INTRO RAP: [00:00:00] 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: Welcome to Stories, Labels and Misconceptions with Val Barrett. 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: Welcome to the final chapter in our health inequality series. Episode six common sense solutions.

WHOOSH SOUND: Mhm.

Val: This is mine and Dr. Jeremy's own common sense [00:01:00] solutions. So we've walked through definitions, causes, Consequences and decades of reports. And now it's time to ask what can we do right now that would make a real difference, practical actions that break the cycle.

Val: In this first part, we're looking back to move forward. So let's rewind. Let's look very quickly in episode one. We asked what are health inequalities. 

Dr Jeremy: Health inequalities. No one's health is exactly the same. We know that, but when we talked about health inequalities, we're specifically talking about the inequalities are systematic and preventable and unfair.

Dr Jeremy: So we're talking about differences related to things like income, ethnicity, gender, geography, like where people live. And education and these [00:02:00] create differences in health outcomes. So these are systematic things that we could change if we wanted to the shape, everything from life expectancy to quality of care.

Val: Episode two tackled the social determinants of health. 

Dr Jeremy: Yeah. These are looking at so not just the kind of the healthcare we receive that is just going to hospital or something but rather things like housing, education, employment, 

Val: housing impact on your health.

Dr Jeremy: Yeah. We've talked about the impact of housing damp and mould 

Val: Yeah 

Dr Jeremy: Impacting, your physical health. Employment, the environment you live in exposure to things that cause ill health 

Val: a lack of access.

Dr Jeremy: Exactly. These have an impact on people's physical and mental health. 

Val: Okay. In episode three, we asked who gets left behind, 

Dr Jeremy: We're looking at, who gets most affected [00:03:00] by these inequalities. because these specific groups, it's not that there's something inherent about the group but these factors affect different groups differently. Specifically ethnicities. Different ethnic groups get left behind more than others.

Val: Travelling communities. 

Dr Jeremy: Absolutely. We're talking about structural racism structural inequalities, systematic barriers keeping people down. 

Val: Yeah. And people with disabilities. And also we talked about class. 

Dr Jeremy: Absolutely. That is an overarching element. All of these specific groups are getting left behind. When we talk about class, we're talking about income. These groups. Are getting left behind in terms of low income. 

Val: Yeah. 

Dr Jeremy: And that's exacerbating everything. I think that does point to a solution because it's not about, the amount of melanin in your skin or the language you speak that's resulting these inequalities, but it's really [00:04:00] about the amount of income you have. 

Val: Yeah. And episode four. We looked at the long line, the ever growing line of reports after reports.

Dr Jeremy: Yes, we love to discuss a report in this podcast. 

Val: Because his country likes nothing but to produce reports. 

Dr Jeremy: Yes. We looked at 40 years of reports all saying the same thing. 

Val: Yes.

Dr Jeremy: Health inequality is real. It's unjust. It's rooted in social structures, and we need to do something about it. But every time something will get done, we get a change of government, and they bury a report. Or a government says they want to do something, but then there's some sort of economic calamity that means that we can't. 

Val: But the main thing for me with these reports, we talked about three main ones, the black report, the Acheson and report and the moment review he did two 2010 and 2020 even though the report still said the same things.

Val: [00:05:00] Inequality has been exacerbated after the black report was done. So we know that there was another report, was called the social divide. And we know the black report, nothing was done. That was under Thatcher's government, but then what I, Don't like about these reports.

Val: It's all well and good having the reports and data in front of you but there's no commitment to deliver on these recommendations, unless they are mandatory, I don't see the point. If you live in a certain postcode, you have less access to services, or there's more obesity or diabetes, and then nobody will see.

Val: Actions that report, we do a lot of talking, we do a lot of writing, we don't do a lot of action taking. And that's the bit that I do [00:06:00] not like, which we will talk about in our common sense. So the last episode last week brought us up to date, the Lord Darzi report of 2024. Yes. That gave us the harshest diagnosis yet.

Val: As we said, we are flat lining. That's a terminology that we use. The avalanche is there and we're trying to shovel the snow and we still got an avalanche. So do you want to say a bit about that? Yes. 

Dr Jeremy: Yes. This recent report by Lord Darcy is the one the current government is trying to implement some of the things that he's recommending.

Val: Yeah. 

Dr Jeremy: And so talking about needing to, rejuvenate the NHS workforce and make a number of different changes. They've already abolished NHS England. And the folding that into the department of health. And they, most [00:07:00] recently this announcement of community health hubs which is one of the recommendations about moving patients out of large hospital centers that gobble up all the resources and more giving people healthcare.

