Andy Burnham delivered a ‘state of the NHS’ analysis during a One Nation event in Birmingham yesterday. It certainly made very depressing, although not unexpected, listening. I wondered what we should learn from this government’s abject failure even to deliver on its own reform objectives for the NHS and where it leaves the plans for a future Labour health policy that Andy dangled tantalisingly in front of us. Apparently we will see the flesh put on the bones of the fully integrated National Health and Care Service, which Andy has consistently championed, in the next few months.

If health isn’t this government’s biggest policy failure, it’s hard to imagine another that has so manifestly damaged the service it aimed to reform. It has totally failed to deliver even in its own terms and left it so difficult to make future necessary changes because of the way it has ‘infected’ any notion of future reorganisation. The aim of the reforms was to put doctors in charge of commissioning care and to free up the ‘frontline’. Most clinical commissioning groups lack the scale to give the doctors who run them real power in the system. The most powerful organisation is now NHS England. Strategic health authorities at a regional level are gone and Monitor and the Care Quality Commission, while playing an important role in the system, also vie to ‘cover their backs’ by demanding an enormous amount of information from hard-pressed providers. So the system ends up more centralised, more bureaucratic and less coordinated than previously – precisely the opposite to what the Tory reforms promised.

Andy’s speech today rightly focussed on how A&E, as the ‘barometer’ of the health of the system, tells us that this is a system in distress. In 44 of the previous 52 weeks, the NHS nationally failed to meet the four hour A&E target. We can argue about whether this remains the most appropriate target, but it is conclusive proof of the pressure in the system and, more importantly, the people stuck on trollies in emergency departments on a scale we haven’t seen since the dying days (literally) of the last Tory government.

‘But A&E attendances have been going up since the last government was in power’ and ‘what about the GP contract?’ are the Tory defence – or rather desperate attempt to shift blame. But while there were 16,000 more attendances in the last three years of our government, the first three years of this one saw an increase of 633,000. The problem may have pre-existed this government’s reforms, but it has clearly been exacerbated by expecting those leading the health service to take their eyes off the ball at a time of maximum financial and demand risk.

It is harder to see a GP quickly; cuts to social care mean many older people are not getting the support to stay at home; pressure on mental health means that people in crisis more often end up in A&E or a police cell. These are factors that have received much comment, but Andy also made a compelling link with the cost of living crisis. Diseases like malnutrition, scurvy and rickets are on the rise and there has been a steep increase in older people attending A&E with cold related illnesses.

Andy delivered the right diagnosis, but what are our options for treatment? It is clear that the system needs to be more integrated particularly with respect to the care of older people. But we’ve been saying that for years. What will drive that integration? Trusts and services need to be able to work more effectively together. I am not as opposed to some elements of competition in the system, but this government’s legislation has brought competition law into the system in a way that is manifestly preventing and deterring reorganisation and cooperation. Meanwhile it makes more sense to have high performing NHS trusts and managers spreading their expertise through the system than depending on the private sector to ‘rescue’ trusts in trouble. But what is the vehicle for enabling this to happen?

I think Andy and his team are beginning to develop some of the answers to these – and many other – thorny issues in the NHS. I look forward to seeing the details. But perhaps the biggest challenge will be how to ensure a major reform and step change in the currently struggling NHS without resorting to a discredited reorganisation. Good luck with that one, Andy!