EP 19 :HEALTH INEQUALITIES PART 5: THE LORD DARZI REPORT & BEYOND

[00:00:00] 

Val: Welcome to Stories, Labels and Misconceptions with Val Barrett. And Dr. 

Dr Jeremy: Jeremy Anderson. 

Val: And today we are still carrying on with our health inequality series. Part five. We're diving into the most recent diagnosis of our health system, the Lord Darzi report of 2024.

WHOOSH: Mhm.

Dr Jeremy: Yes. It's been decades of reports. About the NHS and the health service and what's gone wrong. Lord Darcy was the most recent author of these reports.

Val: As we discussed last week, we'll do a brief recap. Episodes one, what is health inequalities? Two tackling the social determinants of health. Three who gets left behind. [00:01:00] Four, 4a and 4b, all the reports and still no change. And today it's all about Lord Darcy's report, which will nicely bring us up to date.

Val: So the previous reports Black Report, 1980, the Acheson Report of 98. Before the Acheson Report of 98, there was a report done by some health professionals in 87 called the Service Divide.

Val: Yes. And then the Acheson report came along in 98. Okay. Let me go back 1980. We had Sir Douglas Black report, which was commissioned by the Labour government, released under Thatcher's government and nothing was done with that. 

Dr Jeremy: More or less buried. 

Val: Buried. Dust. Health professionals realized nothing had been done. So in 87, seven years after that, they [00:02:00] did I think it was called the service divide. They said that since the Black Report, health inequalities, had widened. Nothing had been done. But we know that whenever a report's done, Things are going to get worse before they get better over the decades things systematically declined and got a lot worse the Acheson Report of 98., came the marmot review of 2010, he came back 10 years later in 2020. And then let's not forget Lord Darzi did a report under Gordon Brown in 2008 called High Quality Care for All NHS Next Stage Review Final Report, which we know it's not really the final report.

Val: So that's Lord [00:03:00] Darzee, come back under West Streeting we're going to compare and look at the similarities between all these reports, but we know. Without even having to read them in depth, we know, health inequalities has worsened, poverty has worsened, access to services, whether it's GP, the waiting list.

Dr Jeremy: Yes. Let's, introduce the Darzi report from 2024 this is the most recent one, unlike some of the other reports is that to my eye, it doesn't seem to be addressing health inequalities specifically. It's not saying that there are these structural inequalities in the healthcare system. It's really just looking at the healthcare system in general and saying, here is a whole bunch of problems with the NHS right now.

Val: And I'm going to disagree with my colleague. 

Dr Jeremy: Oh, really? Where am I missing? 

Val: Because he hasn't said it.

Dr Jeremy: Yeah. 

Val: Doesn't mean it isn't [00:04:00] there. 

Dr Jeremy: I'm just saying he didn't say he 

Val: hasn't focused on, hasn't said the words because those words have been sung for decades, but when you look into the report, it's like a stick of rock. You cut it open, it's got health inequalities going through it.

Dr Jeremy: Yes, exactly. I didn't mean to suggest there's no such thing as health inequalities, just that wasn't described in the report. Yeah. Yeah. Yes. Lord Darcy lays out all these points. I'm reading the executive summary and all the numbered points. I agree with that, there's certain things that the NHS isn't doing well it's not entirely the fault of the NHS, but actually is saying the nation's health is worse off.

Dr Jeremy: We're not as active, healthy, we're not, we're getting obese, we're getting older all of these things are increasing people's ill health and that's putting a greater demand on the health service. So I think that's important to note. And [00:05:00] then he talks about a whole bunch of where the NHS is at right now, where the health service is at. And the importance of waiting times.

Val: Yes, 

Dr Jeremy: Justice delayed is justice denied. If healthcare is delayed you're not really getting healthcare so wait times is actually an important feature. That we need to monitor and it's not doing well. According to Lord Darzi, we're not meeting promises since 2015. 

Val: Okay. He states that between March, 2010 and June, 2024, 2. 4 million to 7 million people were on the waiting list and don't forget before that we had COVID so we've got that backlog, that avalanche of snow to deal with because it was bad before, but not as bad.

Val: Before COVID and it got worse after 

because 

Val: they shut up shop, not all hospitals [00:06:00] did, because my son still got his care. 

Dr Jeremy: And definitely COVID was an issue, but it wasn't the only issue. It, there were problems before COVID, they were exacerbated by COVID. And people were struggling to see their GP and 0. 7, he's saying, there was a million people waiting for community services, including 50, 000 who'd been waiting over a year. By April, 2024, there were a million people waiting for mental health services. The demand for mental health services has surged. 

Val: Yeah. 

Dr Jeremy: Long waits are normal. 