Dr Jeremy: More directly into their community which is going to be better. So I think that brings us up to date, although not trying to get too political, but I think the 

Val: next report, 

Dr Jeremy: Not meaning to get political, but the current government is announcing things and they can't seem to get it across the line.

Val: I have some faith in this health minister. But it's going to take government, local authorities. It's going to take us all to actually implement these things. We also have responsibilities. For our health instead of shoving down KFC every night, [00:08:00] I should eat better.

Val: There's a lot I could do better I don't expect the government to nanny me. I don't expect them to come around and say, look here's a bowl of fruit and he's a salad, so at times that, there's going to be a lot of education.

Val: I'm glad they're going to be talking to supermarkets because that needs to change, but we'll get into that. We've heard the evidence. Seen the patterns, the time for awareness has passed. No more reports, now it's time for action. In the next part, we're looking at common sense solutions.

WHOOSH SOUND: Mhm.

Val: This is something I like make health inequality, everyone's business, because if we said in the social determinants of health, It crosses everything, [00:09:00] income, housing, education transport, access to services. So it should be designed, I said before, there should be a stick of rock you cut it open and it should say health inequalities.

Val: Going through that stick of rock, it should be everyone's concern. Something seamless from each department in government. It's not an isolated. Issue within social care and health department. That is what I'm trying to say. 

Dr Jeremy: Yeah. 

Val: So even if you don't have a health condition, you could be suffering from health inequalities. If your housing is bad. 

Val (2): Exactly. 

Val: Mold. People think, oh, it's housing. No. Yes. It's a housing issue, but also a health issue. If we start from that point, 

Dr Jeremy: I think it would 

Val: make a difference. 

Dr Jeremy: Yeah, I've mentioned it a couple of times, but I think one of the [00:10:00] solutions has to be.

Dr Jeremy: And I don't know exactly how this would be done, but thinking out loud here, I think we have to have the idea that we shouldn't be keeping budgets completely separate from each other. We need to recognise that if we don't spend money on one thing, we end up spending it on another 

Val: Haven't you noticed that when one budget goes eventually always ends up in the NHS. Haven't you noticed that? The end result is you don't fix housing. Person gets sick, NHS. If you're working, zero hours contract. You haven't got time. You can't afford to take time off to see your doctor. You could have anything. You could have, Cancer. Let's say you don't go to your really ill. Any of these things eventually works its way. Into the NHS, that is the number one [00:11:00] budget that gets bigger and bigger. 

Dr Jeremy: Yeah, I think that's right. So I think at the level of government, we need to recognise that separate budgets and departments end up trickling into the same. The way we allocate resources, for these disparate things schooling or how we fund things according to local property prices, meaning that some boroughs get, get resources or get services. And some don't because there's so called deprived boroughs.

Dr Jeremy: Rather than individual communities getting services based on property prices, pooling everything together and giving Everyone the same level of service, regardless of where you live, might be one solution. So I think there is a budgeting kind of solution to some of these problems.

Val: Every policy, not just health should be evaluated for its impact on inequality. In education, there should be a team That looks at the impact on [00:12:00] health inequality, they should be a core team in every single department is like we said, if each department are cutting like they like to cut, eventually that cut deprives a certain group.

Dr Jeremy: Yeah.

Val: And eventually when it gets worse. Nine times out of 10, that cost goes straight to the NHS. We already know social care isn't working. Until that gets working. Everything goes to the NHS until we get more GPs where people can access their GPs. People are going to go into A& E more, which is a bigger cost. People are going to take up a bed, which is a bigger cost. If your housing is bad, you'll stay longer. If you're elderly, you can't take care of yourself. You're staying in a, hospital bed even longer. So [00:13:00] the cost. Always is in the NHS.

Dr Jeremy: Yeah, I think that's a good idea, Val. In the same way we do environmental assessments, like if you wanna build a building Yeah. Or a transportation project. We do an environmental assessment. What's the impact on the environment of this thing? We could do a health equality or inequality impact assessment. For any project. I think that's a good idea. 

Val: I hate, as we talked before the words that we use which you are now becoming accustomed to. 

Dr Jeremy: Yes. 

Val: Stop using the word deprived. I really do use words where you want healthier communities stop saying deprived. When you keep saying that it's always going to become that. 

Dr Jeremy: You mean by that? Val, when you say, if you use a word, it becomes that. Like a self fulfilling prophecy 

Val: We already know there's a lack of certain things there, which makes that area more deprived. But if you keep telling people where they [00:14:00] lived is deprived, you don't have this, you don't have that. Okay. I'll take it back a bit. When I was growing up, I didn't know my life wasn't as good as somebody else's. I didn't know that. 

Dr Jeremy: Oh, okay.

Val: I was just living my life. . Didn't know. It didn't, bother me.

