Andy Burnham vows to reset public expectations of NHS

Britons must become more realistic about what the NHS can provide and cease to treat it as an "on demand" service if it is to remain financially sustainable, Andy Burnham, shadow health secretary, has said.

His comments represent a frank acknowledgment of the strains on the publicly funded health service which ended the financial year more than £1bn in the red.

Mr Burnham told the Financial Times: "Everyone wants people to have good service but it is about balancing it with only taking what you need and what is appropriate for your need. That message, I think, has been lost as we've driven the NHS more as a consumer service."

Labour has fought to keep the NHS, one of the few issues where it has a big lead over the Conservatives, at the heart of the general election campaign and opinion polls suggest it is the single biggest concern for voters as they prepare to cast their votes on Thursday.

Yet Ed Miliband is the only leader who has failed to pledge an extra £8bn in health funding - the sum Simon Stevens, head of the English NHS, has said is needed annually by 2020 to keep the service going.

Mr Burnham dismissed the figure as a "red herring" that depended on the NHS delivering huge, unidentified efficiency savings. It obscured "a whole set of deeper questions about how do you reset this system so that it is on a financially sustainable path?"

Central to his blueprint is what he described as "the most fundamental financial reform of the NHS in its history".

A bill put forward in the Queen's Speech soon after Labour formed a government would pool the budgets for health and social care.

The move, he said, was designed to tackle the biggest cause of waste and inefficiency in the health system: "people in hospital beds who are medically fit to be at home but can't because support cannot be arranged for them at home".

Without this reform, he argued, money invested in the NHS risked being swallowed up by hospitals driven into deficit by the huge cost of hiring agency staff.

"If you were to wave a cheque for £8bn at the NHS now and just say 'there you go' . . . the tide would drag it into [hospitals] and in about two years' time people will be saying 'oh, we need another eight billion, another ten billion', and you have to make this fundamental financial reform now.

Adding that the problem was "right now" rather than in five years' time, he said an incoming Labour government would inject "hundreds of millions of pounds" into the NHS shortly after taking office - the first tranche of £2.5bn it has promised to put in by 2017 through money raised from a mansion tax.

But the public would need to play its part by using the "finite, limited" health budget more responsibly amid warnings from doctors that patients' expectations were becoming "unmanageable", he said.

Politicians tended to talk about the NHS "as if it were an on-demand service like anything else in modern life . . . It can build a sense that people can just use it as and when and it doesn't matter", he said, citing people who failed to turn up for GP appointments.

However, he ruled out imposing fees either for missed appointments or other services in the NHS. "I believe in the NHS according to its founding principles and I don't believe in charges," added Mr Burnham.

Critics argue there is little hard evidence that joining health and social care together as he proposes will save money. They also accuse him of planning just the kind of structural shake-up for which he has criticised the coalition.

Mr Burnham insisted, however, that new "integrated care organisations", in which hospitals would work in tandem with local authorities to spend money in the most effective way, would emerge at local level and at their own pace over the next 10 years, rather than being driven by a central diktat or deadline.

He quoted figures from Monitor, the health service's economic regulator, suggesting this joint working could yield up to £6bn in savings.

Under the current system, he said, councils had no inducement to invest in preventive care or technology to keep people out of hospital "because if somebody fails at home it's in the end not their problem, it's the NHS's problem. The NHS doesn't have an incentive to do it because in their world, well, 'the council's meant to do that, we don't do that'."

Deep cuts to social care in the past five years have put massive pressure on the inflation-protected health budget and some policy experts believe Labour's plans lack credibility without an assurance that spending on social care will be increased.

Mr Burnham acknowledged that years of underfunding represented "a mountain" to be faced, but refused to be more explicit about how much more money Labour would put in. At the post-election spending round he would be "arguing for the best settlement that I can possibly get for social care alongside the NHS".

He signalled concerns about a measure, due to come into effect next year, which will implement a £72,000 lifetime cap on residential care costs.

While he accepted the "principle" of limiting people's exposure, he argued it entrenched the notion of there being two systems: "[social care] that you pay for on a meter and [NHS care] that's free at the point of use".

He wanted Whitehall to start thinking of health and social care as a single funding stream. "This thing that you can rob Peter to pay Paul, that you can raid social care to pay for the NHS, is gone in my view. I think it's a fraud on the public," he said.

The private healthcare industry has been concerned by Mr Burnham's plan to set a 5 per cent cap on profits made from NHS work, fearing it may deter future much-needed investment.

Defending the move, Mr Burnham said he envisaged a "support" role for the private sector, providing extra capacity to back up NHS providers. But he suggested that his decision to make the health service the "preferred provider" was designed to secure the backing of NHS staff for his new approach to healthcare.

He said: "I knew that if we were to rise to the efficiency challenge, you've got to win the hearts and minds of NHS staff to embrace a different way of working . . . from home to hospital and everywhere in between."

"It was my judgment that you would be able to do that if you were to secure the position of the NHS organisations that they cared about and worked for," added Mr Burnham.

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