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neoliberalism is ruining everything - the food system is poisoned, zero community cohesion, school is a disaster for millions of kids, most people hate and are harmed by their jobs - and all of this and more is being obfuscated . by the out of control mental ill health industry and the DSM mindset currently convincing every person and their dog that they have some voted into existence construct like 'adhd' and 'asd' and millions of children and adults are now drowning in dangerous largely ineffective psychiatric drugs - the amount of kids and adults now prescribed long term amphetamines is truly shocking - The DSM and its lates reinvention 'neuro' diversity movement is so profitable and mostly harmful.
As a physiotherapist who worked in the NHS for the better part of 40 years,both as clinician and service manager and then retired to France,I can tell you from personal experience the French system is light years better. Many more of the clinical staff are self employed and contracted in ,the management structure is less, Ambulance service is provided by the fire service. Preventative healthcare is a priority,GP's actually examin their patients (and continued to see patients face to face during Covid) So yes it will cost more, but the service provision will be excellent .An example my husband had his hip replacement done in six weeks ,eight if you include the two week wait for the Consultant appt.
The fire brigade in France does have some ambulances, but most ambulance services are provided either by the A&E departments of hospitals or by private companies.
Yes. We're so irrationally attached to the NHS. It's an awful system that hurts the good healthcare providers and patients the most. The french system is so much better. But people flip out in this country if you even suggest any changing to a more rational system. It's like they prefer a nice sounding sentimental position over a sensible, effective one.
@@John-kj7tvCorrect. UK is the only country in the world that treats it's public health system like a national religion. Makes it impossible to reform politically. Healthcare is just an industry, no different to any other. It responds to the same incentives.
As a retired doctor who has worked in hospitals in the NHS and the French public health system, I have to comment on the "three pillars" for NHS reform. 1. Computerization can help with simple things. But huge complex computer systems in the NHS and the French system were and are doomed to failure. (The one at the French hospital where I worked was an expensive disaster.) 2. Care in the community has been proved to be more expensive than equivalent-quality care in hospital. 3. Poverty and poor health are closely correlated. One effective measure of prevention is to increase lower incomes (and certainly not to cut pensioners' fuel allowance). Piketty ("Capital in the 21st Century", 2013) argues that a 1-3% wealth tax would provide sufficient funds for an efficient health service free at the point of use plus free university education for all.
Completely agree. I don't think there is any denying the NHS is in need of Reform and also prevention is like you said is so key. I've also seen prevention is a model they use in Cuba a lot. It goes on a Family Doctor and Family Nurse system and they try and do more community and prevention work for the population because they know that Cuba can't afford to see one misstep as its still quite frankly a poor country and given the difficulties they face they fair better life expectancy than the average country in South America and even in some areas do better than USA overall. It's honestly surprising what Cuba can do with such little money even though this not a glowing praise of Cuba as they do have issues on bed blocking and access to medicine. And, prevention is the cure but also while we might like to pretend that doing reforms can be done at no expense the reality is that it actually needs more money first before we see a return. And something neglected when they compare to other countries like Australia, France, Germany and the Nordic countries they do spend more per head, sometimes leagues more, than what we do. Whether it's in their taxes, out of pocket or European social insurance system it's no denying they spend more so it needs to be balance with bettering the bank account but make sure we are spending it wisely. And I think tying it back to prevention, I think that community led support is going have to see us putting more money in first before we see the rewards.
To actually reverse type 2 diabetes and solve morbid obesity took me about 2 months once I'd worked out that the standard dietary advice of the last 50 years is rubbish. It then took a few weeks of trial and error to work out what foods were good and which were pushing blood sugars high. Most of the preprepared packaged foods on the supermarket shelves are also rubbish. The problem in making a real change lies in getting the right information and education out there to the people who need it. After decades of hearing ultra processed food is cheapest and all we can afford it will take a lot of effort to change. In Italy families still teach kids to cook and just walking down the street you notice the lack of hugely overweight folk - and Italy is not a richer country than UK. They eat lots of fresh vegetables and fruit, relatively little meat because it's expensive.
Italy still grows a reasonable amount of food and has less fast food places… or it did in the towns I visited. They have more pride in their traditional foods and growing their own fruit /veg/herbs when they can, which are much healthier. How many times do you hear, eat a Mediterranean diet.
What a subject, the brutal truth is 1) don't consume sugar and, 2) burn more calories then you consume. Today most western societies have sedate, bored populations, they eat for something to do. Scandinavian & the low countries are a bit different, less in your face advertising, generally higher metabolism.
There's plenty of truth in what you've said but something I struggle to get past is how so many saying similar things seem to absolve so many almost entirely for their poor dietary decisions - in some cases essentially arguing that there's no free will involved and people can't be held in any way responsible (which I find impossible to square with our legal system). No one really taught me to cook but I've never found it difficult to find information if I want to know how to do something. That eating 'real' foods is better for you than ultra processed crap isn't some modern revelation. Surely most people are, deep down, aware that fad diets are going to be nonsense, and that losing weight and keeping it off requires permanent dietary changes. A lot of the claims about people having a lack of time are, frankly, nonsense, when you consider how much time the average person spends watching TV/media, or the fact that higher earners, who are less likely to be obese, tend to work longer hours (and are more likely to take their work home). Whilst some may (and I'd emphasize may, as a lot of this again comes down to poor decision making) be handicapped by prices when it comes to eating well, this is clearly massively overstated and seems to ignore that people in question, clearly, for whatever reason, are failing to use access to information they virtually all have (i.e. the internet).
I watched just the NHS segment, the other bits are important but I'm most concerned about the state of UK health. Current NHS spending is around £160 Bn per year and rising exponentially. But the state of the NHS is not the problem, it is a symptom of a nation getting ever closer to death's door. 64% of the UK population are overweight or obese, 26% are actually obese. 8% have diabetes of which 90% of those have preventable type 2 diabetes, a further 5% are pre-diabetic and without urgent intervention will add to the T2 figure, 4% have heart problems, 1% have dementia, 4% have COPD, 6% have kidney issues, 15% have chronic pain, 7% have cancer, 10% suffer from axiety and/or depression. Of those suffering individuals sadly reduced to statistics, probably 2 thirds are preventable. There are about a million people in the UK without access to a fridge, 2 million without access to a hob/oven, 3 million without access to a freezer. How can you be healthy with just a microwave and a delivery app? You could double or triple the amount of money spent on the NHS and it would still take 30/40/50 years to sort this out even if the NHS was the actual problem. The scope of the actual problem is our whole society and our relationship with food/exercise/work/time. Rory/Alistair, how about an actual useful discussion on that?
well you can tell people what they should do but you cant control what they actually do so ya know whats the point? they dont know anything about nutrition, excercise, diet
They talk about that in this exact video. Did you not hear them discuss the emphasis on prevention instead of curing and the implications on policy of that?
@@thenoobdestroyer100 This is true up to a point but there are ways of providing education within another framework. When I was a registrar training in psychiatry I led an educational group of about six young offenders who had been convicted of alcohol-related offences. I was able to explain the effects of alcohol and to suggest strategies to reduce their consumption. I don't know if it stopped them re-offending but their attitude to the group was positive.
I studied public health. Health promotion etc. BSC. MSC hard work - I invested my life in health prevention. Then government pulled the plug leaving me with no secure career pathway or employment. Today health prevention it’s led by third sector and charities and with respect - sadly it’s a mess. 😢
I had a career in Public Health. The idea was to prevent people getting ill, rather than cure them once they are ill. Unfortunately politicians have no idea of this concept.
(if you've got valuable things to say on the topic, why do you need a government job? This is the number one problem with healthcare in the UK, it's a black hole for our taxes and it's full of people who couldn't possibly find employment without a government backed monopoly) We need to scrap the whole thing and let the actual doctors and nurses and value adders get employed and let everyone else go.).
@@TranquiloTrev Yh, it's the same problem as the lack prisons. They get far more public credit for spending money on responding to problems than they do for preventing them in the first place so that's naturally what they do. We could do with an independent body (kinda like the OBR) for health that has the ability to review and criticise govt. plans so that the govt. actually has some incentive to plan ahead
Something Rory gets wrong here is that AI will make unions upset as it'll get rid of healthcare jobs...we're already understaffed so the idea that people are going to lose jobs to AI is laughable
AI could theoretically eliminate an entire job role, even if overall headcount still has to increases as you suggest. Unions would definitely still resist this as although most of their membership would be unaffected, for those that are the change would be severe
Don’t forget the population is getting older so the use of the NHS is growing so this will always push costs up. Also remember the extra cost is always off set to some degree with more people in work and better outcomes for the public
Yup, back in the 1980s when it was tax cut cut cut across the west was when government should have started saving for when the boomers got old, but the boomers wanted those cuts, now we're stuck without enough tax base to pay for the services we want.