Dr Jeremy: I gave an example of a patient looking for mental health care in the community. Told they had a two year wait. Said why do I have to wait so long? And the person said it's a deprived borough. And it's that's a description, it's not quite the explanation. It's just, it's yes, I know I'm deprived, but no, why is but the question she was asking, like she, was saying, she knows she lives in this borough, but why is it deprived? Why are we not funded? That's it.

Val: Exactly. Cause those are the very areas we talked about, I was involved in new deals for communities back in 2001. It's all right. Using the word [00:15:00] deprived, but if you are still using that word 20 years later, then you ain't done nothing.

Val: . The dial hasn't moved these areas shouldn't still be deprived. If these areas have been labelled deprived for so long, why haven't they moved on? That's exactly where the mental health services should be. That's exactly where the GPs should be a more of them exactly where more social care and health should be to take it from an area of.

Val: So called deprived to an area that is healthier, more on par with other areas. We shouldn't have a system where inequality is so wide. That is what I'm saying. It shouldn't be so wide I admit that yesterday I had to book for [00:16:00] a pneumococcal vaccination.

Val: I booked it. Then I got a call an hour later. From the doctor saying, you've booked this. Are you still caring for your son? Yes. I'll extend the appointment so we can talk about that and do an assessment. 

Dr Jeremy: Yeah. 

Val: Okay. Simple thing. 

Dr Jeremy: Yeah. A visceral reaction to the word, would it be fair to say that the real problem is when the term we use to describe something, whatever that term is, 

Val: yeah.

Dr Jeremy: We want people to respond by saying, that's where the resources need to go rather than as an excuse for, can't do anything. Isn't that the problem? 

Val: I gave you the opposite coin to that. Okay. I live in Kensington and Chelsea. 

Dr Jeremy: Yes. 

Val: As soon as you tell people 

Dr Jeremy: snooty neighborhood.

Val: Not snooty. Get [00:17:00] lost. As soon as I say where I live, Ooh, I could be living in a wheelie bin, love, everything. But yet there are two parts to this borough. You've got that long road, Ladbroke grove, one end is on, as they say, on the poverty scale. The other end leading up to Holland park is wealthy.

Val: But yet the overall riding factor in people's minds is that we're okay. Do you see what I'm saying? Just because we live in this borough. People don't think there are pockets. Of neighborhoods that are deprived. No they bypass that. Say we're all rich. They're not bloody rich, but then you'll mention an area.

Val: In the North of England, people think the North is really bad. You'll [00:18:00] mention an estate or area known for being deprived. But there'll be people there working, yes. People there with good jobs. 

Dr Jeremy: Oh, of course. 

Val: Yet we label it all that, and don't think there might be a pocket in that neighborhood doing okay.

Val: . 

Val: Do you see people think, we don't need as much because we're all okay in K and C when we're not. The house prices in this borough don't reflect the low income in certain areas. The house prices are high, but yet there's a lot of poverty as well as a lot of wealth, but in people's minds, the wealth overrides the poverty.

Val: But then that's not fair. So it's what people think of an area when you mention it. You mention certain parts of North, okay, [00:19:00] Chipping Norton. They think, ooh, people there, they've got money. Now, I've never been there. There might be a little area

Val: where people are not doing as well, but we tend to do that because we label, we talk about it before labels, 

Dr Jeremy: Yeah 

Val: It doesn't help. We've got to get to the stage where, it's deprived now, but that's not where we want it to be. If you keep saying it is. It's going to stay that way. It sticks in people's minds. 

Val: People might not invest in that area. People might not set up businesses there. If indicators say, it's deprived. You want an area like that to thrive. You want to bring people in. You want to bring housing in. You want to bring in businesses.

Val: Yeah. Resources. You want to make it healthier. You want to make it more attractive. But the more you keep saying [00:20:00] it's deprived, no bugger's gonna want to go there. 

Dr Jeremy: Yeah. That's one of the solutions we talked about give resources to where they're needed most.

Val: Yes. 

Dr Jeremy: If you have a community that needs resources, rather than just using that label to shrug your shoulders and say that's the way it always is. That should be a magnet for resources. 

Val: That's for one. Make health inequalities everyone's business.

Val: It's not just about policy, not just about health policy. We want everywhere to evaluate its impact on inequality. We want to embed equity. Is it equity? 

Dr Jeremy: Equity is, similar to equality, but rather than treating everybody equal. It's recognising some are starting out further ahead we want to do is give resources again, where they're needed so that we achieve [00:21:00] equality. 

Val: We want to embed equity in everything, transport, planning, employment, education. They failed on transport when HS2 started in London as usual, they said the North is deprived. God forbid they start a major project in the North. And then it comes down to it. Oh, we can't afford it anymore. And it doesn't reach the capital. Yeah. Do you see what I mean? And that's so sad. Yeah. It's like the North is always short changed.