Val: Do you think it's gotten so bad because COVID has exacerbated things we know more people, more young are suffering from mental health. And there's not enough people being seen. Do you think, Oh God, it's like shoveling snow and it's still snowing. That we know realistically. That there's no magic wand, no matter [00:07:00] if we had a hundred billion pounds today, nothing's going to be solved tomorrow. What I don't like, like I said last week Lord Darcy's report covers 10 years fundamental change will take 10 years, things can come quick in the first year, the first three years, but huge change is going to take 10 years.

Val: What I'm afraid of is. When new government take over, and that's why I don't like 10 year plans, unless taken out of politicians hands. Because all it does is, A, it gets put to the scarp heap like previous reports. They delay it by thinking, okay, we'll show them we're doing something by doing another report, calling it another name, and nothing's [00:08:00] done.

Val: We're just plastering over the cracks and nothing is changing. When they talk about reforming the NHS, it really needs to be taken out of their hands. For the sake of it to continue, it might not stay in the current form, if we're writing these reports and trying to get on with the work of delivering change within these reports for clinicians to get on board for service providers to get on board, you want everybody to buy into this.

Val: I want everybody to believe in this change. And they've all had a hand in it. So what can be demoralising to any team, which I can imagine is one day you're being told a, you brought into it, you believe it. And then next minute. A new government has come in and said, no, we're not doing A anymore. Do you see what I [00:09:00] mean?

Val: That's the part I don't like. I don't know what you think as somebody that works in the NHS, because it can be confusing, not only for patients like myself. What about the people that work in the system change in every three to four years, the message is changing, the message changes, but the problems are still there.

Dr Jeremy: I like your snow shovelling metaphor as a good Canadian. Anything involving shovelling snow makes a lot of sense to me, right? So when you have a blizzard. And there's the snow coming down, right? You have to get the snow plows out while the snow is still falling.

Dr Jeremy: You have to be clearing it away all the time because if you let it build up the snow plows can't run and you get overwhelmed. It takes longer to dig yourself out. This is the situation we're in where the system hasn't been funded long enough. At a high enough level. And we're being overwhelmed.

Val: But [00:10:00] is it just funding? 

Dr Jeremy: It's partly funding, but if one government says, we're going to do this and five years later, another says, no, we're going to change that. And then another says we can put funding in, but if we never get the work done, we get overwhelmed. And so I think you raise a good point about the NHS always changing direction every five to 10 years when a truly new government comes in. And they decide to restructure things. So I think that is a problem. 

Val: Think they get to do that. Because when you think about it, they come along and say we've got the answer to the NHS. Labour may have created it, but we're the ones to fix it., The Tories, sure. And they will oppose whatever plans labour come up with just to oppose it because they want to say, look, we're different. We're radical. We know the answer. So they come in. Okay. Lord Darzi [00:11:00] reports there. And say three years, four, four years time, let's say the Tories come up with something else.

Val: They'll get their own Lord or Baroness to do another report, but then still nothing has been done. And then four years down, when that report's done. They may go on I don't know what they call it a listening exercise, up and down the country. Delaying tactics. 

Dr Jeremy: Oh, consultation.

Val: Consultation. Just like the inquiries going on and on.

Val: They get the report. You don't know if they're going to implement that report or not. This is the thing we don't know because we know through history of reports, either the government implements it or not here you go. This report, do it or not which says to me, that's not a commitment.

Val: Cause if it's a commitment, you would say, this is the national strategy. [00:12:00] This is what we're doing. Then you'll have the national strategy and you'll have the localised strategy. Because what one postcode will have issues with may not be in the same postcode, let's say the other end of the country. One plan doesn't fit all regions. 

Dr Jeremy: No. 

Val: Overall, the government will have a national plan. To say what we're going to do, but locally, they will have to have their own plan. Like we said before, there's no need to build a hospital where I live.

Val: There's five. They have to look where it's needed. Sometimes that could be the problem. Is it always going where it's needed or where it's easier? 

Dr Jeremy: Yes. 

Val: Do you see what I mean? 

Dr Jeremy: Yes. Point 13 of Lord Darzi report was arguing that there's too much money going into large hospital centers.

Dr Jeremy: We need to move some of that [00:13:00] service into the community. It depends on where in the, or which community that money flows into. So if you set up community services. That's great if it's in the communities that need it. 

Val: Yes.

Dr Jeremy: He makes a good point here that there's a huge growth in the amount of people in hospitals, but they're not necessarily flowing through hospitals because there hasn't been, we've said this, you in particular have said this time and again, social care support. for when people leave hospital hasn't been funded.

Dr Jeremy: So what that means is there's large numbers of people who are not flowing through hospitals. And what that means is it creates extra work. Yeah. So the people working in hospitals are not as productive, but it doesn't reduce their workload. So they're demoralised. 