@@gorgu08 Your argument is misleading: People in their late career do tend to be wealthier as a result of building up savings ahead of retirement. That doesn't mean they have more disposable income though! Once retired they have to live entirely off their wealth without a salary so they typically become poorer with age after that peak
If the Healthcare system took a more holistic approach to heath. The tax payer and the patients would be better off. A better approach to what people put in their mouths would lead to a reduction in obesity, diabetes, cancer, demntia and many other problems that are currently only have symptoms treated by big pharma. In stead of treating the root cause.
VO2max (the exercise measurement of how much oxygen your body can process per kilo of weight) is also the single most important measurment in predicting length of life. It drops with age, with increase in weight and with lack of exercise. The lower it goes, the harder the body is working for day to day things. Once you've got older peole at a maximum effort to climb stairs, its not surprising things go bad, whether it's cardio disease or falls and broken bones. The health costs of older people have large multiples of the general health costs of younger people. To have healtheir older people you have to have healthier habits in younger people, that are sustained through their life. As it's population level stuff you only have to make a small improvement to start dropping costs by really large ammounts. And it's all easy stuff, better diet, more exercise as part of day to day life (active travel, less car use). Nobody looking at the problem argues about any of that, now over to politicians to find how to sell it to the public and to start to really fund it ;-)
I couldn't agree more thank goodness at least one reply to this topic understands the real issue for the NHS. We are what we eat and unfortunately people think they can go on stuffing themselves with the most unhealthy food without suffering any consequences. Whenever I walk into my local supermarket I cannot believe the size of some people and then you look at their shopping trolley and you understand why. I moved to a WFPBD sometime back and I only wish I had educated myself sooner.
@@Tridhos It's interesting too still hearing 10 years being called long term, as what you want on a population scale is lifestyle changes in current 45 year olds and younger carrying through to NHS savings once they hit 65+. Some gains come right away, but it's a 20 year span to really get payoff.
Yes the NHS needs investment in infrastructure and people. But one problem which I carnt see a answer to is accountability, top to bottom. I know people who work in the NHS at all levels who have worked in the private sector they spend most of their days saying what the Fuxxxxxx . It’s like the old joke, question, how many people work in the hospital, answer about half of them. I don’t have the answers but more accountability at all levels is needed
No amount of reforming strategising cutting waste is going to save the NHS. It's very simple, it needs proper funding, and the money can ONLY come from tax. Not from borrowing, not from taxing only the very rich, not from withdrawing support to Ukraine, not from kicking out immigrants. Tax, from most taxpayers. The British people have shown time and again that they prefer tax cuts over paying for the NHS. A recent survey showed the average person is prepared to pay only 10 pounds more in tax to fund the NHS. Hey here's an idea, why not just bang some pots and pans when a nurse walks pass? Worked so well the last time, doesn't cost a penny and the nurses love it.
Here's the big problem with productivity - it means in general a much poorer service because you are asking Doctors, Nurses, etc. to spend much less time with each patient in order to get the numbers up. These are caring professions and as such those that enter it want to give their patients the best possible care which does mean spending time with them, reassuring them and building relationships. If you tell a nurse she now can only spend say, 20 mins per patient per day and see double the amount of patients - yes productivity has improved but the standard of care has dramatically decreased.
I was a big supporter of Blair at the time. I came from abroad for the millenium celebrations. Very disappointed by the night, my first realisation Blair was overhyping and underdelivering. Remember the promises of a river of fire? It really wasn't.
No, it really wasn't. Couldn't see a bloody thing. But, do you have good memories of the night..? I do, and when all is said and done, life is what you make it. And remember...Things can only get better....!
With 300 organisations in the NHS there are 300 management systems and that is the problem. All successful companies have a standard management system. That needs to be a priority to reduce non clinical expense and productivity.
It's absolutely damning that Alastair has been banging on about Tory corruption' for years but when the story breaks about Starmer accepting £100k worth of gifts it is dismissed with no comment whatsoever
Honestly I think trying to spin the O2 as a cultural landmark is worse 😅 They're both examples of his chronic inability to see things through any lens, other than 'red good blue bad'
I’ve had post viral ME/cfs for 28 years. I am housebound and mostly bedbound. Now millions more have it from Covid because the NHS has never taken it seriously. I was very healthy (vegetarian, exercised and doing a Ph’D before that). The only reason I can’t work is because of the NHS failing to take it seriously. Now thousands of Drs have it and are finding out how serious it is and they too are being gaslit by colleagues.
Rory, you mention complaints from the Aussie listeners from missing out and returning to Oz for a SECOND tour without even touching ground on NZ soil once! What about us? 😭
Yeah Rory, what about us, another New Zealander I've listened to every episode since those 1st early days even messaged u both suggesting that u give more information on books as u mostly failed to mention the authors.🎉 At that time you hadn't become the rockstars of now, clearly become too big for your gumboots(look it up)
Hey, I was at the Millennium Dome at the main event and thought it was a great evening. You are letting your politics get in the way of a venue that has proved it's worth.
The problem with the NHS is its size, truly bewildering complexity, and aims/purposes - it increasingly reminds me of the old Soviet Union- a massive bureaucracy about to collapse under its own weight! I defy any government which says it’s going to “fix it”! The major advances in health are NOT medical - they’re about infrastructure, housing, education, good sewage systems, access to green spaces and excellent social care & so on. All these lie in the province of local government - not hospitals or even GPs. Time to rethink the NHS completely - it can’t be “fixed” by building hospitals!!
I agree, as a GP, so much of our workload is due to illness from environmental and social problems. Doctors and GPs are asking for more money quite rightly, because the workload keeps increasing because the government keeps making communities poorer
We need cottage hospitals bringing back, put bed blockers & anyone recovering from routine surgery in them. You could even put women recovering from difficult births there, in Derbyshire there was a cottage type hospital where any mums having straightforward birth went to give birth & women recovering from C sections were transferred to. Partners were able to stay, the rooms were set up like a hotel room, there were enough staff to help with breast feeding & teach first time mums the basics, it had a very good record on preventing post natal depression & had one of the best records on prevention of birth injuries to both women & babies in the country, the Tories shut it down when it was actually saving the NHS money.
After lifetime working in NHS and social care - I see the big historical error of 2010 coalition was to reorganise NHS together with its relationship with social care. Just about everyone with influence was advising the government to stay with current system BECAUSE it was finally working. Reorganising NHS in 2010 was a political vanity project which destroyed an effective system. How much the Tories then spent became irrelevant. Now we have a broken NHS and social care which need a much deeper systemic approach to rebuild. This includes a food policy not dependent on DEFRA and big 5 supermarkets, fitness of the nation commitment, and a reorientation to functional medicine as well as public health. All of this needs setting up before you even begin to look at improving systems.
Prevention needs proactivity. Not possible with staff levels being so low and those staff that are there are firefighting. When I left the NHS in 2001 our management had been pushing for us to go out and find the mentally ill clients and provide for them. WTF, were we to knock on doors and ask, "Are you mentally ill. Would you like to come with is to this community hall and be helped?" Out of fucking touch. 23 years on, the staffing levels are probalby half what they were when I was working. I hate the Tories and good luck to any government managing to make any improvements into a broken NHS. If only a party would dre to raise income tax and tax the bloody rich. They'd be money.....bnut no, can't do that. Continue to try to make a silk purse out of less and less pig's ear. Oh poo, you made me rant 🤐
If you close hospitals and centralise services you need to make sure that the transport infrastructure has to be in place so people can get to the new central service. It may be a far better hospital but if an 80 year old person can not get there by public transport it is useless.
I can tell you both The Millennium Dome was positively Magical when I came to visit age 12 on a school trip in 2001 it was AMAZING so please don't forget that, it was HUGE and interesting and magical and so much fun hands down best school trip we had, We loved it. Not everyone see's things through the eye of politics and media :D We felt proud of it and our county so thank you.
Prevention is better than cure. Need to focus on educating kids how to eat healthy! Bring in 50% tax on all processed foods and sugary drinks and use that money to subsidise British farming
If you think it’s bad in the U.K. you ought to see China or the US. Only Europe seems to consider the end consumer as a priority, everywhere else backs the producer.
We have lost 2000 GP practices in the past decade. Protect the partnership model or we lose the NHS as we know it! Just in Nottingham a practice has closed and has been taken over by a private company who are being paid £130k per year more thanks to NHS England corruption. GPs are not out of work thanks to money being put in the wrong direction of cheaper additional role staff. Studies show only GPs and Nurses improve patient outcomes. More primary care appointments does not equal better outcomes! Fund health and social care property and relieve some bed blocking and allow flow in hospitals. Many outpatient departments in hospital are totally overstaffed. Mental health service need far more funding. Cost of living crisis is exacerbating MH issues.