Dr Jeremy: That was another solution that we proposed is why don't we do some things backwards? That is, if we're going to start a project, 

Val: yeah. 

Dr Jeremy: Start in the North. North. See whether we complete it then. If we're going to make another report, rather than spending a whole lot of time talking about the problems. Put the solutions up front. 

Val: I know. I hate problems. Let's move on. Episode two we looked at social determinants. So invest in the social determinants. Like we said before housing seems to be getting [00:22:00] worse. Social housing, really bad. Too many deaths. Awaab law came into force, I think was October last year. We'll see how that is going. But as far as I know, it ain't going very well, but since then another child has died, think it was due to housing So we know what happened after Grenfell. You would have thought around the clock that would have been taken down cladding up and down the land. 

Val: No such bloody thing. So it's you look at what's the right thing for them to do. Take a hit on the money and put people's lives first, cost to take it down, people's lives. They have to make that choice. They've already made the choice. Because after all these years, the cladding is still up. That tells you all you need to know,

Val: [00:23:00] so we know affordable housing, people need secure jobs. I think they talked about that just recently, getting rid of zero hours contract I don't know how that's going to work because you look at places like, is it delivery places like that? I don't know how that is going to, as I said, there's always a wishlist, but where's the meat on the bones?

Val: How is it going to happen do you bring in these companies? Do you say, look, this is a policy we like, how can we work with you to make this work? Instead of rising off the hoof and thinking, yeah, this is what we'd like, nobody wants to know one day they've got work. Next day, they have it because you can't budget one month. You've got money. , Next month you haven't, eating or not eating is not an option. Paying your [00:24:00] bill is not an option. Yeah, not like whether you want to implement a report or not.

Val: Bills is not an option. So that, I don't know how they're gonna sort that out. Quality education. It's like everything's going down the tube.

Dr Jeremy: Yeah. 

Val: They need to sort that out, whether it's special needs education. Had to fight for that. Thank God he's 31 now.

Val: They've just got to think, about prevention, not just cure. My doctor phoned me back. Let's talk to her a bit more. Find out what she needs help with prevention. It's Prevention before I could get worse. I remember that call when I was shopping and the GP called me.

Dr Jeremy: Yeah. 

Val: I said, Oh, I've got to stop. I'm not breathing right. And he [00:25:00] said, what's going on? I said, my neck and things like that. But because I have lung disease, we thought it was my lungs. So I went in for that. As we later found out it was my heart,

Val: Do you see what I mean? Yeah. This is the thing is about prevention is about trying to catch something early. We MOT our cars We have insurance. On our homes. God forbid our laptops phones or in your case, your dog gets stolen. 

Dr Jeremy: No, my dog will never get stolen.

Val: Oh, jeremy.

Dr Jeremy: I never leave him alone. 

Val: So what I'm trying to say is we have insurance on everything.

Dr Jeremy: Yeah, 

Val: When was the last time you went to see your doctor? When's the last time you had a check? Checked your blood pressure, your saturations?

Dr Jeremy: The last time I went to the doctor was about six months ago. For a health check. I donated blood a little while [00:26:00] ago, so I didn't get my saturations checked, 

Val: Okay. 

Dr Jeremy: They do checks and things and the whole idea of prevention should resonate with policymakers because 

Val: yeah, 

Dr Jeremy: Prevention saves money. The sooner you catch something, the cheaper it is to fix

Val: so even if you brought it on, the little sats monitors you can buy.

Dr Jeremy: Yeah. 

Val: If everyone got taught to use one of those at home their blood pressure, Monitor that can help find a way where we talked before about AI, which they are investing in, we can input our numbers. If something alerts wherever it goes to, then they say, Go to X, Y, Z, I got to look at things people can do at home for ourselves. I'm always doing temperatures at home. 

Dr Jeremy: Yes, there's really great stuff right now with all these wearables electronics that that monitor parameters like blood pressure and heart rate and things, [00:27:00] oxygen saturations. Essentially what's really good about that is people can have.

Dr Jeremy: Essentially do biofeedback with themselves. So biofeedback is just basically taking one of these parameters and presenting it to a person in a way you can see, you can't feel your blood pressure, but if you have a beat to beat measurement of your heart rate or your blood pressure that you can see on a screen, 

Val: Yeah 

Dr Jeremy: now you have a certain level of control because there's things you can do.

Dr Jeremy: to lower your blood pressure. If you're doing relaxation, you will lower your blood pressure. And if you can see your success on the screen, then you know, you're doing it right. So this kind of information can really help people. To do things to help make themselves healthier. 

