for the NHS. How will you be taking forwards this idea?

Andy replies: 

In the 60th anniversary year of the NHS, I think it would be a great thing to put its founding values into something binding. I have no doubt in my mind that the NHS represents the fairest and most efficient way of delivering quality healthcare to a whole population. A constitution could seal a public consensus around the NHS as the right model for the country's future healthcare needs. But it has to be developed bottom up and I am considering with colleagues in the department how we might take that process forward. 

Joan: Hi Andy, I worked with you in the Home Office, I think this is a great idea - have you recommended to your ministerial colleagues that they do work shadowing - in education or defence, for example?

Andy replies: I can wholeheartedly recommend it and know that some of my colleagues have been doing the same.

katie Farnell: Please can you give your views on how Gerry Robinson managed the NHS pls?

Andy replies: 

I spoke to many people about the programme and it's fair to say that many people in the NHS recognised that it contained some home truths. But it's also true that NHS organisations are very complex and I think that came over as well. I think NHS managers are to a large degree unfairly villified. They do an incredibly important job working on our behalf. They manage a service that delivers one million treatments every 36 hours. There is no doubt that the NHS couldn't function without good management. 

Shirley Hawke: During my life I have been in hospital on quite a few occasions and on the whole I am very grateful for the way that the NHS has looked after me. However I do feel that some thought should be given to the fact that NHS staff and not just the nurses no longer change into different, clean clothes when starting work. I feel that this must have a big impact on the infections that are brought into hospitals etc. My first stay in hospital was in the early 60's at which time there were still Alomers and Matrons and staff did not leave the premises in the clothes that they worked in.
I'm sure that someone must have thought of this already, but have they?
Many thanks

Andy replies: There is a team that has been looking at this issue and I know that some trusts have introduced a uniforms policy along the lines you suggest. There is anecdotal evidence that such a step can improve public confidence but the direct link to tackling infection is less clear.  

Miss Lynne Hedley: 
why is the donor scheme a 'opt-in' and not a 'opt-out' system. surely it would make more sense that way, for lots of reasons people don't registar as a donor but most, probably wouldn't mind if their organs were used to save someones life, a small propotion may mind and thats their perogotive but why miss out on the use of those healthy organs when a small change could be made, to help literally thousands?

Andy replies: My personal view is that there is something in what you say from a public protection point of view. I am aware that there is a transplant taskforce that has been looking at how to optimise donation rates and they are due to report soon. But there would need to a full public debate on whether to take this step. 

John Mallaby: Of the jobs he shadowed which was the one he would least like to do?

Andy replies: 

I think the job of hospital porter is a really tough one. You deal with lots of the problems but don't get all of the rewards.

Pauline Lloyd: If the health service is improving so much how is it that I have tried today to get an appointment for my husband with our GP and have been told there are no routine appointments for the next two weeks. I have been told to phone on the day requiring an appointment at 8.30am. This is a regular thing as no one can book with their GP. It is taking 3 to 4 days to get a repeat prescription if this is progress I would like to go backwards at least we could see a doctor when ill. Can we have some inquiry into the state our doctors appointments are booked?

Andy replies: I'm sorry to hear about the problems you are experiencing and I don't pretend that everything in the garden is always rosy. We are currently conducting a major survery of patient access to GPs' services and we expect action where necessary. Where there are problems, we want to know. But, overall, there are high satisfaction rates with GP services.  

Andy says: 

I'm sorry that I've not been able to answer all of the questions. My limited typing skills have been stretched to the limit today. I know that the NHS and health services in general arouse very strong feelings and we need to keep on getting out and listening to staff and patients to get things right, particularly in changing times. For our part, we do believe we are doing the right thing by the NHS. Of course there are challenges. But overall the NHS delivers an excellent service to the public. To improve things further, the NHS will benefit from an uplift in funding of £8 billion next year.

Thanks again - I hope to do this again soon.