Prevention of ill health can be massively impacted by getting the major food companies regulated more strictly. The almighty dollar has driven the standard of food to such a poor level with ultra processed foods driving so many of the health problems we are seeing now.
I went to A and E recently, because I'm an idiot, but I saw an elderly lady that looked like she'd been in a car crash, or mauled by a bear She was waiting for hours and hours Horrific
Covid was a big opportunity for the government to emphasise the importance of personal decisions in health outcomes. One of the reasons so many British people died compared to other countries was that we had a lot of unhealthy people. Too many people do no exercise, eat a lot of rubbish, get obese and are diagnosed with serious health issues (diabetes, high blood pressure, etc) before they even hit 40.
Good points however I’d also add that climatically Britain is an ‘indoors culture’. Spain and other southern Mediterranean countries have an easier time distance separating as well as the benefit of a ‘healthier diet/lifestyle’, possibly complicated by multi-generational living. Covid wasn’t a simple problem.
I was recently pressuredised by concerned friends/families to get a couple of moles looked at (being the usual bloke, I had ignored it for a year !!). I phoned the GP surgery on Monday, was offered an appointment on Wednesday, referred to Dermatology and was offered a cancellation 7 days later. Having see the consultant at 9am, the mole(s) was removed there and then. 10 days from inital enquiry and 90 minutes from walking through the hospital doors I was discharged (fingers crossed, still waiting on biopsy results) but if left 5 years, it could havbe been a LOT worse and required major surgery/radiotheropy/chome, so more expensive and resourse in tensive. Lesson should be that by early intervention, it might need extra resource BUT in the long term is will be cheaper and free up resources for other cases.
The only good things in the Dome were the walkthrough body and Blackadder. The rest of it was entirely forgettable, hyper-corporate, and a bit naff (very on-brand for New Labour).
I quite liked the 'rest zone', the big white bean-shaped hall you could go inside, where it was all softly and dimly lit in slowly-cycling pastel shades, and just sit around the edge on the soft sloping walls. One of the simplest "zones", but actually pretty neat because of that: it didn't have over-engineered, nannying, designed-by-committee earnestness that made some of the rest of it so naff!
Rory presumes when he says move A and E to a further away hospital. that there are good public cheap tresnsport links for patients, workers and those who visit. The issue is that in many cases there are not. Then there are the piss poor ambulance workers who struggle with taking people further and further. There are good reasons people complain about these issues.
I do think that we need to take some personal responsibility for our health. We spent a lot of time at our local hospitals last year when my partner was undergoing cancer treatment (successfully) and I couldn’t help but notice how many people milling around the place who were significantly obese. I am a couple of stone over my ideal weight, so can’t say too much about others. However, so many were morbidly obese. Without knowing why that’s the case, one shouldn’t criticise - who knows what traumas in their lives they’ve had. But it’s not surprising that the NHS is under such pressure. Funding has not kept up with demand and we may have to accept that either we accept its limitations or we pay more into the state to increase funding significantly.
Part of the problem for some extremely overweight people is that they have a major medical condition that would have killed them in the past, but is now controlled by medication that has side effects including interfering with the metabolic system and/or water retention. Trying to balance medications to reduce this is a skill where success is often preventing weight gain rather than weight loss.
@@AliceHutchinson-ve2lwI’m sure you’re right about some. Steroids can have that effect. However, one can alter one’s eating habits to mitigate the effects of drugs. I’m afraid with so many of us it’s a case of eating unhealthy but cheaper foods, or just plain being gluttons. Alcohol consumption in this country is also among the highest in Europe.
Bit of a conundrum Public Health. We are living much longer but with chronic conditions … not helped by average BMI or lack of good regular exercise. It is not just any Governments fault. Public attitude has not helped.
Rory Stewart explains things so clearly and in depth. Why the government haven't accepted his offer of sitting in on the NHS reform meetings is beyond me! He is solution focused and has such in depth knowledge, they are fools not to accept his input.
Funding technically did go down as the disastrous Lansley reforms were payed for from NHS budgets. This is the point at which the NHS became broken. Add to that the fact that the boomers are now a huge burden on the NHS and the care home sector. The reality is we just don’t have enough people to care for all these boomers, we are rapidly turning into a boomer care economy. The only answer is immigration but that opens the door to Reform and the Tories. Of course one option would be to send the boomers to Rwanda that would save us so much money.
People buy into the big projects but don’t get the truth on cost…. Everyone knows governments go for the cheapest tender to ‘protect the publics purse’ but the companies know the tender price and time lines has nothing to do with reality so go in cheap and quick and then milk the public purse from there on, the contracts don’t deal with project creep for what ever reason, its just put your hand out and money will come your way… if we keep over promising and under achieving we are close to being never able to get public by-in on any big projects.
How can we fix the NHS when our society structure is failing - appalling diet, obesity, high stress levels, burnout etc… that are triggers for increases in heart disease and cancers. education and things like ‘sugar’ tax are required?
I understand you have to pay the bills but please stop the awkward adverts and even more extended promotional pieces about live events. It’s s podcast, keep it simple.
The Dome was a very overpriced tent that aged into something quite shabby and tacky (especially inside). I lived on the peninsula next to it, so went inside a few times. White on the outside but yellowing on the inside. Freezing in winter and the air is kinda stale in summer. Btw, most of that $800M cost was cleaning up the land, including the peninsula with its thousands of apartment homes, so perhaps some of it was recouped from the developers.
I think as a nation we are far too proud of how profitable our drugs companies are compared to their supposed primary focus of making people healthier. I don't know how you move away from it as all new drugs seem to be blank cheques.
Access to "misinformation" is a key important component to having free speech. Without the freedom of ppl to say things we don't like or are 100% false we DON'T HAVE FREE SPEECH!!!
I think the biggest health issue in Britain is the mental health. For various reasons but, in my opinion, the main reason is poverty and the second one is lack of basic education
We have record waiting lists in the NHS because the Government canceled 1.5 million out patient appointments during the pandemic, with the opposition's full consent...
Rory you should know it’s West Cumberland Hospital…not Infirmary…That aside this is madness. Where is the backlog? In hospitals….What is crippling NHS acutes…? Labour’s disastrous PFI schemes…The Trust System…The internal market…World Class Commissioning…Remember that ? Hospitals competing with each other instead of working together. Our NHS needs to be based around well run, adequately funded hospitals. We’ve heard care in the Community before…it doesn’t work….Our GP services are in crisis…18 pharmacies are closing every week…apparently…and yes we need to change the approach to preventative health but….it’s a very long term project and is unlikely to be delivered by overweight GPs…We used to have good hospitals both acute and mental. Co-ordinated on a regional basis….that worked…I had hoped Labour would save the NHS but this isn’t a good start…The sensible thing from Rory is we need a long term multi party plan….
I'm not interested in Labour blaming the Tories for the NHS until Labour actually fix the NHS without bankrupting the country. If they manage that, then they will be trusted to do other things and the Tories need never be voted back in again because of Labour's mess. Ever.
If your kids are online then let them have a fake online identity. Let them join communities under a fake name joining others who share a hobby or special interest. And they can keep that separate from school friends.
Just how are we as a public ever going to acknowledge that we have to change our expectations of public provision services or pay the cost and have less personnel wealth? We’ve run our public infrastructure into the ground but as a country we’re all so entitled that we want everybody else to pay to put it right. We’re a society who want no responsibility; no accountability and yet maximum public provision. I’m not sure there’s a way back. 😢
80% of healthcare costs are spent in the last 5 years of a person’s life, and the longer the life the more it costs to keep you alive. Ergo, the more very old people we have, the more expensive healthcare becomes. So today there are a) 8 million more people living in the UK and b) twice as many people over 80 as compared to 30 years ago. So of course the NHS is creaking at the seams.
Rory is a lesson in British politeness! ... Slagging off something which cost hundreds of millions of pounds and which Alastair probably poured blood, sweat and tears into - to his face - but doing it so gently that it feels like he's suggesting slightly reordering a flower arrangement. Fantastic :D
Hospitals already are 24/7. Outpatients generally don't function 24/7 because when it's been trialled patients didn't like out of hours appointments and either rebooked to mon-fri 9-5 or just didn't turn up!
I disagree that technology or digitisation is about replacing people. I work in tech and the NHS is lightyears and billions of pounds away from the type of disruption that takes jobs away. The demand in staffing will increase exponentially. Efficiency will be driven by AI, yes, but most importantly modernisation. Second topic I disagree with, don’t conflate big infrastructure projects with political vanity projects. Eurotunnel, empty the fens, railways, are all momentous infrastructure projects that should be hailed and encouraged. We don’t lead on infrastructure at all because of these ridiculous vanity projects getting in the way.