Val: I read somewhere there are community well being link workers, something like that.

Dr Jeremy: Yeah. 

Val: Especially if there's someone not able to take their own blood [00:28:00] pressure, SATs, temperature, there should be somebody to visit them at home we've got to think prevention, not just cure, what can we do to help people help themselves at home?

Val: Okay. So let's look at what we talked about. Episode three is about protect the most marginalised when we looked at these groups. So in those groups, we have ethnic minorities. We've got disabled people people living in poverty, which is not about color low income. Those groups could be the protected characteristics.

Dr Jeremy: Yes, 

Val: We need to fund culturally competent care. What does that mean to you? 

Dr Jeremy: What does it mean to me? 

Val: I'll tell you this When I look online, my son has just [00:29:00] gone through a rash or his body. You can always find what it looks like on a white body. Very few of our color. in some cases, it will take somebody from your own culture. Do you see what I mean, whether it's someone that works with the trans community ethnic minorities the disabled community, sometimes it takes that specialist but I don't know, in some cases, 

Dr Jeremy: I think what we mean by that bike, by culturally competent, it just means people who are familiar and understand.

Dr Jeremy: A group of people intimately, you just have a better understanding. For example, doing a workshop on, healthy eating. 

Val: Yeah. 

Dr Jeremy: But you're recommending everyone go to Whole Foods and buy fancy expensive stuff. [00:30:00] Not as effective. You need to know where people are at.

Val: I remember we did that where I used to live. This woman told Jamaicans, stop using coconut cream in your rice and peas and chicken. Really? 

Dr Jeremy: Not going to go well. 

Val: That ain't going to happen. Because culturally, whether you're Greek and you traditionally cook Greek food, you traditionally cook Italian food, Spanish food, Caribbean food, and everyone's got a way of cooking.

Val: And he takes another person, whether it's a language barrier. I have a neighbor who's Spanish. And sometimes I find it hard understand him and he finds it hard to understand me it's easier for him to get it. When it's spoken in his first language, it's a lot easier, so what I think we need culturally is not just about color, that language barrier and understanding how that culture does things [00:31:00] differently.

Dr Jeremy: Yeah. And yeah, so understanding obviously giving people information that they can accept, but also giving it to them in a way that they can understand. 

Val: We're going to tackle systemic racism in health systems. West Street is doing another, I don't know if it's another report or review, looking at. Maternity care, black women. 

Dr Jeremy: Another report.

Val: Come on.

Dr Jeremy: We'll have to make an addendum and add a report to our series. 

Val: Because I've made a comment, I made another one. Make services truly accessible for disabled people. I remember I watched this award show. They knew they were given an award to somebody in a wheelchair and they never made it accessible for the person [00:32:00] to get on stage to get their award. 

Dr Jeremy: the person has to stay in the audience.

Val: They moved up and then couldn't get on stage. That tells you a lot, tells you a lot. And as well, what I've noticed, I know we're going off topic, talk about disabilities, you know what else I don't like. After the Olympics, we have the paralympics. Why is it they have a party?

Val: Before the paralympics is finished. So they'll have a party to celebrate the Olympians took part in the Olympics. Yes. In great Britain before the power Olympics is finished. Don't you think all Olympians do you see what I mean? I've always found that strange. I think we're supposed to be inclusive.

Val: Talk about an inclusive society, but yet [00:33:00] treated them differently. I was watching a show the other day. And, , I can't remember his name, the guy out of JLS, one of the singers he's doing something to help young carers, we talk a lot about carers.

Val: But a young carer can't get to school because the person they're caring for needs them at home. Or they can't do an after school club because they're going to rush home to cook. They can't go out and play with their peers because they've got to go home and cook.

Val: They're doing what adults do. When you look at the age, we are children for a very short time. Up to 16. 

Dr Jeremy: Yes. 

Val: From 16, we're basically adults. So our childhood window is extremely short. Time is spent caring and [00:34:00] not enjoying the joys of childhood has to offer because there's no support for you.

Val: You're falling behind at school. Where's the hope for that person, even when they become an adult, it says a lot when we have the seventh richest country in the world where we've got young carers. 

Dr Jeremy: Yeah. 

Val: Gone are the days where we sent them up the chimney. They shouldn't be doing that. 

Dr Jeremy: Yeah. 

Val: Not the way they're doing it now. No. They need something more around that. I don't know if they do. But they need to do more. Okay. Let's look at episode four. Stop commissioning report.

Dr Jeremy: Yes. 

Val: Stop writing reports. . Stop it. And start committing. All in. full commitment. 

Dr Jeremy: Yeah. 

