Health Secretary Wes Streeting has just given junior doctors a 22% pay rise, saying it's now time to think about reforming the NHS. Handily, the left-leaning think tank the IPPR are publishing a a three-year piece of work on how to make Britain a healthier nation, which Streeting is set to launch later in the week. The Head of the Commission Chris Thomas is on to explain what's in it. Hosted by Caroline Hepker and Yuan Potts
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Ultimately, all doctors want is to be valued as they once were in two thousand and eight, and the government has promised things in the past. Promises don't hold much value unless there's credibility behind them. This could mark the change between the relationship between doctors and the government.
This was the right deal, a fair deal, fair for patients and also fair for junior doctors, and crucially means that having drawn a line under this bitter dispute, we can now focus on cutting waiting lists and also reforming the NHS.
So junior doctors have accepted a paid deal from the government of twenty two percent. But what next. Hello, if you're listening to Bloomberg UK Politics, I'm Caroline Hepke and.
I'm new and Potts. So you heard from Vivektravadi of the BMA Junior Doctors Committee and the Health Secretary was streeting both of them, signaling a turning point in relation. But it other sounds like they might have a different destination in mind.
It's meant to bring an end to one of the worst strikes in NHS history. Forty four days of strike action since October twenty twenty two, although junior doctors now resident doctors are made clear that they still expect more progress on their earnings. There is a long way to go, but some might say that the tough part actually comes next. Kiss Ptarma says that there will be no more money without reform. The scale of the challenges is immense and is health all about the NHS?
Yeah?
Well, our guest today is authored a major port called the Commission on Health and Prosperity. Plenty of major figures took part, including Lord Darzai, who recently led that government review which concluded the NHS is in a critical state. Today's report is the results of three years of work and it is radical in scope. It starts by showing just how much sick of the UK is than other countries and them before the pandemic. The solutions It offers far more than just the NHS, but also your job and workplace, how you live your life, and how children and young people are supported at school.
Well.
Joining us now is Chris Thomas, who's head of the Commission and from the think tank the Institute for Public Policy Research. Chris, now, just what's the background to all of this? How unhealthy are we in the UK.
That's exactly the right place to start. So the UK really struggling on health outcomes. So we've done lots of work to compare the UK to different countries and particularly comparable countries, and what we see is that the UK tends to sit towards the bottom of the packs. So if we take the G seven group of seven countries, the UK is consistently in sixth place on a range of different health measures. It's only ahead of the US, but the US is a relatively unique example, so really not in the position that we'd want to be. And we're saying that, you know, that kind of point in time analysis is complemented by the fact that we're not improving our health outcomes as quickly as other countries either. So it's seems to be that in the face of the twenty first centuries specific health challenges, the UK has been or coming up with the solutions it needs, where other countries have driven ahead.
The philosophy behind the report, I mean it is advocating very clearly for pursuing health rather than simply treating sickness. That in and of itself might not be a new idea, but you've got some quite as we called them, radical solutions for how you would get there, just outline the most important points.
To you this Today, the Commission, with cross party involvement lots of different experts, has really come forward with a plan that I would sum up as one about proactivity rather than reactivity. It's a plan to stop just waiting for people to feel sick and then to intervene, but rather to intervene much earlier. So what does that mean? Well, I think the most substantial recommendations are around who we try to crowd in to health creation as across society mission. Now, I think that means that we will need to do some pretty bold things in terms of those in society, particularly businesses that harm our health. So those that might produce say alcohol or tobacco or unhealthy food, we might, within that approach need to ask them to pay for the full societal cost of that and in that way to change the incentives that act upon them so that they prioritize healthier food in their own right. It might mean that we need to do much more to think about standards of health in work. Work is often something that can make us healthier, but in Britain today it's also for too many people in insecure work something that makes them less healthy. So higher standards for work really important. But ultimately what we're saying is that we need to bring health into the places people actually live they work. You might only spend a few weeks in a hospital over your life, you'll spend much longer in school, in your workplace and your community and your home. That's where the frontier of health is, and that's how we deliver a healthy country in the twenty first century.
Some of the solutions you're proposing, some of the most radical solutions, really are about widing out who looks after health, and so you're talking about companies taking a more active role in the health of their employers, and schools getting involved more and intervening in the way that parents raise their children. Not all of this is going to be welcome, is it by many people.
It's a really interesting dynamic this, which is that sometimes the kind of proposals putting forward can be controversial in the media, but actually when you test public appetite for some of this, well, well, actually it's normally fairly popular. The kind of case studies that we have of where government has delivered in kind of isolated examples the policies of the genre we're talking about soft drinks industry levy, the smoking ban, even kind of proposals that are in the manifestos that were tested. They're generally popular and they get more popular after implementation as well. So I think what we're seeing is actually a case where public are ahead of politicians and ahead of the policy debate. They're up for this, recognized the importance of getting good health, and that much of this is about, you know, thinking about health beyond the walls of the NHS. It's time perhaps for the rest of us to follow a sleep.
Yeah, although I can imagine that that employers might be slightly concerned about the increased weight being placed on them something like the new Fair Work Charter that you talk about in order to create healthier workplaces. It's about whether the UK becomes you know, a costly a place to do business in terms of you know, global competitiveness. I think that's you know, one of the bits of background. But the other huge important element of this. Yes, it's about schools and about workplaces. You say there is also a chunk that is about the NHS. I mean, one of the very well known names attached to this report, Lord Darzy he put out a damning report only last week about the state of the NHS. What's the prescription in terms of the health service? And you heard there from where streeting there's also a fundamental issue about reform and financing of the NHS.