Val: Yeah. 

Dr Jeremy: People are stuck in hospitals.

Dr Jeremy: Gobbling up funds not getting good care. 

Val: I don't like these mega hospitals, the town I'm from, Stafford, built a mega one in Stoke on Trent. It's huge. Really [00:14:00] big and the one in Stafford, A& E closes at 8 pm So God forbid, if you have an emergency, 8 o'clock. So where do 

Dr Jeremy: Where do you go after 8 o'clock? 

Val: When me and Andre were at my dad's, Andre got sick with his sickle cell. A and E were just about closing. They said, we can't see you. You're going to have to go to Stoke. So he hears that 16 miles supposing he was having another stroke, the localised things, they're just going because they seem to think bigger is better, bigger isn't always better in remember me telling you, we used to have these community hospitals. And we talked 

Dr Jeremy: Sure Start 

Val: but we still have one in the borough I live in, 

Dr Jeremy: excellent. 

Val: We used that. It was a young lady, never forget this. As we go for routine [00:15:00] assessments Andre went in for his heart. They detected the clot on his heart. And there was an ambulance outside it went to. St. Mary's, that's local, that's community, do 

Dr Jeremy: I think community services are important because it means people who need care don't have to travel as far, for the bulk of people's care. They don't need to be in a mega hospital, the stuff they do to not get sick can be done locally. It's better when people don't have to travel as far. I remember with GPs, a question people used to ask is, do you do home visits?, People would be sick in bed not moving. If you need a physician, the physician would come to you. 

Val: You get home visits in Canada? 

Dr Jeremy: Never had a home visit, 

Val: did they do that there?

Dr Jeremy: Some GPs did home visits some didn't. Gradually nobody does home visits. I don't know why it was too expensive to do home visits , or, the compensation [00:16:00] structure that the way physicians get compensated for the work they do if you structure it in one way, people will do home visits. If you structure it in another way, they won't do home visits, they won't do community work.

Val: How have you noticed the way that things come around? Years ago, we had. infirmaries, , and then there were community hospitals. Everything was community.

Val: You had district nurses, community nurses Then some bright spark, thought it was a brilliant idea to build monster hospitals that took away money from the local community. When you look at a hospital as big as Stoke.

Val: You're going to look at areas like Newcastle, Stafford, Cannock, all these surrounding areas in Staffordshire that [00:17:00] had hospitals that are either not there or they're closing early. 

Dr Jeremy: Yes, 

Val: They've completely shut down children's services. Everything gets directed to Stoke because that's where the money is, but it's not local for everyone. Do you see what I mean? Whoever did that, they've taken away the importance of social care. In the local community, you know what I've always used to, I've always had this dream.

Val: I've always had this dream me and . My friend Paul used to always talk about this dream, but he used to always have this dream that in the community you'd have whether it was a hub, you'd have a mental health specialist. 

Dr Jeremy: Yes. 

Val: You'll have somebody from housing. If you needed emergency housing or you're.

Val: Partner abused you and you needed somewhere to go to find an emergency place to [00:18:00] sleep. You'd have a GP, a nurse. You'd have all these things we have in separate departments, in separate buildings that close at five our lives have changed.

Val: This is no longer the seventies. It's no longer the eighties and it's no longer the nineties. We are a 24 hour. Service, and we're still not reflecting that, not reflecting that. 

Dr Jeremy: This isn't a 24 hour service, I am excited to talk about the community MDT that I'm a part of for people with sickle cell.

Dr Jeremy: It's separate from what the government announced. But consistent with the direction of travel. We've set up, I didn't set this up, but I'm a part of it is a community multidisciplinary team that looks after people in the community, people with sickle cell in the community, because the bulk of the assistance that people need to stay well, they don't actually need to go to hospital.[00:19:00] 

Dr Jeremy: And this team there's access to, to. Physicians to consultants as needed, but it's primarily psychology, pharmacy, social work, nursing. And social prescribers. 

Val: Yes.

Dr Jeremy: These are link workers if someone needs to join a gym fill out a form or know where to go to fix a problem, these are the people who help we're setting this up as a community program, I'm very excited about it. It's a good example of a program that if it's set up now under one government, it would be an awful shame if it was cut the next time the next government comes in because they don't agree with it, this is getting services into the community.

Val: Now you see why it's going to come out of government hands. It really does. This is one of the things I feel strongly about something, maybe I'm chatting shit. I don't know, I don't really care, but unless you are a [00:20:00] recipient of the NHS, living with a chronic disease or whatever, I was thinking about this also reliant on it.

Dr Jeremy: Yeah.

