Labour's last game of musical chairs?

Gordon Brown's struggle to stay in power has brought some new faces to the DoH. Jonn Elledge reports.

It's typical of British politics. A minister arrives at the DoH, knowing nothing of the NHS and less about general practice. There follows a lengthy period filled with awkwardness and gaffes, while the GPC and others slowly and painfully explain how things actually work.

Then, just as relations are beginning to improve, the minister is unceremoniously packed off to a new department, only to be replaced with another minister who, it seems, knows nothing about the NHS either.

'So, he knows sod all about health,' said one senior GP, after a quick run through new minister Mike O'Brien's CV. 'Great.'

Whatever this reshuffle was about, it was not the health service. Two weeks ago, fighting for his political life, Gordon Brown moved his potential rival Alan Johnson to the Home Office; a move somewhere between a promotion and the poisoned chalice.

Unfinished business
Taking over at health is former culture secretary Andy Burnham. He is a familiar face following his year as a junior health minister between 2006 and 2007.

In that time he came up with the idea of an NHS constitution, called for the phase out of MPIG ('paying people for existing') and was the first to talk about putting the money into incentives for longer practice opening hours.

This may not sound like the best set of policies for a friendly relationship with the GPC. But GPC chairman Dr Laurence Buckman says he is not worried about Burnham's views on practice funding. 'That was two years ago. We have moved on since then,' Dr Buckman said.

Other leading GPs, who dealt with the minister directly, speak very highly of him.

Dr James Kingsland, president of the NAPC, notes that - unlike some ministers - Mr Burnham understands the key role GPs play in managing NHS demand (indeed, one of the minister's last acts before leaving the role in 2007 was to host a summit on strengthening practice-based commissioning). 'He was part of the best ministerial team we had had for some time.

'I was disappointed he left after a relatively short time,' Dr Kingsland added.

NHS Alliance chairman Dr Michael Dixon agrees, arguing that Burnham is a good man to clean up unfinished business.

'Alan Johnson was a safe pair of hands. But I see Burnham as the one to complete policies that need a boost. He was very much perceived as the person you need to talk to to get things done.' But, he adds: 'He is not a walkover. I do not think he will be afraid of the odd clash.'

The reshuffle also had a knock-on effect lower down the department. Care services minister Phil Hope, former nurse Ann Keen and heart surgeon Lord Ara Darzi all remained in post. But two new ministers with little experience of the health service were also brought in.

New faces
As public health minister, Gilliam Merron will have little direct impact on primary care, at least if history is anything to go by (her predecessor Dawn Primarolo was 'invisible', complains Dr Dixon).

But as minister of state for health, Mike O'Brien is likely to have more of an impact. His predecessor, new culture secretary Ben Bradshaw, after all, was hip-deep in policies - such as extended hours and Darzi centres - that directly affect GPs.

His views on health are also, to say the least, obscure.

A flick through Hansard shows that he has taken an interest in prescription charges, wants more attention paid to hospital whistleblowers and wants management power balanced by the sack for those who fail. But he seems to have taken little interest in primary care or in GPs.

His speech to the think tank Reform last week offered little enlightenment.

He toed the party line, talking about the new focus on 'quality' and the importance of choice ('I do not believe in competition for the sake of it. It is about looking at what works best for the patient'). He also seemed to be in denial about the scale of looming NHS funding crunch.

The details of the new mini-sterial team may not matter that much. First, even the most optimistic Labour supporters are now expecting David Cameron to set up home in Downing Street some time before next June. Even if the government manages to avoid further games of musical chairs, Burnham and co will likely spend less than a year at Richmond House.

Second, there is the trifling matter of the funding crunch. 'Most clinicians have not really woken up to how deep and how far the cuts are likely to go,' says the NHS Alliance's Dr David Jenner.

'The announcement of a new ministerial team is of less importance than what (NHS chief executive) David Nicholson announced last week.'

After all, those cuts will be with us, long after the new health secretary is just a memory.

ANDY BURNHAM - Secretary of State for Health
Replaces Alan Johnson

CV: Parliamentary officer for NHS Confederation 1997; MP for Leigh since 2001; member of the health select committee 2001-3; minister of state for health 2006-7; chief secretary to the Treasury 2007-8; culture secretary 2008-9

Expenses: Eight month battle with Commons fees office over repeatedly rejected claims for £16,000 toward work on a London flat. Had a £19.95 claim for an Ikea bath robe rejected.

GILLIAN MERRON - Public Health Minister
Replaces Dawn Primarolo

CV: MP for Lincoln since 1997; Lord commissioner of the Treasury 2002-6; junior transport minister 2006-7; parliamentary secretary to the Cabinet Office 2007-8; minister for the East Midlands 2007-8, junior minister for international development 2008; junior minister in the Foreign Office 2008-9

Expenses: One of five MPs to receive personal tax advice from the husband of Meg Munn MP, her predecessor at the Foreign Office.

MIKE O'BRIEN - Minister of State for Health
Replaces Ben Bradshaw

CV: MP for North Warwickshire since 1992; trade minister 2003-5; solicitor general 2005-7; minister for pension reform 2007-8; energy minister 2008-9

Expenses: O'Brien was the minister responsible for pushing Freedom of Information laws through the House of Commons, but has resisted requests that he publish his own claims. Has stressed that Parliament is bound by the law and needs to abide by a court order.

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