We need to take politics out of the NHS at the level of operational decisions. A commission should be formed made up of internationally recognised health experts as well as those from social services, mental health experts etc. They should advise on what reforms are needed snd cruciallly how they should be implemented - sequenced and developed and tested. If we take this seriously there is no reason for us not to succeed
In view of your discussion of Peter Malinauskas’s ban on social media for kids, it is a shame that South Australia is the only mainland Australian State you are not visiting on your tour, Rory!
Yes and it could have gone so badly wrong. A few people I know almost died in childbirth and required immediate urgent medical care that could only be provided in a hospital
Campbell wants to turn this into a party political debate about whether or not the Torurs spent a few extra pennies here or there. Its nonsense. The NHS needs to be torn up and started again. No other country runs healthcare like the UK. The fundamentals of the NHS are not fir for purpose. And if Labour think throwing good money after bad is the solution then I expect their time in office will be short.
Whilst the NHS has many benefits its created a culture of "eat as much as you like", "drink as much as you like", "take no exercise" and turn up at NHS 30 years later and ask for a free knee replacement operation, cos of ive paid my taxes. Governments do their bit, monies spent on the NHS increase every year, at the expense of other depts, time to yield the big stick towards the population. Higher taxes for the obese??Ideas welcome?
Treat it like tobacco. Much higher VAT on unhealthy food (plus a ban on discounts) and get rid of VAT on health-promoting activities (e.g. gym memberships) and you'll at least make people pay for their choices, if not actually change them. It worked v. well with the plastic bag tax
@@PJH13 I can see some value in that. But the challenge is coming up with a list of unhealthy foods. Depends on how consumed. Fruit juices - sugar water? Cereals? Sugary fizzy drinks - an issue because consumed between meals. Sugar consumed after a meal with protein has less impact. Potentially there are so many items you could tax. You are taxing everyone for the actions of some. Bi-annual MOT/Testing by chemist? Lose discounts/incentives if overweight. Target those that drain the NHS of resources vs everyone.
@@selectmarketing844 Yh, I don't doubt it's complicated to figure out exactly how best to implement. I just think it's necessary to link the amount someone's choices end up costing the NHS to the amount you pay for it (whilst still being free at use), so that people consider their habits more carefully in advance
Watching from the US, the idea of a cross-party 10-20 year plan to reform the healthcare system sounds ludicrous. (34:22) We haven't been able to do that since before 2008.
@@Spengleman2 ah just checked, diameter 365. Such random stuff to base a building on. Why don’t they just come clean and admit it’s an alien spaceship 👽
Brought the missus from Vancouver to 02 for the Blind Faith reunion. Couldn't get tickets; next day went for a peak inside the venue, and a staffer said we can't look because security innit.
The most important healthcare issue is that general health improves. That starts in education while placing limits on capitalism, i.e., what's sold with certain ingredients and its availability. The country also needs to look at the best systems that produce better results outside the UK while accepting we haven't had the best health service in the world in decades. We have to stop saying we have a free at point of use system and begin a system of charging for some limited services to discourage abuse and reduce load. Carrying on as is even with more money just won't work.
Tech companies are given far too much leeway. If a snack bar company said it would be "really difficult" to stop putting arsenic in their snack bars they wouldn't be allowed to sell snack bars! No company is entitled as a fact of nature to do business and profit.
As a doctor, I think you overestimate the displacement power of AI today. It’s dictation is fine, it’s note taking is fine, it’s reasoning with prompting can be fine, but not medical grade. It’s nowhere near the nuance. I love AI but it’s not there. And this discussion of “can Starmer take on the unions as AI sacks nurses” is wild. I have three jobs as a doctor. And yhe tech with all of them slows me down a lot. A lot. Can AI turn a referral into 30 seconds not 3-5 minutes? Great. Can it listen to consults and type up my notes perfectly? Great. Can it check prescriptions more accurately than a pharmacist? Great. It can’t do any of those things at present, certainly not to trust your literal life to it. And for it to be implemented as a productive adjunct would cost a fortune. We are talking billions. Basically every computer system would be replaced. The training the change to workforce. Crack on, because the IT sucks, but this isn’t clear cut Rory. If it’s a panacea it’s in its infancy and we have NO track record on good tech deployment.
The Millennium dome really was a lame duck, I remember my parents wanting to take me for my birthday and I said it's either Thorpe Park or I'll politely pass
Here's an easy way to increase productivity in nhs - get rid of the pointless stats which are gathered to demonstrate how efficient the nhs is! My wife has to spend 15+ minutes a day filling in forms, which over a week is 3-4 patient slots
Haha, so Labour was averaging 9% nominal / 7% real increases p/a in the 2000s. If we'd continued increases at that rate we'd be spending £260B p.a more than we currently are on the NHS. That's an extra £8,000 per person in work in a country where the average salary is c. £34k before tax. Does that sound plausible to anyone?
It is important to emphasize that prevention plays a crucial role in health management. Both individuals and employers have a responsibility to foster a culture of health and well-being. To achieve a high-quality National Health Service, we must recognize that this requires appropriate funding, which may necessitate an adjustment in tax along with a big culture change. Perhaps removing oversight from politicians would be a beneficial first step.
They'll never top Danny Boyle's Olympic ceremony(s) like they'll never top Rory's trenchcoat. Also, my sister is a mental health nurse and she ended up at ATOS doing benefit assessments (PIP) because it was a whole lot easier, significantly less dangerous and for more money.
We’ve got an NHS and primary care built for a population of 60 million. Unfortunately the problem started at the start of the millennium not 10 years later. You could still get a GP Home visit back in the late 90’s. You discuss moving back to local services but where I live they’re just about to close a GP surgery.
our local town/village has doubled in size and population in the last 2 decades. all British families in some nice new builds, but there is still only 1 surgery? 1 school?
Being old and Scottish but having lived in England most of my adult life, I think you missed a couple of important points about the independence debate. The SNP did well mainly because they acted like a traditional Labour govt, no student fees , prescriptions etc etc and Labour never looked likely to win. Obviously wheels have come off with things that haven't gone well but comparing my mum's experience to mine Scotland Vs England I'd say most things are less broken service wise although it's true she doesn't need a ferry. But the main problem was there is no legal mechanism for Scotland without Westminsters ok so everyone can moan if they want one but voting SNP doesn't get you closer to one. Also I think I'm disproving the algorithm, the older I get I've gone from agnostic to pro although I won't have any say unless I move back to the land of midnight shortbread
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neoliberalism is ruining everything - the food system is poisoned, zero community cohesion, school is a disaster for millions of kids, most people hate and are harmed by their jobs - and all of this and more is being obfuscated . by the out of control mental ill health industry and the DSM mindset currently convincing every person and their dog that they have some voted into existence construct like 'adhd' and 'asd' and millions of children and adults are now drowning in dangerous largely ineffective psychiatric drugs - the amount of kids and adults now prescribed long term amphetamines is truly shocking - The DSM and its lates reinvention 'neuro' diversity movement is so profitable and mostly harmful.
As a physiotherapist who worked in the NHS for the better part of 40 years,both as clinician and service manager and then retired to France,I can tell you from personal experience the French system is light years better. Many more of the clinical staff are self employed and contracted in ,the management structure is less, Ambulance service is provided by the fire service. Preventative healthcare is a priority,GP's actually examin their patients (and continued to see patients face to face during Covid) So yes it will cost more, but the service provision will be excellent .An example my husband had his hip replacement done in six weeks ,eight if you include the two week wait for the Consultant appt.
Well said, thank you for your service
The fire brigade in France does have some ambulances, but most ambulance services are provided either by the A&E departments of hospitals or by private companies.
Yes. We're so irrationally attached to the NHS. It's an awful system that hurts the good healthcare providers and patients the most.
The french system is so much better. But people flip out in this country if you even suggest any changing to a more rational system.
It's like they prefer a nice sounding sentimental position over a sensible, effective one.
Yeah, I worked in healthcare in 3 countries and NHS is the worst by far
@@John-kj7tvCorrect. UK is the only country in the world that treats it's public health system like a national religion. Makes it impossible to reform politically. Healthcare is just an industry, no different to any other. It responds to the same incentives.
They clearly hate doing the adverts at the beginning.
Not as much as we do!
@@mediastudiesnetworkI suspect most of us fastfoward over the Adverts.
It's so funny! Neither need the money!
Gary Linkear needs his due...
It works as I'm changing to fuse!!
As a retired doctor who has worked in hospitals in the NHS and the French public health system, I have to comment on the "three pillars" for NHS reform.