Val: You realise it. Every time a government changes, it impacts on you, one minute I'm going to SureStart, this minute I'm knocking on the door, it's shut, just like USAID.

Dr Jeremy: If you have a system where there's a lot more support in the community, in different communities that are spread out that actually gives people, particularly if you have a long term condition, more freedom to live where you want, right?

Dr Jeremy: If you have a long term condition and the only place you can get any support is in one of these large hospitals, it means you're more like a lot of my patients are pretty much tethered to a large hospital that limits where

Val: there isn't much choice. 

Dr Jeremy: There is no choice. It limits where they're allowed to live. They're stuck. 

Val: When you're in social housing, you haven't got a choice. You go wherever you are put. You don't have [00:21:00] much of a choice. You have a choice when you're looking to buy. And even then you're limited because of the amount of money that you've got. So it's not really a choice. 

Dr Jeremy: Let me give you an example. Many of my patients would love to pursue certain employment opportunities, but it would require them to move out of London. If they could get this job and pay private rent right? But they can't afford to be far from a specialist center because that's the only service offered. So now they're stuck in London, 

Val: London isn't the only

Dr Jeremy: no, it's not, but the opportunity they would have, they turn it down. So now

Val: there's birmingham, Manchester, yeah, there, 

Dr Jeremy: There are regional specialist centers but it's like, far away are you willing to move? And I think if a lot of the services people needed we're spread out it would give people more choice more flexibility. 

Val: That's hard because when you're looking at specialism, like sickle cell, [00:22:00] it's not widely available because the numbers are low, you've got to be realistic, but they're going to be in areas where it's concentrated, but Birmingham has one Manchester does or the parts of London does London is not the center of the universe.

Dr Jeremy: Yeah.

Val: So if you're going to move to Birmingham. You will have to travel within Birmingham to get to see that specialist you have your GP. But you want to see the specialist. So it depends how much you want that job? Right now I bet you don't live on the doorstep of the hospital that you are going to now.

Val: So what difference would that make if you moved to Birmingham? Have you been, have you seen where the job is? The hospital places to live? Do you see what I mean? 

Dr Jeremy: Yeah. 

Val: It's about figuring it out. It's not going to be next door. I just happen [00:23:00] to live Where it's really convenient. And that's it. But I have lived in places where it hasn't. 

Dr Jeremy: Yeah. 

Val: Let's get back to Lord Darzi haven't. So  Lord darzi doesn't just point fingers. He diagnosed a system that's overwhelmed the difference this time is urgent. It's like the NHS is on its own life support machine. And it's nearly flat lining. 

Dr Jeremy: Yeah. 

Val: We don't want it to flatline. 

Dr Jeremy: No. We're giving it, 

Val: what's that thing that they do? 

Dr Jeremy: The defibrillator? 

Val: We're using a defibrillator now, and want to get it back.

Dr Jeremy: We don't want, 

Val: we want to shock it. Back into 

Dr Jeremy: a rhythm. 

Val: Exactly. 

Dr Jeremy: In 

Val: order to do that, we've got to find out why it got to be nearly flat lined in the first place. Which he diagnosed, but many reports have diagnosed so why now is it more urgent than in 1980?

Val: [00:24:00] It's always been urgent. I try not to be too cynical, but I can't help it. History tells me that. I do have faith in Labour. I try my best to, and it comes to the NHS. But, like I said, the downside is when we have elections and governments change. That's the downside.

Val: What are the Tories plans for the NHS? What are reforms planned? It seems to be the, political football that everybody wants to kick and score. Everybody wants to be the one that, yeah, I solved the crisis within the NHS. But when you're playing that game, people die every winter.

Val: People on a trolley having a heart attack no beds. Ambulances back to back because there's nowhere to offload the patients, so those are the [00:25:00] quote unquote, the crisis in the NHS. The people are the so called crisis and they can't see it getting better. 7 million on a waiting list.

Val: Yeah. Avalanche, snowing. 

Dr Jeremy: Yeah. 

Val: Tumbling. 

Dr Jeremy: That's a lot. 

Val: Overwhelming. 

Dr Jeremy: The snowplows don't clear the snow away quickly. 

Val: No snowplows. They can't get through. 

Dr Jeremy: They can't see. It takes a lot of extra work. To dig yourself out. Yeah.

Val: So if you can imagine the snowplows. All the money does follow me with this, the snow plows all the money

Val: even though we're getting loads of snow plows, nothing much is changing because it's going to take more than money to make this change, to stop the flat line.

Dr Jeremy: What takes more than money? 

Val: I don't work there. 

Dr Jeremy: Yeah. 

Val: Reform, it's got to change, definitely got to [00:26:00] change, before we look at cause when we talk about the NHS, people think of hospital and that's it. I'm thinking of social care.

