REFORMING NHS ENGLAND & AWAABS LAW: A STORY OF ACCOUNTABILITY 

Dr Jeremy: Mostly, you would think you wouldn't need a law to tell landlords to keep their buildings maintained.   

 Val: What means more to me is,  are waiting times lower? Yeah. Am I going to see my GP, whether it's called NHS England or the Department of Health or Social Care, I really don't think anybody really cares. No. They just want it to work.

 Rap Intro: Stories,  labels,  Misconceptions,  NHS, remains a blessing,  Created in 1948,  We want it to remain great,  A podcast, Where we share our stories, Explore solutions. In all their glories,  They say it's broken, But it's not done, With your host, Val Barrett, Dr. Jeremy Anderson

Val: [00:00:00] Welcome to Stories, labels, and Misconceptions co-hosted by me, Val Barrett. 

Dr Jeremy: And me, Dr Jeremy Anderson, 

Val: a podcast where we share our stories, experiences, and explore solutions to the issues we face today within social care and health. 

Val: And today we're going to, first of all, update you on the latest information about Awaab Ishak.

Val: We spoke about him and his family in episode two, about housing and health. 

Dr Jeremy: That's right. 

Val: And after that, Dr Jeremy will take us through the latest government announcement Yes. On NHS England. 

Dr Jeremy: Yes. 

Dr Jeremy: Dispatching NHS England. And so just to be clear. They're not abolishing the NHS in England. They're abolishing a upper management structure called NHS England. It's a specific organization. So we will talk all about that.

Val: Okay. Let's get [00:01:00] to it, shall we? As you all remember, if you've listened to episode two of Housing and Health, we spoke about a little boy. He was living in social housing in Rochdale and in 2020 he died at the age of two from exposure to mold. So we know that the family, they complained over years and years to Rochdale Borough Wide Housing and Bottom line is obviously nothing was done, which is sadly why poor Awaab lost his life.

Val: So the update I've found recently is we have a new law which is coming into effect. In October of 2025, that's be this year, Awaabs Law was created by the Social Health Regulation [00:02:00] Act 2023. And as we know, it follows the tragic death of Awaab Ishak at the age of two as a direct result of his exposure to mould living in social housing. 

The Secretary of State intends to implement Awaab law in phases, which are, Phase 1 is from October 2025, which states social housing provider landlords must address damp and mould hazards, presenting a significant risk of harm to tenants. Within a time scale to be specified within the regulations.

Val: Social landlords will also have to address emergency repairs relating to any hazards as soon as possible within no longer than 24 hours. 

Dr Jeremy: That's really quick. 

Val: It is quick. 

Dr Jeremy: Anything within 24 hours its pretty quick. 

Val: Yeah. But like I said, it comes [00:03:00] into effect in October. And even though We have laws and everything before in social housing, when it comes to actually implementing them, there seems to be a problem there, an issue there, whether it's lack of funding from social housing or tenants not listen to, I don't know, but let me go through the phases.

Val: So we've got phase two, so this will come into effect in 2026. So it says in 2026, repair requirements will apply to hazards, including excess cold and heat, falls, structural collapse. Fire, electrical and explosions, and hygiene hazards.

Val: So what does that say to you, Dr. Jeremy? 

Dr Jeremy: The last part about hygiene hazards, I'm assuming that means [00:04:00] vermin sources of infection. Just filth, basically. 

Val: From what I've been seeing online, there's a lot of properties that are rampant with a lot of problems, a lot of damp, a lot of mold. Social housing has a lot of work to do. Yeah. These landlords do. And the last phase, phase three, which will come out in 2027, repair requirements will extend to all remaining hazards, which are defined by the Housing Health and Safety Rating System, except for overcrowding. That says a lot.

Dr Jeremy: What does that mean that the, there won't be requirements to address overcrowding, or is it just saying there that the. That the hazards defined by the housing, health and safety rating system hazards related to overcrowding are defined in a separate document. I don't know. 

Val: Let's hope [00:05:00] it is.

Dr Jeremy: Yeah, 

Val: we do know that there is a shortage of larger properties. And there are families there that are overcrowded housing, there is a lot of issues there. But the, It specifically says, except for overcrowding. So I wonder why, we can speculate, but we'll go on to have a look another time to see if there is legislation that particularly addresses overcrowding.