Yeah, really really interesting points. So if I can start just by lingering on that point around business, because it's important to say that this was a piece of work that was undertaken with businesses. There are industry bodies within the group of experts that formed as commissioners and a lot of consultation with employers during the process. And the thing that balances their attitude to prioritizing health and things like our proposal of higher standards for health and work is that the costs at the moment the sickness and business are just extreme. So in terms of the cost of doing business in the UK, well, actually our rates of sickness are probably one of the biggest drivers of that. So that tends to support their appetite, particularly after the pandemic and we saw such a viteral kind of account of how expensive health or poor health can be. That's part of their appetite for this agenda, but moving into the NHS. So yes, Lord Lord does a co chair of the Commission alongside Dame Sally Davison, and has released that kind of very sobering account of just how challenging things are for the NHS. And I suppose in this case it's moving from the diagnosis he gave independently as commissioned by the Secretary of State to the solutions. And ultimately, I don't think we can be fatalistic on the role that the NHS has to play in health creation. I think it can go alone or do everything, but it's still an organization with a budget bigger than the GDP of Greece. It has a phenomenal amount of money, of staff, of resource, so our aspirations for it should be similarly big. I think what we'll need from the NHS is a far bigger shift into the community. We have far more people living with long term conditions, but a health service that's really organized for emergency acute need i e. People coming in with an isolated case of very severe need. What we really need is to re organize the NHS around long term management and in that way, what the NHS can do is treat people or look after them in the place as they call home and stop them needing the much more expensive, much more resource intensive care that we provide in hospitals or A and E departments. That's a path to better health, but it's also a path to more financial sustainability. So in that kind of formulation you played earlier of no money without reform, well, that's probably the kind of reform that the Prime Minister is talking about and that.
The NDAs needs. But it is true also to point out with that pay rise given to junior doctors, with the junior doctors wanting more to come, there were actually no productivity gains or changes to their work announced with that cash Number one. And the other issue is that the NHS has resisted all previous significant reforms. Why would it be.
Different now, Yeah, excellent question. I mean, I think you're absolutely right. The challenge this new government comes into efaces is that the reform that the NHS needs is exactly the same reform that we were talking about in nineteen ninety seven or twenty ten or twenty sixteen, or any kind of other tatamic changes in the nature of the government. The successive governments have said, look, we need more prevention, we need more care in the community. I think the challenge that poses, having seen those attempts fail, is that it's probably not enough at the moment to just say, you know, more prevention full stop. It's that the government will actually have to engage with what creates institutional resistance to reform within the NHS. Now. I think that means that it might need to think about where and how the NHS is led. That might mean putting more management capacity into the front into local systems, or it might mean giving much more power to the front line so that it's led from the right places. It might mean modernizing the approach to managements in the NHS. We often suffer in the healthcare system from relatively kind of antiquated approaches to leadership, so that might support our capacity for change. And you know, I think we'll have to engage very seriously with the new structures of the NHS that were brought in by the last government, things called integrated care systems, which are meant to provide kind of more place level partnership healthcare, population health management, but actually at the moment are being undermined by having a huge amount of centrally dictated targets that don't really give them any leeway to do things autonomously. So I think stripping back targets and thinking about what the real priorities are to free up systems places to get on with it would help tea.
Of Chris what streating is called this thought provoking. You've clearly got the ear of government. But how much of this do you think is actually going to be implemented over the next few years? How much hope do you have in change coming about?
Yeah, I mean the burning platform is pretty immense that you know, we've got a government that you know, one be tested on how well it does on the health agenda, because the public often expect that of labor governments, but two that has made fairly kind of clear commitments to growth. And as we're saying today and as we evidence fairly you know, comprehensively, you don't get growth in the UK at the moment without prioritizing health. So I think that burning platform is really important as a starting point. I'm seeing, you know, green shoots. It's obviously very good to have encouraging words from the sectory of state about the work today, but the green shoots of actual policy happening are the most important things. So I've been pleased to see, you know, health checks announced in employment settings, tough action on tobacco, regulation of junk food marketing advertising before the watershed. These are all policies that take health outside of hospital walls and that can boost healthy life expectancy so that we have healthier lives much as longer ones. The real test now is sustaining that momentum, right, this has to be for all those good green shoot signs. This has to be a five to ten year program, a long term program. So I'm encouraged, but we need to see that commitment maintain over the course of years.
Really well, a really interesting point to end on. Chris Thomas is head of the Commission on Health and Prosperity reporting after three years of investigation into the state of the UK's health system the think tank the Institute for Public Policy Research. That report basically shows nine hundred thousand missing workers in the workforce in the UK due to sickness, no shortage of ideas. I think in the report many quite interventionists when it comes to business and again raising that recurring theme for the UK about poor management skills. Can these radical changes actually be delivered by governments.
Yeah, we talk a lot about the problems facing the NHS, of which of course there are many, but when you widen out to look at the impacts of health on the economy and on wi society, it really is a big problem and so much for the government to tackle. Whether some of these solutions get put in place interesting to see.
Yeah, that's it from Ask for Today. If you like the program, don't forget to subscribe and give it five stars so that other people can find it on Apple, podcast, Spotify or wherever you listen.
This episode was produced by James Walcock and our audio engineer is Seawan Rosta Machia, Pine and Poss and.
I'm Caroline Hepger. We'll be back with more tomorrow. This is Bloomberg.
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