Dr Jeremy: Yeah. 

Val: You cannot clear the crisis in the NHS. Without first shoveling the avalanche in social care, but because you have made a ruling to state that you are not allowing foreigners to come in to be what was it's working social care anymore? We're going to have a deficit. Yes. Yes. So you're doing one thing, we need help in social care, but you decide to wake up one day and say, okay, you're not having the social care work visas anymore for foreigners.

Dr Jeremy: Yeah.

Val: Yeah. It is, a area that is starving of staff. It's starving, but [00:27:00] you haven't said what you're going to do to fill that gap. 

Dr Jeremy: I'm just thinking about that, looking through the report although Lord Darzi recognised a lack of investment in social care was driving the lack of productivity by hospitals. When you look at his 10 point plan, that's a section 28 in the report he lists all a bunch of things and what is conspicuously missing is a call for funding that social care. 

Val: You sure really? 

Dr Jeremy: Maybe I'm missing it here, but he's saying re engage staff, re empower patients mental health, community services, expanding, simplify and innovate care in the neighborhood.

Val: Mental health can be done in the community. Mental health shouldn't be taking up beds in the NHS. 

Dr Jeremy: When he talks about beds, he's fixing flow with operational management. Investment in buildings equipment, technology, contributing to the nation's prosperity top down [00:28:00] stuff and a balance of management structures. I don't see where he says we're not going to fix the NHS. Funding social care properly. That's a glaring omission. 

Val: I dunno how they're going to do it. 

Dr Jeremy: He diagnosed a significant problem. He recognises it is a problem. I don't

Val: social care.

Dr Jeremy: He yeah. Earlier in the report that was one of the problems he mentioned. But nowhere is that in his list of 10 solutions. 

Val: Oh, you're joking. So it's problem isn't solved. What happens to that problem? It gets worse. 

Dr Jeremy: It gets bigger. And I suppose that's why we shouldn't be surprised that the government, although they did implement one of the recommendations where they abolished NHS England, this management structure. I think, they're trying to do a good job. In terms of helping people get an appointment with their gp.

Val: But you need gps. 

Dr Jeremy: But you need gps and no [00:29:00] one will report, we're going to massively expand social care.

Val: I'm sure I read somewhere that GP desert it. The most deprived communities, that's exactly where they need to be. So again, the inequalities, no wonder you never mentioned it. Who who wants the data to see in black and white to say it's getting worse. And I know there's always going to be health inequalities, but it's the amount,

Val: if the government is still going to be singing on that tune, we're putting money in they just keep saying it over and over again to make people think, Oh, we're putting loads of money in, which equates to we're doing something.

Val: People aren't feeling the changes people need to feel it. I wanna feel the change. I wanna know that, like I said before, I'm not sitting in a and E for 10 hours.

Val: I'm not gonna be lying on a trolley. We don't need to advertise for a corridor nurse. When you put up an [00:30:00] advertisement for a corridor nurse, that tells you everything about the NHS. You don't advertise for where you are now. You advertise for where you want to be.

Val: If you do that today, you're going to advertise for another healthcare assistant, that corridor is going to become its own department and then it's going to become normal and it shouldn't become normal. 

Dr Jeremy: I've long thought we need a redundant amount of like physical space of rooms. To meet people in, so in the work that I do, and I won't mention the trust that I work for, but we don't have enough clinic space. We don't have enough room to see as many patients as we'd like. We have to share, we have to schedule, we have to almost compete for room space.

Dr Jeremy: And I'm relatively lucky in that I get some room space. [00:31:00] Assigned to me, but for a long time, I had colleagues who, I had no room space assigned, even though they were supposed to have confidential conversations with patients I've wanted to have a group space for a long time, that space doesn't exist.

Dr Jeremy: And. I think there's some idea within healthcare that, if you just make too many rooms, it'll get filled. And so when we're keeping the cost down I think it gets filled with the staff that look after people. If we had the rooms to see people it would make it a lot more efficient.

Dr Jeremy: And so I'm. I'm a big fan of building spaces and obviously we've talked about the need to maintain those, fund the maintenance of those spaces, but actually having physical space to see people would be really helpful. Even if the staffing level stayed the same, actual having the space for those existing staff to see people unfettered, that would be it.

Val: Do you want to say any, [00:32:00] anything else? The other points? 

Dr Jeremy: I think the 10 year health plan makes good recommendations, right? Some of it's I don't know vague, right? Just let's re engage staff, whatever that means, or re empower patients,

Dr Jeremy: Moving certain. Services into the community outside of hospitals, especially for long term conditions or mental health.

Dr Jeremy: Yup, so he's consistent with that. Wanting to simplify things and bring it into the neighbourhood, I think that's great.

