How Austerity Made Us Sicker | Dr Amir Khan

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0:36Grow accepts over 100 insurance plans, including Medicaid in some states. Sessions average about$21 with insurance, and some pay as little as$0, depending on their plan. Visit growtherapy.com slash start now to get started. That's growtherapy.com slash start now. growtherapy.com slash start now. Availability and coverage vary by state and insurance plan. Health is everything. Whether you're talking about housing, education, justice, social services, your local council. Health runs throughout everything because we both all need to keep healthy, exercise and avoid sickness. So who better to talk to today than TV doctor Dr Amir Khan, who is also a practising GP.

1:28Hi Zach, it's a big day today. I'm meeting the boss to give him an update on EcoTalk. But I'm feeling good. Spring's in the air, feels like the new year's really starting and good things are coming. If your listeners want to do a good thing, they should switch to EcoTalk. Then they can be part of helping nature. All they need to do is go to ecotalk.co.uk slash bold politics to find out more.

2:03Thank you so much for being here. I'm incredibly excited to have you. I said to you before we went on that I was going to start with, if someone doesn't know who you are. And I don't imagine there's many people who don't know who you are because if they turn on the TV, you are often on it talking. But who are you and what do you do? I'm sure there's plenty of people who don't know who I am. I am an NHS GP. Sorry, I should actually say my name first, should I? So I'm Dr. Amir Khan. I'm an NHS GP based up in Bradford. I'm also a broadcaster. I'm on ITV's Lorraine and Good Morning Britain. Author, activist, I would like to add to that as well.

2:34There are lots of skills there. And I guess I'd start with the activist bit though, actually, because I didn't know you would describe yourself that way. Have you been kind of active in terms of health activism for a long time or is it a kind of newer thing? No, health activism has always been a passion of mine. I think anyone who is serious about health needs to be an activist because health is politics, it's policy. People's health is decided by how much funding an area gets, how much that gets in the community, not just in the NHS, what the food prices are like for them, what access they have to green spaces, what access they have to clean air, what access they have to education.

3:10All of that determines people's health. And I think if you are really passionate about health, you've got to get to those root causes to have good health outcomes. But beyond that, I think it's about, you know, making sure the people that you're looking after and beyond that, because I think as a doctor, you don't just, you shouldn't just care for the people you're looking after. It goes wider than that, I think. And when you see healthcare professionals being bombed, attacked, all those things in other countries, you've got to stand up against that as well. There was a lot there. That was amazing.

3:47We often hear about this phrase health inequalities and I felt like you were touching on it there. How unequal is healthcare outcomes in this country in particular? Incredibly unequal. You know, you've got an NHS that has been battered and bruised, particularly since the 20, kind of 2010 onwards. We've seen a huge drop in funding and anything that does that widens the health inequality. So we see people who are living in poverty have much more difficulty accessing health. And that's for a number of reasons. Yes, in terms of getting a GP appointment, waiting lists in hospitals, all of those factor into that.

4:23But also the lives that they are made to live, not through choices of their own, but because of policies that go beyond them, mean that they don't have access to all those things I listed before. Good quality food, clean water, well, access to clean air, things like those green spaces I talked about. All of that widens health inequalities. But what it does mean is those who can afford health and where the NHS is failing, they can afford to go privately. So you see that massive, massive health gap there. I often hear politicians say that the NHS will stay free at the point of use. But this is at the same time as giving contracts to private health care companies.

5:03There's a there's kind of a gap there. What is the gap? So the push for for private health within the NHS has come from a drive to want to kind of push down the wait times within the NHS. and that is because we haven't invested in NHS infrastructure, staffing and service. So there's been a real gap between the demand that is needed and the capacity we have. And a quick fix for that is to say, right, let's just give these contracts out to private companies who can help us with this. But the issue there is then these private companies really root down within the NHS and it's hard then to pull away from them.