1. Computerization can help with simple things. But huge complex computer systems in the NHS and the French system were and are doomed to failure. (The one at the French hospital where I worked was an expensive disaster.)
2. Care in the community has been proved to be more expensive than equivalent-quality care in hospital.
3. Poverty and poor health are closely correlated. One effective measure of prevention is to increase lower incomes (and certainly not to cut pensioners' fuel allowance). Piketty ("Capital in the 21st Century", 2013) argues that a 1-3% wealth tax would provide sufficient funds for an efficient health service free at the point of use plus free university education for all.
Completely agree. I don't think there is any denying the NHS is in need of Reform and also prevention is like you said is so key. I've also seen prevention is a model they use in Cuba a lot. It goes on a Family Doctor and Family Nurse system and they try and do more community and prevention work for the population because they know that Cuba can't afford to see one misstep as its still quite frankly a poor country and given the difficulties they face they fair better life expectancy than the average country in South America and even in some areas do better than USA overall.
It's honestly surprising what Cuba can do with such little money even though this not a glowing praise of Cuba as they do have issues on bed blocking and access to medicine.
And, prevention is the cure but also while we might like to pretend that doing reforms can be done at no expense the reality is that it actually needs more money first before we see a return. And something neglected when they compare to other countries like Australia, France, Germany and the Nordic countries they do spend more per head, sometimes leagues more, than what we do. Whether it's in their taxes, out of pocket or European social insurance system it's no denying they spend more so it needs to be balance with bettering the bank account but make sure we are spending it wisely. And I think tying it back to prevention, I think that community led support is going have to see us putting more money in first before we see the rewards.
To actually reverse type 2 diabetes and solve morbid obesity took me about 2 months once I'd worked out that the standard dietary advice of the last 50 years is rubbish. It then took a few weeks of trial and error to work out what foods were good and which were pushing blood sugars high. Most of the preprepared packaged foods on the supermarket shelves are also rubbish.
The problem in making a real change lies in getting the right information and education out there to the people who need it. After decades of hearing ultra processed food is cheapest and all we can afford it will take a lot of effort to change.
In Italy families still teach kids to cook and just walking down the street you notice the lack of hugely overweight folk - and Italy is not a richer country than UK. They eat lots of fresh vegetables and fruit, relatively little meat because it's expensive.
Italy still grows a reasonable amount of food and has less fast food places… or it did in the towns I visited. They have more pride in their traditional foods and growing their own fruit /veg/herbs when they can, which are much healthier. How many times do you hear, eat a Mediterranean diet.
What a subject, the brutal truth is 1) don't consume sugar and, 2) burn more calories then you consume. Today most western societies have sedate, bored populations, they eat for something to do. Scandinavian & the low countries are a bit different, less in your face advertising, generally higher metabolism.
But like other Europeans, they smoke a lot.
There's plenty of truth in what you've said but something I struggle to get past is how so many saying similar things seem to absolve so many almost entirely for their poor dietary decisions - in some cases essentially arguing that there's no free will involved and people can't be held in any way responsible (which I find impossible to square with our legal system).
No one really taught me to cook but I've never found it difficult to find information if I want to know how to do something.
That eating 'real' foods is better for you than ultra processed crap isn't some modern revelation.
Surely most people are, deep down, aware that fad diets are going to be nonsense, and that losing weight and keeping it off requires permanent dietary changes.
A lot of the claims about people having a lack of time are, frankly, nonsense, when you consider how much time the average person spends watching TV/media, or the fact that higher earners, who are less likely to be obese, tend to work longer hours (and are more likely to take their work home).
Whilst some may (and I'd emphasize may, as a lot of this again comes down to poor decision making) be handicapped by prices when it comes to eating well, this is clearly massively overstated and seems to ignore that people in question, clearly, for whatever reason, are failing to use access to information they virtually all have (i.e. the internet).
Rory: public health is dire
Tories: moved public health to councils in 2012 and cut them to the bone
But how could this happen?!?!
I watched just the NHS segment, the other bits are important but I'm most concerned about the state of UK health.
Current NHS spending is around £160 Bn per year and rising exponentially. But the state of the NHS is not the problem, it is a symptom of a nation getting ever closer to death's door.
64% of the UK population are overweight or obese, 26% are actually obese. 8% have diabetes of which 90% of those have preventable type 2 diabetes, a further 5% are pre-diabetic and without urgent intervention will add to the T2 figure, 4% have heart problems, 1% have dementia, 4% have COPD, 6% have kidney issues, 15% have chronic pain, 7% have cancer, 10% suffer from axiety and/or depression. Of those suffering individuals sadly reduced to statistics, probably 2 thirds are preventable.
There are about a million people in the UK without access to a fridge, 2 million without access to a hob/oven, 3 million without access to a freezer. How can you be healthy with just a microwave and a delivery app?
You could double or triple the amount of money spent on the NHS and it would still take 30/40/50 years to sort this out even if the NHS was the actual problem. The scope of the actual problem is our whole society and our relationship with food/exercise/work/time.
Rory/Alistair, how about an actual useful discussion on that?
Ditto. The NHS won't be able to cope with 3x the budget if poverty is not addressed
well you can tell people what they should do but you cant control what they actually do so ya know whats the point? they dont know anything about nutrition, excercise, diet
There is no such thing as the actual problem. Just different leavers you can pull
They talk about that in this exact video. Did you not hear them discuss the emphasis on prevention instead of curing and the implications on policy of that?
@@thenoobdestroyer100 This is true up to a point but there are ways of providing education within another framework. When I was a registrar training in psychiatry I led an educational group of about six young offenders who had been convicted of alcohol-related offences. I was able to explain the effects of alcohol and to suggest strategies to reduce their consumption. I don't know if it stopped them re-offending but their attitude to the group was positive.
I studied public health. Health promotion etc. BSC. MSC hard work - I invested my life in health prevention. Then government pulled the plug leaving me with no secure career pathway or employment. Today health prevention it’s led by third sector and charities and with respect - sadly it’s a mess. 😢
I had a career in Public Health. The idea was to prevent people getting ill, rather than cure them once they are ill. Unfortunately politicians have no idea of this concept.
Why do you want to prevent health?
(if you've got valuable things to say on the topic, why do you need a government job? This is the number one problem with healthcare in the UK, it's a black hole for our taxes and it's full of people who couldn't possibly find employment without a government backed monopoly)
We need to scrap the whole thing and let the actual doctors and nurses and value adders get employed and let everyone else go.).
@@TranquiloTrev Yh, it's the same problem as the lack prisons. They get far more public credit for spending money on responding to problems than they do for preventing them in the first place so that's naturally what they do. We could do with an independent body (kinda like the OBR) for health that has the ability to review and criticise govt. plans so that the govt. actually has some incentive to plan ahead
@@John-kj7tvHow old are you?
Something Rory gets wrong here is that AI will make unions upset as it'll get rid of healthcare jobs...we're already understaffed so the idea that people are going to lose jobs to AI is laughable
A machine is a machine and AI is not good at covering all personal circumstances and align them with a persons perception.
AI could theoretically eliminate an entire job role, even if overall headcount still has to increases as you suggest. Unions would definitely still resist this as although most of their membership would be unaffected, for those that are the change would be severe
Don’t forget the population is getting older so the use of the NHS is growing so this will always push costs up. Also remember the extra cost is always off set to some degree with more people in work and better outcomes for the public
Yet all of the wealth sits with the older generation and the young have the tax burden, itnis time for a wealth tax….
Yup, back in the 1980s when it was tax cut cut cut across the west was when government should have started saving for when the boomers got old, but the boomers wanted those cuts, now we're stuck without enough tax base to pay for the services we want.
@@gorgu08 Your argument is misleading: People in their late career do tend to be wealthier as a result of building up savings ahead of retirement. That doesn't mean they have more disposable income though! Once retired they have to live entirely off their wealth without a salary so they typically become poorer with age after that peak
@@jeffparker1617 Government doesn't save.
@@PJH13 lol, look at my piles of money. Please don't tax me!
Hyping back to Tony Blair won't save the Tories,
If the Healthcare system took a more holistic approach to heath. The tax payer and the patients would be better off.
A better approach to what people put in their mouths would lead to a reduction in obesity, diabetes, cancer, demntia and many other problems that are currently only have symptoms treated by big pharma. In stead of treating the root cause.
VO2max (the exercise measurement of how much oxygen your body can process per kilo of weight) is also the single most important measurment in predicting length of life. It drops with age, with increase in weight and with lack of exercise. The lower it goes, the harder the body is working for day to day things. Once you've got older peole at a maximum effort to climb stairs, its not surprising things go bad, whether it's cardio disease or falls and broken bones.