Val: We'll see. And it continues. It says these hazards are listed in schedule one. to the housing health and safety rating system. So all these things are online, but this one that I'm going to read now, the secretary of state also announced additional reforms the government intends to bring forward in 2025. [00:06:00] So this includes the introduction of a new decent home standards and minimum energy efficiency standards To tackle disrepair, safety and heating issues in social rented properties. Legislation requiring social landlords to carry out electrical safety checks. I'm sure they do that. At least every five years, a mandatory appliance inspections on appliances supplied by the landlord.

Val: So the introduction of a new access to information requirements for private registered providers, new standards for competence and conduct of staff. So moreover, the provisions of Awaabs law are [00:07:00] implemented. The renter's right bill. As currently drafted would extend Awaab's law to the private rented sector, which is good news because a lot of these legislation are often only for social housing.

Val: So now it's extended into the private rented sector because the misconception is, as we know, some people only think that really bad. Inadequate properties are only in the social yes, they're not. They're in the private as well, but they don't seem to have as much right. So that's extended to that.

Dr Jeremy: Even if you're paying full rent for someplace, the law would just mean that the landlord is required to repair the properties, address and make emergency repairs. 

Val: Yeah. All we can do is. hope things get [00:08:00] better I don't want to be cynical and say, yeah, it's, it's, cause at the end of the day, it's whether it's legislation or not it only works if it's implemented or it doesn't make sense. 

Dr Jeremy: Honestly, you would think you wouldn't need a law to tell landlords to keep their buildings maintained 

Val: of cause 

Dr Jeremy: because it's their investment, right? If you're, if you own a building, You don't want it to fall into disrepair and just become worthless, right?

Val: I know that really baffles me. it really does Because I think you own the property. You rent it out. Doesn't matter where the rent's coming from, whether it's. It's coming from DWP or people are working, you're getting paid and you would think the first thing you would do is maintain it to a decent standard.

Val: I was on Twitter or sorry, X the other day and I saw a [00:09:00] woman living in a property where the ceilings is ready to collapse water coming through. 

Dr Jeremy: So water damage has just,

Val: and she's been living like that for 13 years. Water coming in, starting to come in another room and it doesn't just affect you physically. It's the mental, it's a mental scar. Yeah. Waking up to that every day, not knowing when the ceiling is going to collapse. She's, they've complained. Like you do, you complain over and over again and nothing happens. It falls on deaf ears. It really does. So me been me very cynical.

Val: I don't think this alone is going to solve the problem. I really don't because there's [00:10:00] no accountability. There's none at all, because we forget a two-year-old child has died, just aged two. And if we take away social housing, and this child died under another circumstance, the family would see a process. Whoever was responsible would get arrested, charged, and go to court.

Val: And they would have their day in court and the family would be there to see justice. Whereas there's no, to me, there's no justice here because a death has occurred, and all we have is a new law. That applies, that really tells us about common [00:11:00] sense. That's all it does. It's common sense.

Val: These things are, will they be able to respond in 24 hours? It's all well and good stating that. Yeah. But if they didn't respond in three years, come on, Dr. Jeremy how are they going to respond in 24 hours? I really don't know. And what are the consequences if they don't?

Dr Jeremy: I think it's very complicated. I'll just my own experience. I don't live in a council flat, but like I'm a leasehold for my flat, but it was formerly a council. Yeah. But and the council is the freeholder. Okay. From the building. So when there's a, when there's a repair to be made the council pays for it. And then they send us the bill for half 'cause Oh, it's, there's two flats in the buildings. One is, one is the council flat, so that person. They pay rent, they don't pay the repairs. Yeah. But the freeholder [00:12:00] tells us we have to pay half the repairs. So something like the roof happens. Yeah. And so first off, it's not directly repaired by the council.

Dr Jeremy: They follow up the repair contract. 

Val: Contract it out, yes. 

Dr Jeremy: To another company. Yeah. Which puts up scaffolding sometimes for months because they they don't want to pay for storage for scaffolding. Yes. So they'll have it up there. Not doing any work and then they'll claim work is done and send you the bill.

Dr Jeremy: Yeah, sometimes for thousands of pounds Yeah, maybe all I did was you know, put some paint on You can buy a lot of paint for 2, 000 pounds, 

Val: of course 

Dr Jeremy: Or they'll say in my experience that said the roof was fixed the leak was fixed Then just the bill you pay the bill and it's not fixed. They have to come back and there's no you get mad at the council, but the council, they're saying it's this provider and then this provider loses its contract.