Val: If you're gonna do it right. Go hard or go home. Of them. But [00:35:00] there's no point in me reading a report for, oh, they're going to do this. And then I get to the end. One report said is not going to be legislated , meaning they can either do or they don't. Oh God. Oh, 

Dr Jeremy: right. The point is we've been looking at these reports for 40 years.

Val: set up legally binding health inequality targets that are timeless and accountability, whichever government is in. That's why I keep saying. Dr. Joe, now you understand, like it's saying, take all this out of government control and whoever's in power, they can't mess with this.

Val: That has to be something that says, okay, this is the last 10 year plan. And we'll see how it goes for 10 years, because a 10 year plan is going to take 10 years. That's how long it's going to take. Yes, you're going to see things happen [00:36:00] probably in the first three years I haven't seen the plan, so I don't know the milestones are and blah, blah, blah. But it's going to take 10 years. I don't want another government to come in.

Val: I don't want another government to come in and scrap it. We're looking at another election in four years. So I don't want it scrapped off after five. That's if labour make it through the five years, I don't want it scrapped.

Dr Jeremy: No,

Val: after that, you want this to be the report that is fully committed is a very good report. It's at the crucial stage where we know the NHS is flat lining. And it's like it's on its last legs. 

Dr Jeremy: Yeah. 

Val: And it's make or break and I hate the handprints all over it. Empower public health leaders. [00:37:00] Politicians. Commissioned the report. We've got to get public health leaders and social care to buy into this. Deliver on the implementations of the recommendations.

Val: politicians now take a step back and empower those that are on the ground and lead in the charge to make the difference. And don't fiddle with it. Because you don't work in the NHS day to day. Come to the dispatch box and make your announcements, update us now it's a time to take a step back and allow this 10 year plan to go into full 10 years

Dr Jeremy: I think it's important because a lot of these changes, they're not easy fixes, right? So if we think about, what do we need to do to fix the workforce problem that we've got? [00:38:00] So it takes a long time to train people, to do these jobs. It's not something you can do in a year or two.

Val: Yeah. Episode five, , rebuild trust in the system.

Dr Jeremy: We need to. Fix our workforce because we've got shortages that's not something we can fix quickly

Val: they just made a big booboo with the yeah. Social care visas.

Dr Jeremy: Suspect there's another I 

Val: suspect there's gonna be another one. I can feel it

Dr Jeremy: but whether they do or don't, it, it takes a long time to train people to do these jobs 'cause they're highly specialist.

Val: Exactly. So you think that they would wait, train people before they say we're not doing anything and I think one of the issues that Labour has. They're too concerned with what reform are going to do, or what reform is saying. And if they keep doing that, they're going to be making a lot of mistakes, doing a lot of U turns.[00:39:00] 

Val: Labour's best when it's labour, and they've got to remember that. They've got to stay true to who they are, to their values, their principles, and not chasing reform. They are not reform. And for them to do the visa thing without what answer what's going to replace that nothing.

Val: Social Care has already got a big gap already in its workforce and then they go and do that. It makes no sense whatsoever at this time. At this time, it makes no sense when you have no plan B. They're just hoping by some miracle that the British workforce suddenly apply for these jobs, that's going to take a while to be talked about that before that's going to take a while, and I think it's one of the facts that they think.

Val: Working in [00:40:00] social care homes. And that is a low skill job that any old jackal Jill can do it. And I think that's one of the mistakes they and they've got to change that. We talked about that before. Get a register like they've got in Scotland and Wales.

Dr Jeremy: Raised the status of the profession,

Val: exactly upskill it, let the staff know that there's somewhere that they can progress to properly to become nurses that can be the stepping stone, perhaps, they've got to think of different ways of training nurses as well. That can be a stepping stone. into nursing, working in a care home and studying at the same time.

Val: I'm just thinking out loud, but that could be another route. We're short of nurses. We need more nurses or even doctors. Wouldn't it be good if you actually had a trained doctor that started off working in care homes? 

Dr Jeremy: Sure.

Val: That's [00:41:00] experience. 

Dr Jeremy: I was thinking about making these jobs more attractive to the local workforce, right?

Dr Jeremy: Because a lot of these things that, these are necessary jobs, but they're jobs that are not attractive to people. So there's a lot of people who don't want to do the jobs. You're not going to fix the workforce problem until those jobs are attractive.

Val: Well respected and appreciated by the government. And this is especially in deprived areas. I've read GPs are fleeing deprived areas, perhaps because there's not enough of them. They're overworked. They need to look at that as well. Yeah. And we talked about this before shift focused on hospitals. The hospital should be the end result.

Val: Our aim should be, let's keep them out. And you only go in where you really need it, which of course we do, but like we said before, when it [00:42:00] comes to mental health, that's no place, A& E is no place for someone that is having a mental health episode. No place for that. It needs to be community based person centered care. How that works. I don't know. I don't work in gov. 