5:39But the big issue I have with it is actually giving these contracts to private organisations does destabilise the NHS? service as well. So I always use this example. We have two patients with a hernia that need operating on. One is really fit and well and just has a hernia because he's been to the gym. And the other one has multiple health conditions like diabetes, COPD, chronic lung disease, heart failure, all of these things. So you've got these two patients, but they both need their hernia operating on. The private company will not touch this patient with all these conditions because they don't have the facilities for the aftercare after they've done the operation to look after all those other health conditions that could become complicated after the procedure and that operation and looking after them for longer will cost them so much more.

6:21The other person who just needs a hernia op as a day case and will go home, they'll go, all right, we'll take that. And the complex one goes to the NHS service. Both the NHS and the private organisation gets paid exactly the same to do that hernia op. But you can see the NHS is paying more here to look after this patient. I'm not blaming the patient, it's the system. And so all the relatively easy, straightforward patients are creamed off for these private organisations because they say, well, we can't do these complex ones because we don't have the right equipment to look after them before and afterwards.

6:53So they'll take all the easy ones. The more complex ones that need more complex care get done by the NHS. They both get paid the same. Eventually, the NHS will go, actually, you know, this is really bankrupting us because we can only do a limited number of these because that patient stays for longer. And so we're not going to do this operation anymore. And that private company goes, right, OK, we're the only player in this game now. So we're going to up our prices if you want us to do this. It's the same procedure, but there's no competition anymore. So up the price it goes. And that's a real, real issue within the NHS.

7:26So when we give people private contracts, yes, in the short term, patients go, great, I can go here, here and here, and I'm not waiting as long. In the long term, it really does destabilise the NHS. And then we have, I'm not pulling you into party politics because you're a doctor and we shouldn't mix doctors and party politics. Health is politics. Quite. But we can talk about the plan. And Nigel Farage has, we don't exactly know what the plan is, but it seems to be increasingly moving towards a point based private health care system. What's your opinion of the plan? so i i have heard this um and i think people really need to understand what an insurance based healthcare system looks like um and there's two models really so there's the u.s model which is a private insurance based based model uh where the government isn't really that involved in negotiating anything and people have to pay privately yes there is the affordable care act as well in america but what you need to understand is because people are paying such high amounts because the government has not negotiated any prices for medicines, procedures, all of this kind of stuff.

8:30These private companies and healthcare companies and pharmaceutical companies really skyrocket their prices for things because they know the insurance companies are going to pay. When you look at America's health outcomes, first of all, they pay more GDP for their health, so it's more expensive for them to pay for their health. But their health outcomes in terms of life expectancy, infant mortality, chronic disease management are far below ours. And they're paying around 17, 18 % GDP for their healthcare. We pay about 10 or 11 % ish. And so that massive discrepancy between cost, but the health outcomes are so much poorer.

9:08And if you speak to anyone there, health costs are one of the number one causes for bankruptcy in America as well. So it's huge. And you've got people delaying access to health because they can't afford it. You've got people not taking their medication or rationing their medication because it costs so much money there. And so when you look at how it works in America, they're paying for it themselves. They've got worse outcomes. Of course, the health and wealth divide is huge over there. That is a terrible system. It's not a system that we want anywhere near here in the UK. People often say, well, actually, you know, if you look at other European countries, they've got insurance based policies like Germany and France and the Netherlands.

9:49Well, actually, it's very different there. They have like a social insurance policy where the government heavily subsidises their health care. So Germany, for example, 70 or 80 percent of the health care is subsidised by the government and they may have to pay a little bit for insurance, but a lot of it is claimed back as well. And so it's very different to what's going on in the US. Either or the government is paying, whether it's the NHS or whether it's these social insurance companies, it's taken out of taxpayers' money. And the answer isn't insurance based policies here, because I don't think when certain politicians talk about insurance based policies, they're talking about Germany, France and the Netherlands.