The health costs of older people have large multiples of the general health costs of younger people. To have healtheir older people you have to have healthier habits in younger people, that are sustained through their life. As it's population level stuff you only have to make a small improvement to start dropping costs by really large ammounts.
And it's all easy stuff, better diet, more exercise as part of day to day life (active travel, less car use).
Nobody looking at the problem argues about any of that, now over to politicians to find how to sell it to the public and to start to really fund it ;-)
I couldn't agree more thank goodness at least one reply to this topic understands the real issue for the NHS. We are what we eat and unfortunately people think they can go on stuffing themselves with the most unhealthy food without suffering any consequences. Whenever I walk into my local supermarket I cannot believe the size of some people and then you look at their shopping trolley and you understand why. I moved to a WFPBD sometime back and I only wish I had educated myself sooner.
@@Tridhos It's interesting too still hearing 10 years being called long term, as what you want on a population scale is lifestyle changes in current 45 year olds and younger carrying through to NHS savings once they hit 65+.
Some gains come right away, but it's a 20 year span to really get payoff.
Yea, we should privatise healthcare, put power and choice back in people's hands.
Yh, we currently pay no VAT on cakes but 20% on a gym membership... go figure!
Yes the NHS needs investment in infrastructure and people. But one problem which I carnt see a answer to is accountability, top to bottom. I know people who work in the NHS at all levels who have worked in the private sector they spend most of their days saying what the Fuxxxxxx . It’s like the old joke, question, how many people work in the hospital, answer about half of them. I don’t have the answers but more accountability at all levels is needed
Love Rory’s reaction to Alistair’s claim the building is pretty amazing …. “Is it pretty amazing??” (High pitch tone) 🤔
squeak!
No amount of reforming strategising cutting waste is going to save the NHS. It's very simple, it needs proper funding, and the money can ONLY come from tax. Not from borrowing, not from taxing only the very rich, not from withdrawing support to Ukraine, not from kicking out immigrants. Tax, from most taxpayers.
The British people have shown time and again that they prefer tax cuts over paying for the NHS. A recent survey showed the average person is prepared to pay only 10 pounds more in tax to fund the NHS.
Hey here's an idea, why not just bang some pots and pans when a nurse walks pass? Worked so well the last time, doesn't cost a penny and the nurses love it.
Here's the big problem with productivity - it means in general a much poorer service because you are asking Doctors, Nurses, etc. to spend much less time with each patient in order to get the numbers up. These are caring professions and as such those that enter it want to give their patients the best possible care which does mean spending time with them, reassuring them and building relationships. If you tell a nurse she now can only spend say, 20 mins per patient per day and see double the amount of patients - yes productivity has improved but the standard of care has dramatically decreased.
Agree, the tick box mentality to productivity.
I was a big supporter of Blair at the time. I came from abroad for the millenium celebrations. Very disappointed by the night, my first realisation Blair was overhyping and underdelivering. Remember the promises of a river of fire? It really wasn't.
No, it really wasn't. Couldn't see a bloody thing.
But, do you have good memories of the night..? I do, and when all is said and done, life is what you make it.
And remember...Things can only get better....!
With 300 organisations in the NHS there are 300 management systems and that is the problem. All successful companies have a standard management system. That needs to be a priority to reduce non clinical expense and productivity.
It's absolutely damning that Alastair has been banging on about Tory corruption' for years but when the story breaks about Starmer accepting £100k worth of gifts it is dismissed with no comment whatsoever
Honestly I think trying to spin the O2 as a cultural landmark is worse 😅 They're both examples of his chronic inability to see things through any lens, other than 'red good blue bad'
That really annoyed me too.
Please don’t put clothing and a VIP lane for your mates in the sum of billions, in the same boat.
I’ve had post viral ME/cfs for 28 years. I am housebound and mostly bedbound. Now millions more have it from Covid because the NHS has never taken it seriously. I was very healthy (vegetarian, exercised and doing a Ph’D before that). The only reason I can’t work is because of the NHS failing to take it seriously. Now thousands of Drs have it and are finding out how serious it is and they too are being gaslit by colleagues.
Even if they took it seriously, is there a cure, or some kind of therapy to relieve symptoms?
Rory, you mention complaints from the Aussie listeners from missing out and returning to Oz for a SECOND tour without even touching ground on NZ soil once! What about us? 😭
Yeah Rory, what about us, another New Zealander I've listened to every episode since those 1st early days even messaged u both suggesting that u give more information on books as u mostly failed to mention the authors.🎉 At that time you hadn't become the rockstars of now, clearly become too big for your gumboots(look it up)
More Kiwis in Australia
I knew you’d play the O2 roof one day!
Hey, I was at the Millennium Dome at the main event and thought it was a great evening. You are letting your politics get in the way of a venue that has proved it's worth.
The problem with the NHS is its size, truly bewildering complexity, and aims/purposes - it increasingly reminds me of the old Soviet Union- a massive bureaucracy about to collapse under its own weight! I defy any government which says it’s going to “fix it”! The major advances in health are NOT medical - they’re about infrastructure, housing, education, good sewage systems, access to green spaces and excellent social care & so on. All these lie in the province of local government - not hospitals or even GPs. Time to rethink the NHS completely - it can’t be “fixed” by building hospitals!!
I agree, as a GP, so much of our workload is due to illness from environmental and social problems.
Doctors and GPs are asking for more money quite rightly, because the workload keeps increasing because the government keeps making communities poorer
We need cottage hospitals bringing back, put bed blockers & anyone recovering from routine surgery in them. You could even put women recovering from difficult births there, in Derbyshire there was a cottage type hospital where any mums having straightforward birth went to give birth & women recovering from C sections were transferred to. Partners were able to stay, the rooms were set up like a hotel room, there were enough staff to help with breast feeding & teach first time mums the basics, it had a very good record on preventing post natal depression & had one of the best records on prevention of birth injuries to both women & babies in the country, the Tories shut it down when it was actually saving the NHS money.
The O2 is a bit crap for a global music venue, already outdated. Even Manchester has bigger venues too
I could listen to Rory Stewart all day (and I'm not a conservative).
After lifetime working in NHS and social care - I see the big historical error of 2010 coalition was to reorganise NHS together with its relationship with social care. Just about everyone with influence was advising the government to stay with current system BECAUSE it was finally working. Reorganising NHS in 2010 was a political vanity project which destroyed an effective system. How much the Tories then spent became irrelevant.
Now we have a broken NHS and social care which need a much deeper systemic approach to rebuild. This includes a food policy not dependent on DEFRA and big 5 supermarkets, fitness of the nation commitment, and a reorientation to functional medicine as well as public health. All of this needs setting up before you even begin to look at improving systems.
Prevention needs proactivity. Not possible with staff levels being so low and those staff that are there are firefighting.
When I left the NHS in 2001 our management had been pushing for us to go out and find the mentally ill clients and provide for them. WTF, were we to knock on doors and ask, "Are you mentally ill. Would you like to come with is to this community hall and be helped?" Out of fucking touch. 23 years on, the staffing levels are probalby half what they were when I was working.
I hate the Tories and good luck to any government managing to make any improvements into a broken NHS.
If only a party would dre to raise income tax and tax the bloody rich. They'd be money.....bnut no, can't do that. Continue to try to make a silk purse out of less and less pig's ear.
Oh poo, you made me rant 🤐
If you close hospitals and centralise services you need to make sure that the transport infrastructure has to be in place so people can get to the new central service. It may be a far better hospital but if an 80 year old person can not get there by public transport it is useless.
I can tell you both The Millennium Dome was positively Magical when I came to visit age 12 on a school trip in 2001 it was AMAZING so please don't forget that, it was HUGE and interesting and magical and so much fun hands down best school trip we had, We loved it. Not everyone see's things through the eye of politics and media :D We felt proud of it and our county so thank you.
Prevention is better than cure. Need to focus on educating kids how to eat healthy! Bring in 50% tax on all processed foods and sugary drinks and use that money to subsidise British farming
I wish I could hear a voicemail from John Snow shouting "what the f*** is going on?!"
If you think it’s bad in the U.K. you ought to see China or the US. Only Europe seems to consider the end consumer as a priority, everywhere else backs the producer.
We have lost 2000 GP practices in the past decade. Protect the partnership model or we lose the NHS as we know it! Just in Nottingham a practice has closed and has been taken over by a private company who are being paid £130k per year more thanks to NHS England corruption. GPs are not out of work thanks to money being put in the wrong direction of cheaper additional role staff. Studies show only GPs and Nurses improve patient outcomes. More primary care appointments does not equal better outcomes!
Fund health and social care property and relieve some bed blocking and allow flow in hospitals.
Many outpatient departments in hospital are totally overstaffed.
Mental health service need far more funding. Cost of living crisis is exacerbating MH issues.