Dr Jeremy: I think one thing that I thought was also interesting was the demand for for results. So not just I think it's in some ways the way the healthcare system in this country works is, we have these bodies that decide what a good service is, right. And then we go in and we evaluate a service and we say, these guidelines say you're supposed to have X, Y, and Z.

Dr Jeremy: And you don't, so you need to put those people in place. And then, so you need to pay for that. You need to hire these people and say, okay, so we've done that. Now we're a good service. Not necessarily. It's a service isn't working right. If it's not producing, if it's not helping, then you've spent all that money, [00:33:00] but you haven't actually you haven't actually provided a good service.

Dr Jeremy: necessarily a good service. So I think some way focusing on output, not just input, I think that's actually a pretty good idea. Tilting towards technology, I think. AI is going to be a huge thing. We'll probably do a whole podcast episode on that. 

Val: What, can you say that again? What did you just say? I think 

Dr Jeremy: AI is going to be a huge thing in the future.

Val: Yes, of course, yeah. I think, 

Dr Jeremy: I think we'll need to at some point do a podcast episode about that. I think it's going to be incredibly important. It's already important in places like radiology. And increasingly in other areas. I think, there's an ongoing debate about whether or not AI will replace psychologists.

Dr Jeremy: I happen to think it will not right away. I just want to let everybody know 

Val: that Dr. Jomi is AI. 

Dr Jeremy: No I'm not an AI voice. I'm I'll 

Val: have to ask your wife about that. 

Dr Jeremy: I really do sound this calm. Oh, really? Yeah. Yeah. So I think, I think the Darzi report makes a number of good recommendations.

Dr Jeremy: And hopefully the current government will implement at least some of them. Like I said, I think the lack of mentioning social care in the recommendations is a glaring omission.

Val: But do you [00:34:00] think when you just said, I hope the government implement some of them.

Val: They've asked him to do yet another report. Oh man, he'll be back again in 10 years time. And I don't think it's good for any government to pick and choose which recommendation they're likely to implement, because they may choose it based on cost. And he's done this report.

Val: He's got his findings. He should have nothing to do with politicians People will read this report. They might not, or read the summary, the key points. I think, wow, this sounds good. Yeah. But then how is it going to work? People want to know the meat on the bones right now.

Val: We, and we've got the bones, but in order to get the meat on the bones, we need buy in from clinicians, professionals. Politicians need to commit and they need to commit by saying, we're going to implement all the recommendations. This is another thing that I don't like very quickly. [00:35:00] All the hoo ha, when there was at first, when Starmer said he wasn't going to have a national inquiry into the grooming gangs, then all up, uproar, Elon Musk saying what he said.

Val: He then of course commissioned someone else as we know what's her name? Dame Casey. She doesn't pull any punches. And then he quickly says, we're going to implement everything. Why? Because that was news. That is what everybody was screaming about. This is what I don't like. You do it because it's the right thing to do.

Val: You do it because you should have done it. You don't do it because you were hung drawn and quartered to do it, that you were nailed to the cross to do it. It shouldn't have taken. Yet another U turn. Do you see what, do you see what,  you see what I mean? Unless it's the flavour of the month, this is what I'm trying to say, unless the whole country is in uproar over one particular thing, it's like nothing gets done.

Val: He gets obsessed. By a [00:36:00] drama, 

as 

Val: good as that drama may be, it was a drama. We have real life knife crime going on in this country. That's what he should be getting obsessed about. Not getting obsessed about a drama. We already have crime.

Val: Real crime. I could understand if it was a documentary. 

Yeah, 

Val: but it wasn't. It was a drama. It was a drama. It's what it was, so when it comes to yet another health report, it could be just another health report. 

Dr Jeremy: Yeah, 

Val: it could be just another one. And then it just doesn't get done, or some of it gets done and then halfway through people get pissed off, that's why it needs a panel.

Val: Just like we've got, I know this is going to sound silly, but this is the only way I can describe it. Just like you've got MI5 and MI6. Whatever happens, they're always there. 

Yeah. 

Val: They're constant. They, one does homeland [00:37:00] security, one does the other, whatever it is. Protect us from whatever. We should have a panel just does this.

Dr Jeremy: An expert panel that is guided by the facts. It seems to me like what you're saying is these, all these politicians at Westminster they're playing this kind of game, where they're competing with each other and always going back and forth. It's a battle of wits that is all about current drama, but it's not really the nuts and bolts of what we need. We don't look to politicians to legislate. Two plus two equals four 

Dr Jeremy: right there's certain things that are just facts about the world that we all have to accept, right? And, we leave some of this other stuff to politicians. And, but really, I think what you're advocating for a world in which when there's things that are just facts that nobody's arguing about, we need to, that's something we need to take out of politicians hands.