Dr Jeremy: So they go away. There's no recourse to say, give us our money back because that provider doesn't exist anymore. [00:13:00] They didn't do their job. Now there's a new provider. And so the whole thing is a mess. It's very difficult to manage. Obviously, I've never experienced anything like what that poor family went through. Yeah, mould for three years.

Val: Don't forget some councils. They got, Oh, what was the word? They outsourced the housing. Yeah. Yeah. Almos, they created these arm's length management organizations. The borough, I live in Kensington and Chelsea, an arms-length management organization was responsible for Grenfell Tower.

Val: So I think not a hundred per cent sure, 'cause I wasn't sure I was going to mention this. They have taken back control of the properties. I'm not sure because one minute, the councils were running all the housing. Next minute, they were saying, Oh, let's create these Almos. So what Almos do, they're the ones that make the decisions.

Val: When something goes [00:14:00] wrong, you blame them. Yeah. Do you see what this would have mean? But whoever owns them, whether it's an Alamo or a council, where's the accountability when someone dies, where is it? What's Alamo? Alamo is what? Arms length management organization. So you'll find loads of those.

Val: They'll own old council properties. Yeah. I think social housing are Almo's. I'm not a hundred per cent sure, but I know for sure it was Almo that was managing Grenfell Tower. So I think now some councils are taking them back under their wing. I'm not sure. I'm not a hundred per cent sure, but we can look into that. 

It's. back to the accountability. So it's all well and good having this new shiny legislation and a new law named after him. From what I read as [00:15:00] well, the family would like accountability. Someone has to be accountable. It's all right. Coming to a meeting or going to the. The inquest or whatever, when you go there and you apologize, you say things failed, we failed the family, blah, blah, blah. You can't say they were hard to reach. You can't say you didn't know. You can't say there was a language barrier. They speak English, so what is the issue?

Val: What is the problem? You can't say you didn't see the mould. So there's just so many excuses or reasons you can come up with. You can come up with, we don't have any money for what? Because I think the immediate response should have been move the family out. That should have been the immediate response.

Val: Get them away from danger. Do you see what I mean?

Dr Jeremy: Assuming you can, [00:16:00] assuming there is a place to move them. 

Val: But we talked about this the other day and I understand what you're saying, but even if you put them in a hotel, that outcome would have been better than the outcome we're left with now. You understand? Some cases they've got a lot of money. When I read that. Some of them may spend how much millions a year, doing up their properties.

Val: I think, are you really telling the truth? Because a lot of your properties I'm seeing online that people are now talking about and showing videos. They're not places that you'd want to live. So exactly which properties are you doing up, where is that money going to? And is that the amount that you're actually spending or is that the amount you want to show government that you're spending, and is it a business?

Val: Yeah. Is it a business, and that, that is the thing. And if it is, [00:17:00] if they're making money, where is that money going to? 

Val: I

Dr Jeremy: suppose that raises the issue of. These arms-length management organizations that these, like, why do you want it to be arm's length from the council or from government?

Dr Jeremy: It's really to make sure government or the council isn't responsible, but in doing so, if you then hire a private business to provide a service that a government or council otherwise would provide now you've got a situation where there's an entity in there that's designed to make money.

Dr Jeremy: Yeah, where is, where's the government of the council wouldn't be designed to make money. And if there's a, if there's a profit-seeking element there, that means that's money that isn't going to providing service for the people living there. Yeah. So I don't know. Maybe it's all above board.

Dr Jeremy: Everything is running perfectly fine. Zero corruption of any kind. But I've never, that I would doubt that. And, uh, it does make one wonder, 

Val: yeah, it [00:18:00] does. They say they're building loads and loads of properties housing to sell and certain amount of housing to rent.

Val: But then what they need to do as well is utilize empty buildings. Utilize the empty buildings that are already here, obviously, they're here, and sort out the ones that you already have that are in disrepair. 

Dr Jeremy: Yeah, we talked about this in the first episode, we need to actually maintain the existing stuff.

Val: Yeah. The difference. Even though we talked about private and social, let's look at what I mentioned before about tower blocks, you've got tower blocks in swanky Dubai, but you wouldn't call them a tower block, would you? What do they call them? Oh, what are they called?