@14:25 is when the program starts
“Where I live, in South Ken…” Love it.
I went to the Dome (aged 9) thought it was good
Prevention of ill health can be massively impacted by getting the major food companies regulated more strictly. The almighty dollar has driven the standard of food to such a poor level with ultra processed foods driving so many of the health problems we are seeing now.
UPFs should be highly taxed, and healthy & fresh foods should be subsided with the proceeds
I went to A and E recently, because I'm an idiot, but I saw an elderly lady that looked like she'd been in a car crash, or mauled by a bear
She was waiting for hours and hours
Horrific
Covid was a big opportunity for the government to emphasise the importance of personal decisions in health outcomes. One of the reasons so many British people died compared to other countries was that we had a lot of unhealthy people. Too many people do no exercise, eat a lot of rubbish, get obese and are diagnosed with serious health issues (diabetes, high blood pressure, etc) before they even hit 40.
It because they don’t want people to be healthy they want them constantly on drugs
Good points however I’d also add that climatically Britain is an ‘indoors culture’. Spain and other southern Mediterranean countries have an easier time distance separating as well as the benefit of a ‘healthier diet/lifestyle’, possibly complicated by multi-generational living. Covid wasn’t a simple problem.
The problem is not the NHS it is the dreadful health of the nation due to the food industry (sugar and processed four) and over medication.
I was recently pressuredised by concerned friends/families to get a couple of moles looked at (being the usual bloke, I had ignored it for a year !!). I phoned the GP surgery on Monday, was offered an appointment on Wednesday, referred to Dermatology and was offered a cancellation 7 days later.
Having see the consultant at 9am, the mole(s) was removed there and then. 10 days from inital enquiry and 90 minutes from walking through the hospital doors I was discharged (fingers crossed, still waiting on biopsy results) but if left 5 years, it could havbe been a LOT worse and required major surgery/radiotheropy/chome, so more expensive and resourse in tensive. Lesson should be that by early intervention, it might need extra resource BUT in the long term is will be cheaper and free up resources for other cases.
The only good things in the Dome were the walkthrough body and Blackadder. The rest of it was entirely forgettable, hyper-corporate, and a bit naff (very on-brand for New Labour).
I quite liked the 'rest zone', the big white bean-shaped hall you could go inside, where it was all softly and dimly lit in slowly-cycling pastel shades, and just sit around the edge on the soft sloping walls.
One of the simplest "zones", but actually pretty neat because of that: it didn't have over-engineered, nannying, designed-by-committee earnestness that made some of the rest of it so naff!
Rory presumes when he says move A and E to a further away hospital. that there are good public cheap tresnsport links for patients, workers and those who visit. The issue is that in many cases there are not. Then there are the piss poor ambulance workers who struggle with taking people further and further.
There are good reasons people complain about these issues.
I do think that we need to take some personal responsibility for our health. We spent a lot of time at our local hospitals last year when my partner was undergoing cancer treatment (successfully) and I couldn’t help but notice how many people milling around the place who were significantly obese. I am a couple of stone over my ideal weight, so can’t say too much about others. However, so many were morbidly obese. Without knowing why that’s the case, one shouldn’t criticise - who knows what traumas in their lives they’ve had. But it’s not surprising that the NHS is under such pressure. Funding has not kept up with demand and we may have to accept that either we accept its limitations or we pay more into the state to increase funding significantly.
Part of the problem for some extremely overweight people is that they have a major medical condition that would have killed them in the past, but is now controlled by medication that has side effects including interfering with the metabolic system and/or water retention. Trying to balance medications to reduce this is a skill where success is often preventing weight gain rather than weight loss.
@@AliceHutchinson-ve2lwI’m sure you’re right about some. Steroids can have that effect. However, one can alter one’s eating habits to mitigate the effects of drugs. I’m afraid with so many of us it’s a case of eating unhealthy but cheaper foods, or just plain being gluttons. Alcohol consumption in this country is also among the highest in Europe.
Bit of a conundrum Public Health. We are living much longer but with chronic conditions … not helped by average BMI or lack of good regular exercise. It is not just any Governments fault. Public attitude has not helped.
British attitude in life in general is that it someone else's problem, even when it comes to their own bodies.
Rory Stewart explains things so clearly and in depth. Why the government haven't accepted his offer of sitting in on the NHS reform meetings is beyond me! He is solution focused and has such in depth knowledge, they are fools not to accept his input.
Funding technically did go down as the disastrous Lansley reforms were payed for from NHS budgets. This is the point at which the NHS became broken.
Add to that the fact that the boomers are now a huge burden on the NHS and the care home sector. The reality is we just don’t have enough people to care for all these boomers, we are rapidly turning into a boomer care economy. The only answer is immigration but that opens the door to Reform and the Tories.
Of course one option would be to send the boomers to Rwanda that would save us so much money.
People buy into the big projects but don’t get the truth on cost…. Everyone knows governments go for the cheapest tender to ‘protect the publics purse’ but the companies know the tender price and time lines has nothing to do with reality so go in cheap and quick and then milk the public purse from there on, the contracts don’t deal with project creep for what ever reason, its just put your hand out and money will come your way… if we keep over promising and under achieving we are close to being never able to get public by-in on any big projects.
Sounds like HS2…
@@lesleybee33 HS2 sabotaged by NIMBYs and soft politicians.
How can we fix the NHS when our society structure is failing - appalling diet, obesity, high stress levels, burnout etc… that are triggers for increases in heart disease and cancers. education and things like ‘sugar’ tax are required?
I understand you have to pay the bills but please stop the awkward adverts and even more extended promotional pieces about live events. It’s s podcast, keep it simple.
The Dome was a very overpriced tent that aged into something quite shabby and tacky (especially inside). I lived on the peninsula next to it, so went inside a few times. White on the outside but yellowing on the inside. Freezing in winter and the air is kinda stale in summer. Btw, most of that $800M cost was cleaning up the land, including the peninsula with its thousands of apartment homes, so perhaps some of it was recouped from the developers.
I think as a nation we are far too proud of how profitable our drugs companies are compared to their supposed primary focus of making people healthier.
I don't know how you move away from it as all new drugs seem to be blank cheques.
NHS should make their own drugs after 1 year of patent protection.
Access to "misinformation" is a key important component to having free speech. Without the freedom of ppl to say things we don't like or are 100% false we DON'T HAVE FREE SPEECH!!!
The problem with the NHS is not caused by politics but society itself…..we do not care about each other enough. We get the NHS we deserve😢
I think the biggest health issue in Britain is the mental health. For various reasons but, in my opinion, the main reason is poverty and the second one is lack of basic education
The 2012 health and social care act is at the root of a lot of the NHS problems imo.
We have record waiting lists in the NHS because the Government canceled 1.5 million out patient appointments during the pandemic, with the opposition's full consent...
Rory you should know it’s West Cumberland Hospital…not Infirmary…That aside this is madness. Where is the backlog? In hospitals….What is crippling NHS acutes…? Labour’s disastrous PFI schemes…The Trust System…The internal market…World Class Commissioning…Remember that ? Hospitals competing with each other instead of working together. Our NHS needs to be based around well run, adequately funded hospitals. We’ve heard care in the Community before…it doesn’t work….Our GP services are in crisis…18 pharmacies are closing every week…apparently…and yes we need to change the approach to preventative health but….it’s a very long term project and is unlikely to be delivered by overweight GPs…We used to have good hospitals both acute and mental. Co-ordinated on a regional basis….that worked…I had hoped Labour would save the NHS but this isn’t a good start…The sensible thing from Rory is we need a long term multi party plan….
The problem with Tories is that there's a gap between what they say and what they do. Not just on health.
People shouldn't be so obsessed with their health. My uncle went to the doctor's and three weeks later he was dead.
Mentally unhealthy yeah. Starting at the top.
I'm not interested in Labour blaming the Tories for the NHS until Labour actually fix the NHS without bankrupting the country. If they manage that, then they will be trusted to do other things and the Tories need never be voted back in again because of Labour's mess. Ever.
If your kids are online then let them have a fake online identity.
Let them join communities under a fake name joining others who share a hobby or special interest. And they can keep that separate from school friends.
Or keep all their profiles anonymous and don't allow them to have any friends/ followers
Just how are we as a public ever going to acknowledge that we have to change our expectations of public provision services or pay the cost and have less personnel wealth? We’ve run our public infrastructure into the ground but as a country we’re all so entitled that we want everybody else to pay to put it right. We’re a society who want no responsibility; no accountability and yet maximum public provision. I’m not sure there’s a way back. 😢
The problem with Tories is that there's a gap between what they say and what they do.
80% of healthcare costs are spent in the last 5 years of a person’s life, and the longer the life the more it costs to keep you alive. Ergo, the more very old people we have, the more expensive healthcare becomes.