Dr Jeremy: We don't need to let them fight over it. It wouldn't make any sense about, to for politicians to [00:38:00] legislate, what direction does the sun rise?

Val: They could have, they could, they would. 

Dr Jeremy: They would, right? And some of these things might be like that, but we're treating them as if they're a matter of political ideology when they may just be facts.

Val: So let's quickly just state that the key similarities between Darzi Black Report, Acheson Mormot. Now we know that the Black Report showed that class and income directly affect health outcomes. 

Val: Akerson Report highlighted the need to improve early years, education, and social conditions. The moment review focused on social determinants of health, housing, income, education, work, et cetera.

Val: Darzi 2024 warns of rising chronic illness, diabetes, mental health, obesity, linked to poor social conditions and prevention failure. When we overlap, all these reports [00:39:00] agree. That health cannot be improved by NHS reform alone. Upstream social factors matter just as much. And we know that there's a big difference between 1980 to 2024.

Val: Like you said we tech, technology. Technology is changing, AI is here, the way that we look at health is different, the way that we look at social care. It's a lot different. So moving things from what we might have done in hospital in acute care can be done in the community now, where I remember years and years ago when I was little when women went in to give birth, they were there for days now, since they've got the cord, you're on the bus home, you're going home.

Val: There's no need to stay, things change, but the NHS needs to catch up and change with it. 

Yeah. 

Val: That's what they [00:40:00] need to do. And it's the cycling and peddling. They're not getting out that bloody hill faster, just needs to change.

Val: It needs to completely change the way it's always work the way they think it should work the way they think how it should be delivered in terms of who oversees it, who has overall. control of it. Do you see what do you see what I mean? I. E. Secretary of State for health. I. E. Government control.

Val: Shouldn't that change if the way that we view health and everything else has changed? Because no matter what health inequalities, until we are consistent, With all the recommendations that have been made from throughout all of these reports, every single one of these reports, and concentrate services and funding in areas that are more at need, not in areas where you're going to get the votes.

Val: That's why [00:41:00] it needs to change. More now than ever, because we're at a crucial point where the NHS is flatlining. And that flatlining means We don't want what America's got. . We don't want that. So when somebody comes along and says We should try an insurance based sys system and people don't fully understand what it is, look at the American Sy system.

Val: Look at the amount of poor people that have cancer that can't afford to get their treatment or diabetes, whatever it is. Yes, it may be okay for some people. For the majority, it won't be so in other, so for us to have a sustainable NHS for the next generation that deserve to have what we are enjoying now, it needs to fundamentally change in a radical way beyond just looking at management.

Val: We need to [00:42:00] look a right above at the top and perhaps cut them out. Do you see what do you see what I mean? But they've got to think beyond ego over keeping this treasured possession that we do have. Cause we are very lucky that we do have it. Yes. Okay. It doesn't work at times. Great. But look at the times it does work.

Val: Yeah. Yeah, look at the wonderful stories that you do here and I, for one, we. You work in it? I use it all the time. I, for one, I'm not gonna say in our theme song, it ain't broken. It may be broken as they say, but it ain't done. 

Val: And it shouldn't be done. 

Yeah. 

Val: Because it's a system that has been here for so long and the next generation have every right to benefit from what we're benefiting from today.

Val: But we are the caretakers of this sys this system. And we have to take care of it for them to benefit from what you have today. And we have to make society healthier. It has to be [00:43:00] healthier. It has to be fitter. I'm holding out hope and I don't hold out hope if that makes sense. That sounds weird, but yeah, I am, I'm praying for the best. I'm for the NHS. 

Dr Jeremy: I'm just taking your point about taking control of a healthcare system out of the hands. Of politicians, so I need to think about that a bit, but I thought I would just throw that in 

Val: the hands. You, are you impressed with what they've done?

Dr Jeremy: No, it's definitely a problem. I'm just wondering what's the alternative, right? So what's the 

Val: alternative? So I've 

Dr Jeremy: asked, I've asked Microsoft co pilot. What the alternatives are, and it's come up with three potential solutions. One is an independent health authority, a nonpartisan, independent commission or authority that's arm's length from government.

Dr Jeremy: The second is technocratic management. That is putting decisions in the hands of health economists, clinicians, epidemiologists, and systems engineer, rather than elected officials. And the other one is social health insurance models. I think [00:44:00] that's more like Germany and the Netherlands where it's there's non governmental, non profit insurance funds that collect premiums and manage coverage.

Dr Jeremy: It's, that's like a blended model between health insurance and like the private health insurance that you see in the U. S. Versus like a national government healthcare. Oh, and there's a fourth option, cooperative regional governance. So it's saying letting regions, cities, or even cooperatives like groups of people.