Val: I just can't, I just [00:19:00] can't think. And then you've got a tower block on a housing estate. They're all tall. Yeah. They've all got flats in there. And the only difference that we said before, one of them, you want to live close to the ground. The other one, you want to get high up because it's, it says something about wealth. The other one, you'll get low down because The lift might break. The lift will break down. You just don't know when.

Dr Jeremy: Yeah, I think we talked about that before.

Val: Maintenance. It is maintenance. Yeah. The bottom line is maintenance.

Val: If you put in a window, why would you put in a window that leaves a gap and it can't close? Does that make sense to you? No, it doesn't. Why would you put on a door that doesn't fit? That leaves a great big gap. It just sounds like it's not just sloppy. It's Oh, it's just social housing. Who cares?

Val: They don't work anyway, they're lucky to get a place to live, [00:20:00] It's a really bad attitude, yeah. 

Dr Jeremy: And I think just going back to the example I was giving about these third-party maintenance companies that get a contract, let's say they get a contract for five years.

Dr Jeremy: Yeah, they're doing a terrible job. The council knows they're doing a bad job. Yeah. And they're going to lose the contract. The next time it comes up for bidding, but that doesn't stop them from doing a bad job sometimes for years. And everyone knows they're doing a bad job, but it's the system in place that they've got the contract in the first place.

Dr Jeremy: It seems like a strange situation where they, I suppose they do it too, with the argument that they're saving money by making companies bid for a long-term contract. But the problem is if the company that gets the bid is the cheapest bid. Yeah. But they're then, they're motivated then to do as little as possible.

Val: The bare minimum. And milk. The bare minimum. 

Dr Jeremy: The bare minimum. Yeah. For the most, they can charge. And so you're actually [00:21:00] getting bad service and there isn't a way to, the system isn't nimble to be able to change when they identify a problem. And so I don't know. I think there's got to be a structural solution in terms of. Just making it easier for councils to make the right decision. 

 Dr Jeremy: Okay, so on that note, I guess we'll move on to the next topic, which is the other big news. And similar to what we were talking about with the almos, these arms-length management organizations and housing is the idea of Quangos, which is a one I'd never heard of before.

Dr Jeremy: Okay. I think it's the equivalent. It's a kind of arms-length organization. Set up in the healthcare sector. That was, that's designed to shield government from direct accountability. It's this arm's length organization to manage things. 

Val: Do you know what it stands for Quangos? 

Dr Jeremy: I don't know what it stands for.

Val: I'm going to try my best to pronounce this. 

Dr Jeremy: Okay. Okay. Educate me. Yeah. 

Val: Quasi-autonomous [00:22:00] on non-governmental organization. 

Dr Jeremy: Oh, okay. Yes, so that's basically the same thing. 

Val: Did I say it correctly? Did I say it right? Yes, exactly. 

Dr Jeremy: Yeah, that's perfect. So quasi-autonomous, so that's basically a fancy way of saying arm's length. You're working on your own. There's maybe a little bit of input there, but, so that's what NHS England was. Yeah. And again so it's not the NHS as a whole in England, but it's this quango called NHS England set up in 2012 in an effort to, I think at the time it was described as making. Um, making the NHS more independent from government interference. And now they're talking about bringing it back under democratic control. So there's a framing issue there, but

Val: Why do you think Sir Keir Starmer used the word democratic? Wasn't it democratic before? This is [00:23:00] the thing. I noticed he used that word democratic.

Dr Jeremy: Yeah. And. I don't know. I think democratic control sounds good. I don't know if you really want a health service under democratic control. I have no problem with democracy in certain areas, but there's certain things. I don't know if you want it under as part of a democratic Okay. Process, right?

Dr Jeremy: Take human rights, for example, right? Do you want someone's human rights to be decided democratically? Do we put it to a majority vote about whether or not we're going to respect someone's human rights? No, I don't think so. I think we just do that, right? 

Val: Yeah. Okay. 

Dr Jeremy: I don't think it should be subject to the whims of, The sort of political whims of the day or who happens to win an election, right?

Dr Jeremy: So I'm not sure that's the best way of structuring something. But at the very least, [00:24:00] I think with more direct government control I think as most people have been saying is that there's accountability of the government for its promises. So if it says we're going to cut waiting times.