So today there are a) 8 million more people living in the UK and b) twice as many people over 80 as compared to 30 years ago.
So of course the NHS is creaking at the seams.
8:00 Alistair slowly realising that Rory isn’t lying😂
Rory is a lesson in British politeness! ... Slagging off something which cost hundreds of millions of pounds and which Alastair probably poured blood, sweat and tears into - to his face - but doing it so gently that it feels like he's suggesting slightly reordering a flower arrangement. Fantastic :D
By the time you see your Doctor your body has fixed itself.
Simple solution for the nhs - the should be working 24/7 on shift rotas at all,levels including gps
Hospitals already are 24/7. Outpatients generally don't function 24/7 because when it's been trialled patients didn't like out of hours appointments and either rebooked to mon-fri 9-5 or just didn't turn up!
I disagree that technology or digitisation is about replacing people. I work in tech and the NHS is lightyears and billions of pounds away from the type of disruption that takes jobs away. The demand in staffing will increase exponentially. Efficiency will be driven by AI, yes, but most importantly modernisation.
Second topic I disagree with, don’t conflate big infrastructure projects with political vanity projects. Eurotunnel, empty the fens, railways, are all momentous infrastructure projects that should be hailed and encouraged. We don’t lead on infrastructure at all because of these ridiculous vanity projects getting in the way.
We need to take politics out of the NHS at the level of operational decisions. A commission should be formed made up of internationally recognised health experts as well as those from social services, mental health experts etc. They should advise on what reforms are needed snd cruciallly how they should be implemented - sequenced and developed and tested.
If we take this seriously there is no reason for us not to succeed
We need HS2 built. We just need to change the people building it.
Also a nursing officer in the reserve our training has been radically cut.
In view of your discussion of Peter Malinauskas’s ban on social media for kids, it is a shame that South Australia is the only mainland Australian State you are not visiting on your tour, Rory!
The rest is Fuse Energy.
LOL! Rory's solution for the NHS is do your own healthcare at home
Dr Google…..
Yes and it could have gone so badly wrong. A few people I know almost died in childbirth and required immediate urgent medical care that could only be provided in a hospital
Campbell wants to turn this into a party political debate about whether or not the Torurs spent a few extra pennies here or there. Its nonsense. The NHS needs to be torn up and started again. No other country runs healthcare like the UK. The fundamentals of the NHS are not fir for purpose. And if Labour think throwing good money after bad is the solution then I expect their time in office will be short.
Please get Slavoj Zizek on Leading!!
Whilst the NHS has many benefits its created a culture of "eat as much as you like", "drink as much as you like", "take no exercise" and turn up at NHS 30 years later and ask for a free knee replacement operation, cos of ive paid my taxes. Governments do their bit, monies spent on the NHS increase every year, at the expense of other depts, time to yield the big stick towards the population. Higher taxes for the obese??Ideas welcome?
Treat it like tobacco. Much higher VAT on unhealthy food (plus a ban on discounts) and get rid of VAT on health-promoting activities (e.g. gym memberships) and you'll at least make people pay for their choices, if not actually change them. It worked v. well with the plastic bag tax
@@PJH13 I can see some value in that. But the challenge is coming up with a list of unhealthy foods. Depends on how consumed. Fruit juices - sugar water? Cereals? Sugary fizzy drinks - an issue because consumed between meals. Sugar consumed after a meal with protein has less impact. Potentially there are so many items you could tax. You are taxing everyone for the actions of some. Bi-annual MOT/Testing by chemist? Lose discounts/incentives if overweight. Target those that drain the NHS of resources vs everyone.
@@selectmarketing844 Yh, I don't doubt it's complicated to figure out exactly how best to implement. I just think it's necessary to link the amount someone's choices end up costing the NHS to the amount you pay for it (whilst still being free at use), so that people consider their habits more carefully in advance
Watching from the US, the idea of a cross-party 10-20 year plan to reform the healthcare system sounds ludicrous. (34:22) We haven't been able to do that since before 2008.
365° for the days of the year? 🤔 a rather over generous circle? 😅
It’s 365 metres in circumference
@@Spengleman2 ah just checked, diameter 365. Such random stuff to base a building on. Why don’t they just come clean and admit it’s an alien spaceship 👽
Brought the missus from Vancouver to 02 for the Blind Faith reunion. Couldn't get tickets; next day went for a peak inside the venue, and a staffer said we can't look because security innit.
The most important healthcare issue is that general health improves. That starts in education while placing limits on capitalism, i.e., what's sold with certain ingredients and its availability. The country also needs to look at the best systems that produce better results outside the UK while accepting we haven't had the best health service in the world in decades. We have to stop saying we have a free at point of use system and begin a system of charging for some limited services to discourage abuse and reduce load. Carrying on as is even with more money just won't work.
Tech companies are given far too much leeway. If a snack bar company said it would be "really difficult" to stop putting arsenic in their snack bars they wouldn't be allowed to sell snack bars! No company is entitled as a fact of nature to do business and profit.
the Dome and the wars 2 years later, money flushed down the drain we could do with now, so labour not much better than the tories with money
What would I get by buying a ticket to your show and all the faff of getting there over just listening to your excellent podcasts?
As a doctor, I think you overestimate the displacement power of AI today. It’s dictation is fine, it’s note taking is fine, it’s reasoning with prompting can be fine, but not medical grade. It’s nowhere near the nuance. I love AI but it’s not there. And this discussion of “can Starmer take on the unions as AI sacks nurses” is wild. I have three jobs as a doctor. And yhe tech with all of them slows me down a lot. A lot. Can AI turn a referral into 30 seconds not 3-5 minutes? Great. Can it listen to consults and type up my notes perfectly? Great. Can it check prescriptions more accurately than a pharmacist? Great. It can’t do any of those things at present, certainly not to trust your literal life to it. And for it to be implemented as a productive adjunct would cost a fortune. We are talking billions. Basically every computer system would be replaced. The training the change to workforce. Crack on, because the IT sucks, but this isn’t clear cut Rory. If it’s a panacea it’s in its infancy and we have NO track record on good tech deployment.
The Millennium dome really was a lame duck, I remember my parents wanting to take me for my birthday and I said it's either Thorpe Park or I'll politely pass
Here's an easy way to increase productivity in nhs - get rid of the pointless stats which are gathered to demonstrate how efficient the nhs is! My wife has to spend 15+ minutes a day filling in forms, which over a week is 3-4 patient slots
Many of our Incomers are Morbidly Obese. This skews the figures for our native population.
And population has increased massively…. So that 1% doesn’t cut it
Isn't reducing a rise still a cut Rory?
No!
Haha, so Labour was averaging 9% nominal / 7% real increases p/a in the 2000s. If we'd continued increases at that rate we'd be spending £260B p.a more than we currently are on the NHS. That's an extra £8,000 per person in work in a country where the average salary is c. £34k before tax. Does that sound plausible to anyone?
It is important to emphasize that prevention plays a crucial role in health management. Both individuals and employers have a responsibility to foster a culture of health and well-being. To achieve a high-quality National Health Service, we must recognize that this requires appropriate funding, which may necessitate an adjustment in tax along with a big culture change. Perhaps removing oversight from politicians would be a beneficial first step.
They'll never top Danny Boyle's Olympic ceremony(s) like they'll never top Rory's trenchcoat.
Also, my sister is a mental health nurse and she ended up at ATOS doing benefit assessments (PIP) because it was a whole lot easier, significantly less dangerous and for more money.
We’ve got an NHS and primary care built for a population of 60 million. Unfortunately the problem started at the start of the millennium not 10 years later. You could still get a GP Home visit back in the late 90’s. You discuss moving back to local services but where I live they’re just about to close a GP surgery.
our local town/village has doubled in size and population in the last 2 decades. all British families in some nice new builds, but there is still only 1 surgery? 1 school?
You can blame Alastair and his mates for that. “Rubbing the rights nose in diversity”.
Being old and Scottish but having lived in England most of my adult life, I think you missed a couple of important points about the independence debate. The SNP did well mainly because they acted like a traditional Labour govt, no student fees , prescriptions etc etc and Labour never looked likely to win. Obviously wheels have come off with things that haven't gone well but comparing my mum's experience to mine Scotland Vs England I'd say most things are less broken service wise although it's true she doesn't need a ferry. But the main problem was there is no legal mechanism for Scotland without Westminsters ok so everyone can moan if they want one but voting SNP doesn't get you closer to one. Also I think I'm disproving the algorithm, the older I get I've gone from agnostic to pro although I won't have any say unless I move back to the land of midnight shortbread
You wont be seeing Mr Malinauskas then Rory, because you're not coming to Adelaide!