10:35I think they're talking more like the US where there's huge profits being made by private organisations at the expense of people's health. And that is something that we just have to avoid. That is not what the NHS is about. The NHS is not about massive profits. The NHS is all about health outcomes and doing the best for patients. and if we move towards that system our our position in in terms of health care but our position in negotiating prices for drugs and treatments really is going to be really affected as well because because it's all going to be privatized and it's just going to be awful and and i've got to say this and i say this with such passion i am nhs through and through i don't do anything but nhs work when it comes to health um once the nhs is gone it is gone forever it we will never get it back don't think oh well we'll try it and see and if it doesn't work we'll get the NHS pack you will not and you will regret it and it will affect generation after generation I could cry when I'm saying this generation after generation after generation it will never ever come back and so so please please please you know protect the NHS and vote accordingly it's literally one of the best things about this country yeah and hasn't been loved for a long time but actually it seems so strange to throw the baby out with the bathwater yes or it doesn't seem strange when you realise what someone's motives are for doing that.

11:50And in terms of the NHS is failing, I was going to say, what is the state of the NHS in your kind of diagnosis? It's a really hard one. I would say the NHS is really struggling, not because of the people who work in it, not because of the people who use the service, but because of years of austerity and underfunding. So if you go back to, you know, consistently since the 1950s till about the 2000s, we saw a steady increase in the funding that the NHS gets, around 3.9 % increased funding per year. We did then see a boom between kind of the 1990s up to about 2010 with the Blair-Gordon-Brown government.

12:35We saw an increase in spending and a lot of the infrastructure waiting lists and all of that went down. Since about 2010, after all the austerity cuts came in, we've seen a steady decline in the funding. Yes, it's still going up year by year, but compared to that 3.9 % average per year, we're now seeing a funding increase about 1 % to 2 % per year. And that's had huge effects on the NHS. First of all, we haven't invested in the staff. We're seeing record numbers of NHS staff leaving the NHS for a number of reasons, including pay, including working conditions, including the quality of care they can give their patients.

13:14And that is one of the reasons they got into that job. The infrastructure hasn't been invested in. Community health hasn't been invested in. So all of those things have led to an increase in wait times, difficulty accessing care. But we're also seeing an ageing population at the same time. We're seeing increasing complexity in care. Certainly as me as a GP, I get 10 minutes, sometimes 15 minutes to see really complex patients with multiple health conditions and underlying mental health issues as well and underlying social health issues as well. So all of those things were expected to bottom in 10 or 15 minutes.

13:51It's impossible. And that patient then has difficulty getting a follow up appointment. So it's a bit of a vicious circle. So in terms of where the NHS is right now, it's in a really precarious situation for both staff and service users. And what that means is there are what I would describe as sharks circling, pushing for perhaps privatisation, pushing for an insurance based system, which would be a disaster for everyone. I definitely want to get back to that. And I've had a strange insight into the 10 minute consultation appointments because before I was a politician, you probably know this, I was a theatre actor.

14:26And one of the ways I was making money in terms of my bread and butter was doing medical role plays. And so when people were doing their final exams to be a GP, they would come in and I would have a kind of script that I would have to do. I would love for you to be my actor when I did that exam. I just used to love it. But you kind of sometimes do like 50 of them in a day. So you're just having the same conversation over and over again. And you're like, have I said this already? But I saw how difficult it is for people to get the amount of information you need to get in 10 minutes. And presumably, and not just older people, I suppose younger people can do this too, but sometimes people really want to talk and they want to tell you the whole life story.

15:00We also know we've got a loneliness epidemic. Yeah. How as a GP do you balance kind of the empathy and the connection of a human being and get the information you need to get and have them out of the door in 10 minutes? It just seems wild. It is wild. And I think it's almost impossible, you know, because the odds are stacked against you. I'm a GP trainer, so I've been training GPs for 13 or 14 years now. I've currently got three trainees that I'm working with as well to get them ready for that exam. And so they really struggle because you do want to talk to the patient. You do want to get all the information out because within all those stories and what the patient wants to tell you is the nub of their problem.