Dr Jeremy: That's consistent with what the government is doing with these community health hubs. I think that is part of the process. And I think there's other initiatives out there that are trying to address people's health needs in the community, particularly if they're lost to follow up because they don't want to come into large hospital centers. That's great. I

Val: Yeah. Okay. Let's look at the last segment here. What's standing in the way? So things , we've talked about, they aren't radical ideas. We know some are happening now. If they're not, why haven't they? 

Dr Jeremy: One thing, we talked about is, political leaders, the people assigning [00:43:00] budgets and making decisions are concerned about things right now. It's concerned about reform, but, anytime you're trying to go somewhere and you're worried about the concerns of the day, you end up zigzagging back and forth and you if you just knew where you want to go and make a straight line for that goal, regardless of what's happening, you'd get there quicker.

Val: We also talked about political short termism. 

Dr Jeremy: That's really what I'm referring to.

Val: My number one thing is take health inequalities out of politicians hands,

Dr Jeremy: Yeah. 

Val: Labour, conservative reform, a new party is in power. It doesn't matter. If this, there's a a blueprint that will always stay and be worked on, irrelevant who's in power , budget cuts as it's, when they talk about reform, we're going to reform the system. You're cutting. Look what happened the [00:44:00] other day with DWP with 

Dr Jeremy: PIP and universal credit these cuts are designed to save money we do have, serious, but why start with 

Val: PIP? A lot of disabled people get PIP, they work. People forget. They work.

Val: Job seekers. People should be seeking job. They are not working. Why did they start with PIP 

Dr Jeremy: with disabled? 

Val: Why these are the people that need it to stay in work 

Dr Jeremy: precisely at the end 

Val: of the day, they thought they'd pick an easy target. Did they get that wrong? They ain't going to save nothing. Anything is going to cost. They're not saving nothing. At all. And it was an embarrassment. It was just awful. It was, and it's like everything they wanted to rush through. Why would they vote this through and the review by [00:45:00] Steven Tims?

Val: The disability minister hasn't even been published. It's like me walking around with a brolley and it's sun shinning Oh, it might rain. It's just ridiculous. Wait till the review. Or work on it more! They knew People didn't like it.

Val: They knew there was a re rebellion. There's no working with, there's this is what we're gonna do and then here, vote on this. Apparently what I read or I heard on the news, he hadn't even met the back benches.

Val: Cause usually they'll come in small groups to meet the new prime minister. He ain't done that. That tells you a lot. Anything you want to do, he should know this. Take people with you. If you don't take them with you. Those same people behind you are going to go against you. That is exactly what happened. , It managed to get through but with the concessions. 

Dr Jeremy: Yeah. 

Val: [00:46:00] So he practically chopped off his limbs. What was the point? So you need a system that listens. we've got a system that listens to data, but not to people, they need to work with these groups more, whether it's disability groups, organizations that work with disability groups, people that live in social housing, whatever, there needs to be more.

Val: around because they keep talking about people centered care. Do you see what I mean? But when they're looking at the quote unquote reform, it's not reform. It's cuts.

Dr Jeremy: At numbers and data. If we look at health inequalities and we treat them as a technical or a budget problem, we're missing the point.

Dr Jeremy: It comes down to a moral choice. What kind of society do we want to have? A 

Val: healthier one, 

Dr Jeremy: if we want a healthier [00:47:00] one, a

Val: equal one, a 

Dr Jeremy: Or at least 

Val: one. 

Dr Jeremy: Yeah. Right. 

Val: People are not stupid. They know they're all going to be rich people. Sure. They want people to pay their fair share of tax. If they want to leave the country by. Stop threatening the government by saying, if you raise taxes and we're going to leave, sod off then. 

Dr Jeremy: I think it's fair to say that people want.

Dr Jeremy: Conflicting things people do like to get things but if they really think about it, what they want everyone to get something. 

Val: Of course. 

Dr Jeremy: Yes, I like to get things. But I also, want to live in a world where everybody gets things too. It's a moral choice. 

Val: Yeah.

Dr Jeremy: Yeah. 

Val: It is so let's look at a call to action. 

Dr Jeremy: Okay. 

Val: If you work in policy, push for cross government accountability, I don't think there's enough accountability. . There isn't you always hear of people going to [00:48:00] court over whether it's somebody has died in their housing or let be case or whatever it is.

Val: But there's no accountability. . None at all. And it doesn't take anybody with a PhD to say that if you live in a house that is covered in damp and mould the likelihood is it's going to affect your respiratory system. When you're very young, you've got a condition or you're very old.