Dr Jeremy: And they don't cut waiting times, but they don't have an arm's length organization to blame and say, okay, we weren't in charge. These people are not doing their job. They have to say the buck stops here. 

Val: No but I think that was still a government policy. It was their policy because even though NHS England was the quango it was taken away the day-to-day interference of politicians, they were still doing all the policies and things like that. So they did have some, they did have that handprint on it because they're quick to play political football with it. So it's not like it was completely hands-off. It wasn't, 

Dr Jeremy: no, it wasn't completely hands-off. It was just holding it at arm's length, just, just to spread the [00:25:00] blame.

Val: Oh, yes, of course, to make decisions that the government is probably too scared to make, but we'll see because it says this significant move gives the government more control and accountability over one of their key pleasures to cut NHS waiting times. But I just thought they were held accountable for that anyway. 

Dr Jeremy: Yeah, they seem to be saying they're cutting out the middleman and as a result, thousands of people are going to be losing their jobs at NHS England. Yeah. And they said it's based on this thing called the Darzi report that came out in November 2024.

Dr Jeremy: And we've heard a bit of of this report reported earlier, things like talk about NHS waiting times and a surge in mental health referrals and different things. And so I was reading the summary letter of the Darzi report and it's like a 28-point letter. And the first 20 points or [00:26:00] so, it goes through quite a bit and it's only about 21, 20, 21 or 22, where he starts talking about NHS England and these quangos and how the top management structure was set up.

Dr Jeremy: And I thought it was actually pretty interesting. Not really in contradiction to what. The government was saying but they didn't mention this, really interesting is he was saying that there 

Val: wasn't in their manifesto. Was it 

Dr Jeremy: not that I recall? No, but what was interesting is the Darzi report mentions that there's, there was already ongoing reductions in management spend and headcount numbers.

Dr Jeremy: So there were at the time of the report, there were 19, 000 people employed between the NHS England and the department. of health and social care, but that was down from 23, 000 people in 2022. So it had fallen by 4, 000 people. Okay. And what, and what it says is, um, over 5, 000 of the [00:27:00] people employed by NHS England are already providing shared services to other parts of the NHS.

Dr Jeremy: That's like IT infrastructure. But also the Department of Health and Social Care had increased. In the last 10 years from 2000 to 3000, because it had absorbed staff when I guess the government abolished the public health, England. I don't know when that happened. What we had was interesting was already dropping its numbers and the Department of Health and Social Care was increasing its numbers.

Dr Jeremy: What's going to happen now is. Now that NHS England has been abolished, they're going to be, some portion of them are going to be absorbed into NHS England, so its numbers are still going to grow. 

Val: When they say it's going to be abolished, it's not going to happen overnight. It's going to take a couple of years.

Val: No. At least. 

Dr Jeremy: I'm sure it'll take, it'll definitely take a while. 

Val: And then. After those couple of years, it'll take another, I don't know, three years to see any major changes. So they've given themselves a big breathing space here. So could they have done [00:28:00] something before they'd done this?

Val: Could they have done more work on improving the services, improving access to services? Because at the end of the day, like myself, I'm a carer. I'm a patient. I'm coming from a place where, you know, NHS England and all these strategic authorities and all these layers don't really mean much to me as such. what means more to me is. Are waiting times lower? Yeah. Am I going to see my GP? The services, social care, whoever delivers that, whether it's called NHS England or the department of health or social care, I really don't think anybody really cares.

Val: They just want it to work. So I think all fangled, dangled and messing around and the major restructuring and reform. [00:29:00] Why now? I don't know. 

Dr Jeremy: Noticed after the government's statement neither, like none of the opposition parties were terribly critical of it. So no conservatives who actually made NHS England.

Dr Jeremy: Back in 2012 said they supported this move of merging it with Department of Health and social care. And the Dems said the same thing. They didn't oppose it. And everyone just said, look, the government's now more fully accountable and they want to see these outcomes. I think everyone in government is on the same page in terms of wanting this to happen.

Dr Jeremy: And then, the government statement did point out that, that they've worked with. GPs to try to help people be able to access more GPs in there. I think their longer-term goal is to revitalize GPs in in the health service. And what else did they say that they had done?

Dr Jeremy: So the first part of the government statement from Wes Streeting of saying, yeah, they delivered 2 million extra appointments. Negotiated the end of the doctor strike. They said, 

Val: but what did [00:30:00] that cost claiming at what cost? 