Dr Jeremy: of patients and professionals run healthcare locally. Switzerland uses this model extensively. How does that work? That 

Val: would be great to find out. 

Dr Jeremy: Yeah, I think we should explore this. How 

Val: that 

Dr Jeremy: actually works. Yeah, it would really be good if we could find some, like an expert, someone who knew about this stuff and could propose alternative models.

Val: Yeah. 

Dr Jeremy: That would be really useful to explore. 

Val: But I do like the idea that if we do have to [00:45:00] have Government officials on it, that it is cross party. 

Dr Jeremy: Something more, one from each party. I 

Val: don't want it to be just cause labor in power or the Tories are in power that they dominantly are the only ones.

Val: No, I think if there's a panel. Then someone from each of those parties should be on that, but it doesn't mean they make the major decisions. Do you know what I mean? But I think it would be good to look at other systems. 

Dr Jeremy: I think that's really good. I've been, as you've probably detected, I've been reluctant to jump on the bandwagon with you Val, in terms of saying, we've got to take it out of their hands because.

Dr Jeremy: And that's 

Val: really 

Dr Jeremy: just because I don't know. I don't know what the alternatives are. 

Val: We don't, 

Dr Jeremy: we 

Val: don't have to have all the answers. Bloody hell government don't. I'm saying it's true. We don't, I'm just saying. One of my preference is because we've tried this for so long, and if we have tried this for so long and reports going back as 1980 till 

Dr Jeremy: now, 

Val: and still, and it's gotten worse.

Val: Then it says it's more than just money. It's more than just management. It's further up the [00:46:00] ladder. And if you don't try something different and radical, you'll never know, and I think Sometimes, unless we do have that conversation, we won't explore other options. We just think, Oh, it's supposed to be this way.

Dr Jeremy: So are you going to get radical though? No, it's not just that. Are you going to vote reform UK? 

Val: No, I bloody ain't. They're quick enough, with these parties, they're quick enough to get rid of the quangos and blame them, whatever. It's there, one minute you've got your quango in, your quango out, in, out, come on, shake it all about.

Val: One minute you've got community hospitals, in, out, in, out. You've got this, you've got that. They go round and around and they don't know the hell what they're doing. They rehash things that they said we didn't need decades ago. They bring it back and realize it was a mistake. 

Yeah. 

Val: And these people are supposed to have gone to the best schools, the best universities, and they [00:47:00] still haven't got a bloody hand in what's going on.

Val: They still haven't made A major impact on the NHS, a major impact, just none, these reports are just. As far as I'm concerned, it's just a report until they action it. It is just something written on a piece of paper until they action it. That's all it is. And they'll probably, and I can bet your bottom dollar, there'll be another one.

Val: Whether it's today or tomorrow, there will be another one. And I can bet your bottom dollar. The only thing that would have changed. Is that health inequalities has gotten wider and on that note, I can predict, I think they should get us to do the report. I can cut and paste from the best of these reports, 

Dr Jeremy: you 

Val: know, if I don't laugh or bloody scream.

Val: It's a disappointment, it really is, come on.

Dr Jeremy: With that, we'll stick a pin in it there and yeah, it's time for me to go look at making [00:48:00] dinner. 

Val: What are you making? 

Dr Jeremy: We're going to make some chicken tonight, but I think I'm probably going to try to cook outside on the barbecue rather than inside.

Dr Jeremy: It's just going to heat up the house. Do you 

Val: cook for your dog or do you give him tin food? 

Dr Jeremy: Oh we give him kibble and,

Val: oh. 'cause some, because some people cook for their dogs. 

Dr Jeremy: Sometimes we'll give him some chicken. He does love chicken. It's true. Really? Oh, 

Val: okay. Okay. But 

Dr Jeremy: most of the time, yeah, we just give him kibble.

Val: Is that dry stuff? 

Dr Jeremy: Yeah, it's dry stuff. It's all salmon. We found his digestion works best when he gets pure salmon. 

Val: Okay. 

Dr Jeremy: It's salmon kibble, but it's fish. 

Val: And next week we were going to do our common sense solutions. Oh, we've talked about that throughout, but we'll just, we'll figure something out.

Val: Yeah. We'll figure it out. Okay. Thank you for listening. Thank you for joining us again and follow us on our socials. Tell people about us and let us know what are your thoughts? Do you agree with me? With Val Barrett that [00:49:00] NHS should be taken out of politicians hands. Yeah. It would be good to know.

Dr Jeremy: Leave us a comment or a review. 

Val: A nice comment.

Val: See you later. 

Dr Jeremy: Okay. Bye bye Val.

You