Val: It's as simple as that. If you don't know that by now as head of housing, you shouldn't be head of housing. . You may not be able to move them to a decent home immediately. This is when hotels. should be used. 

Dr Jeremy: Yes. 

Val: That's the bottom line.

Dr Jeremy: For our listeners if you're a health worker, it's always about pushing for better outcomes for for patients. And ourselves, I think that, healthcare workers, rather than [00:49:00] just, following a checklist, just actually asking yourself, reflecting a bit and saying, what could I do better? What are the better outcomes would like to see for my patients? 

Val: Yeah. 

Dr Jeremy: Yeah. If you're a healthcare worker, if you're not in a position to make changes escalate to someone who is 

Val: If you're a community organizer, keep building power where it matters most.

Val: We've got to empower people more. We've got to. You've got to give them the resources that they need. You've got to give them access. You've got to give them information. Everything that they need to empower themselves to make better decisions. Don't need to treat people like babies. They they don't, some people just need help and support.

Val: We are adults and whether that adult lives in an area that you label deprived or lives in an area that's not labeled deprived, you treat people [00:50:00] different.

Val: So even though where I live, I still need to be empowered with certain things, but I'm okay, but the people that you need to

Val: really empower are those at the other end of the scale, because everybody wants a better life. I don't believe anybody Wakes up every day and say, I want a shit life ridiculous. I want to live in a deprived area. I want my housing to be bad. I want to live in poverty.

Val: They don't circumstances beyond their control. Is led them to be living the way that they live. It is not a choice. Some people want to work. I heard on the news, this young woman, she left university applied for hundreds and hundreds of jobs. Now, if a graduate can't get a job, [00:51:00] how do you expect someone at the other end of the scale that's probably been raising their children for years, out the job market for years, how do you expect them to do it? Just because it's been easy for a certain group of people, nepotism. 

Dr Jeremy: Yes. 

Val: And cliques in government. Things like that works for them in the real world people at the other end people like me probably people like you We don't have a friend that runs XYZ that can just give us a job. 

Dr Jeremy: No, I was involved

Val: hard to get a job. 

Dr Jeremy: I was involved in a hiring process recently. There were over 50 applicants even if you're, in the top 10, you still only have a 10 percent chance of getting the job.

Val: Exactly. That's where inequality comes in. There's inequality in everything.

Dr Jeremy: The job market is. [00:52:00] Tough in some areas. 

Val: Okay. and if none of these work, if you're none of those things we mention, I can't stress it enough.

Val: I would never tell anybody how to vote. I but I would tell people to vote, vote, volunteer, speak up. I started by getting involved in my local community. When new deals for communities came in, when Blair was in power in 97 and they created these new deals for communities around 2001 I was involved in that, so you start off locally, everyone's got something to offer, I don't want anyone speaking on behalf of me on my life.

Val: Only I know how it is. Whether through a podcast or locally I'm going to use my voice because it's one thing we all have. Another is to use it. And let people hear you and [00:53:00] respect what you say, not all of us are going to be able to say it in a way that politicians or people that write policy speak.

Val: I don't speak like them, but before I was like, Oh God, who's going to. I, is it my place no, you're damn right. It's my place, people have to learn to use their voices more. yes, people will say, Oh, I'm not voting. They don't care about us

Val: , if you don't vote, the data shows up the ethnicity of the people that voted the age group of the people that voted. The area who they voted for, 

Dr Jeremy: right into the more people who vote, the more valuable the more attention those groups get, 

Val: okay. So because. When we say health inequality, we're not just talking about statistics. We're talking about people's real lives, real losses and the solutions. They are not out [00:54:00] of reach. They just need courage and commitment.

WHOOSH SOUND: Mhm.

Val: So that's the end of this episode. Dr. Jeremy's going away. Is it the next three weeks?

Dr Jeremy: It'll be 10 days.

Val: Missing two episodes. 

Dr Jeremy: Yes. I'm going to miss two episodes. 

Val: You're going to miss me or the dog more. I I don't know why I said that because I

Dr Jeremy: think we know exactly who I miss the most. Yes. 

Val: Oh, Jeremy, really? I think the dogs are very upset you're going to be missing me.

Dr Jeremy: Junkie will be jealous. 

Val: I'm going to plow along without you, we hope you enjoyed today's episode. Let us know of your common sense solutions. Let us know what you think of what we've said follow us on on Twitter, Instagram, and Facebook, and

Val: Have a nice [00:55:00] holiday, when you're away having a nice time, think of me back here, slogging away, 

Dr Jeremy: sweltering in the heat,

Val: okay, 

Dr Jeremy: good. Okay. 

Val: Thank you bye. 

Dr Jeremy: Thanks Val. Bye. Bye. 

Val: Bye.

OUTRO MUSIC: You