Dr Jeremy: They're cutting winter. Yeah. They're claiming 

Val: see what I mean 

Dr Jeremy: they're cutting winter waiting list and pressures and stuff.

Dr Jeremy: So they're saying they're trying to do stuff. I think there's a lot coming. 

Val: But also in this time. We've had the creation of corridor nurses. So he can sing all he wants about putting money into winter. What did you say? Sorry, into 

Dr Jeremy: cutting waiting lists, winter pressure. 

Val: Then why are people being treated and losing their dignity in a corridor?

Val: Why ambulances back to back and not going out and getting patients so they can sing the tune? The sweetly as they like, but on the ground, this is what I see, this is what we hear. Like I said, I don't care what it's called. It could be NHS Wes Streeting for all I care. [00:31:00] We want to feel the changes and we want to see the changes and don't tell me.

Val: It's changed if I don't feel it because that makes no sense to me.

Dr Jeremy: Yeah, I think you're right. I think the government statement was, here's what we're doing, but it does amount to tinkering in a sense because, cutting off some management jobs at the top isn't certainly, although there was some mention of it in the Darzi report talked a whole lot of stuff like 37 billion pounds.

Dr Jeremy: of spending that's been lost with austerity and post-pandemic and all this kind of stuff. But the lack of spending on the state's budget, so that, we were promised 40 new hospitals that haven't shown up. 

Val: Those 40 new hospitals weren't. 40 new buildings, some of them were, we're going to paint a room, I'm exaggerating, but literally like refurb, they [00:32:00] weren't physical new buildings. 

Dr Jeremy: right even if they were, they would replace an older building but even that didn't happen. It didn't happen. It happened just at the hospitals. Are in this crumbling buildings, and they don't have the newer equipment and we haven't kept pace with technology. And so if you read the Darzi report, there's really a whole lot of good recommendations in there, but it needs to be done.

Dr Jeremy: And I would be. Looking forward to seeing the government implementing some of these things 

Val: I'm going to have a look at that report, but it's when they commissioned someone to do a report, especially in health, they implement the ones that they're comfortable and happy to implement and don't implement them all.

Val: I'm going back to the days of Margaret Thatcher. The health inequalities report. Same old same old. She didn't do anything. So money is spent on these [00:33:00] inquiries money is spent on report after report. These reports relatively say similar things.

Val: May just be written differently because health inequalities is getting wider. They advertised for. A corridor nurse, this is Great Britain, so when you do things like that when you advertise for a corridor nurse, you are making this normal. You are normalizing that people, especially it could be the elderly are going to be treated in a corridor.

Val: It normalizes it. Yeah. You see what this would mean? Dignity. I wouldn't like to be treated in a corridor. I wouldn't. And I wouldn't want to see a loved one being treated in a corridor. But the more they advertise for a nurse or a doctor as just for the corridor. It normalizes it, gets them out the corridor, [00:34:00] focus your energy on that. Even if it's just a room that brings some privacy. 

Dr Jeremy: Well even remember, we talked about The use of virtual wards. And this is one thing that the Darzi report mentions is tilting towards technology, using new technology to clear up space in hospitals.

Dr Jeremy: There are people in hospitals who they do need monitoring, but they don't necessarily need to be monitored in a hospital could be monitored at home. And we've got the technology with Bluetooth to be able to let people, recuperate in their own home, which they may prefer, and that actually frees up space.

Dr Jeremy: In a hospital, so people aren't being treated in a corridor. And so I'll be really looking forward to the government, actually implementing some other aspects of the Darzi report. And I would just mention also that the Darzi report, the summary I'm reading is saying that a top-down reorganization of the NHS.

Dr Jeremy: The integrated care boards is not necessary nor [00:35:00] desirable. So he's specifying that, what we don't need is a whole new complete overhaul top-down restructuring. Yeah. So I hope they don't go that route because that's not what's being recommended. And, they need to put their effort towards, implementing some of these things that have been neglected over the years.

Val: Do you think, by any chance, just, do you think they've looked across the pond and seen what's going on there? 

Dr Jeremy: You mean in Canada or the U. S.? 

Val: No, in the U.S. 

Dr Jeremy: Oh, in the U.S. 

Val: Yeah. The way Elon Musk is going after, the Dodge thing.

Val: The way they're going after. Do you think, I don't know. Do you think? Or I'm just wide off the mark? I could 

Val: be. 

Val: It's just, I'm just thinking about the timing. I don't know. It's the timing. Yeah, 

Dr Jeremy: I don't know. [00:36:00] That's a good point. It I don't really know what Starmer's strategy is for dealing with Trump and Musk.

Dr Jeremy: He seems to be playing nice right now. So maybe. If he is in a conversation with Trump and they're talking about the cuts that they're making, he could give an example of, yeah, we're cutting wasteful spending too. So 

Val: it's a drop in the ocean 

Dr Jeremy: but it is a drop in the ocean.

Dr Jeremy: You're right. 

Val: And then you think if they're going to do this. What other costs are going to come with it? 

Dr Jeremy: Yeah, they're going to have to do something because even in their best, even if everything they want, comes to pass and they save 500 million pounds, which is great that's 500 million out of 22 billion, they need to plug a hole.

Dr Jeremy: So there's more cuts coming. I don't know where it'll be. Yeah, it's coming, but I think that makes a good point. All this talk about all this money you can save [00:37:00] by reducing inefficiencies. Okay, great. Even if they can save a lot of money, 500 million pounds. It's a lot of money, you're not really going to balance the books just by cutting inefficiencies.

Val: Yeah, 

Dr Jeremy: you to balance it. You have to either cut something that's really important to people or you have to increase revenue. Huh. Those are your options.

Val: We'll see. Another thing I would like us to do, because since this was announced, I've been looking into certain parts of the NHS. There are so many layers.

Val: And there was a duplication. Between some of the work that NHS England was doing to the work that the Department of Health and Social Care. So there's a left hand and a right hand, and they both don't know what each other are doing. So at least with this, one positive thing might it be streamlined. There won't be. [00:38:00] duplications.

Dr Jeremy: Yeah, I was thinking about that because you said before, you thought the NHS and our social care budgets need to be recognized as like one contributing to the other. And I wonder if bringing this under a single organization will help do that. Or, I don't know what that will do for the social care budget.

Dr Jeremy: Because much of the reasons why we have, I know you hate the term, bed blockers is because

Val: it's a horrible 

Dr Jeremy: horrible term, but people stuck in a hospital bed because they don't have social care at home. 

Val: So the social care is down to the Department of Health and Social Care.

Dr Jeremy: Because they come from different budgets. Maybe bringing the two together means that, there's somebody will do the math and realize that if you don't put money into social care, then you pay for it in a bloated or overspending NHS.

Val: We'll see. We'll do more research on that because we know that [00:39:00] social care is now with the Department of health and common sense. You have to tackle social care first. You really, so I hope. With this great big announcement that they've made that the next great big announcement is going to be about social care. 

Dr Jeremy: Yes. 

Val: I really do. I really do. And I hope it's something bold. 

Dr Jeremy: Yeah, 

Val: and different, I think this government has to be brave, has to do something different, and because yeah, the NHS has changed, people have changed, we can't keep doing the same old thing all the time, it's got to change, and I think we have to apply more common sense, things have to be more streamlined.

Val: The left-hand needs to know what the right hand's doing. People want to feel change. It's alright telling me the percentages of [00:40:00] people no longer sitting more than eight hours. In A and E and the percentages of how many people have seen their GP within two weeks, people want to feel better change than that.

Val: So improvement needs to come and it needs to come thick and fast. Yes. Yeah. So we'll leave it at that. That was great. So we'll always continue this. Throughout the podcast. 

Dr Jeremy: Yeah. Sounds great. We solved that one. , it's just good talking about, 

Val: it's just for the government to solve it. . . Yeah. I'm hoping they do.

Val: Today's episode, the first half an update on Awaab Ishak and his family lived in Rochdale in social housing and about the implementation the new law, Awaabs law that will come into effect in October 2025 in three phases and second half. 

Val: [00:41:00] Yeah. And then we talked about The government abolishing NHS England, merging that function with the existing Department of Health and Social Care.

Val: Brilliant. Thank you, Dr. Jeremy. As usual. It's been great. 

Dr Jeremy: Thanks, Val 

Val: thank you for coming out on a Saturday. 

Dr Jeremy: No, this is a great way to start a Saturday for me. 

Val: Great. Okay. Please subscribe wherever you get your podcasts. Bye. Bye.