15:35And their problem doesn't exist in isolation. It exists within their life, within their community. And we need to know how it's impacting all of those things at the same time so we can get a management plan that suits them and not just that one particular illness. We are trained to ask certain questions to get all of that out. and I would say you know I've been a doctor for over 20 years now and it was easier before when the complexity wasn't there where all these social issues didn't play as big a role as they do now and all the cuts that have happened in the community don't didn't play as big a role as they do now but now it's really difficult and even I as a I would describe myself as an experienced GP I've been a GP for over 15 years find that that time restraint really hard and so you have to pick and choose.

16:23There are some patients that you can get out the door quicker because they've got a simple-ish issue, but there are those that need your time and you have to connect with them in a different way and really explore their issues. And I think you've got to be okay with running over time as well. That's what I do. I've made peace with it now. And I think if patients want to come and see me and they want, you know, or a doctor who gives them the care that they want and they need that time, then they have to understand that other patients need the same time as well. Do you have, I'm missing a point here entirely, I'll get back to the important stuff in a minute, but do you have people who book an appointment and they don't know that it's you and then they walk out, I mean, it would blow my mind if I walked into my GP and you were there.

17:02All the time. But the thing about my surgery, I've been at that surgery longer than I've been on TV or writing or anything like that. So I think they've laid claim to me before all this happened. So to me, it's just like, oh, it's Amir on the TV again, but he's my GP. And it's also the area I grew up in. so so they know not just me but they know my mum and they know my sisters and they know my family and often if they can't get an appointment zach they text my mum they do and then she texts me and goes oh would you mind at the end of your surgery just slotting in so and so so my lists are about 10 times longer than anyone else because i don't want to annoy my mum i love that your mum's like the part-time receptionist for your work as well pretty much they direct her as well as receptionist probably and the kind of obviously google isn't a new thing but I just even think about my friends and family in fact myself let me not even put this on my boyfriend for instance that we google what we think is wrong with us and then we go in to talk about the GP and we're absolutely convinced that something is much worse than it is because we've read some of the darkest corners of the internet yeah that a real issue it's not an issue uh I don't mind exploring people's concerns and and often you know whether you google things or not if you've got a headache if you've got an unusual pain your mind naturally goes to god this could be a brain tumour, it could be something serious.

18:17And Google can sometimes reinforce that belief. But actually, you know, explaining why it's not that or actually, let's do some tests to make sure it isn't that is actually quite a useful part of the consultation, because it's one way for patients to tell us what they're actually concerned about, because it's easier to say, well, I Google this, and this is what Google said. And I know I should never Google it. But this is what Google said. It's easier for them to say that than it is to well, actually, you know, I did actually think my headache was a brain tumour without kind of that backing of Google just to second them a little bit.

18:49So I don't mind it so much. It gives us a way to explore patients' concerns. You're so relentlessly positive. It's beautiful. I guess we have a relentless energy. Is chat GPT? I mean, it's a similar question, but I know people are using this sometimes now for mental health counselling, which sounds worrying as well, but presumably as well for GP diagnosis. The issue I have with AI is not that it might tell patients, you know, what it could be. It's that it might falsely reassure them. And so they don't seek healthcare advice, a real healthcare professional. In terms of chat GPT and mental health support, we already refer people to online courses and online services for mental health as a result of, you know, it's really hard to access actual face-to-face in-person mental health support.

19:37So one way to kind of get around that and give people the support they need in the meantime is to say, well, actually have a look, read of this website and go on this online course. So ChatGPT is one way to do that. The issue is who's regulating it? What information is on there? Where is it getting it from? How reliable is it? And will it really help people? The websites that we refer people to are highly regulated and written by healthcare professionals, not an AI chatbot. And that's a big issue for me. Yeah, it makes total sense. Coming back to kind of the initial more holistic view, it's a good word at the NHS.

20:10Very often I'm on TV or radio and I say we need to fund the NHS, we need to invest more money and after they've asked me where's the money coming from, we talk about wealth taxes and various things. The next question is, is it about funding or is it about efficiency? And I'm just wondering what your thoughts are on that. I think it's about both. I think it's about both. You know, we've got the very clear evidence from when the NHS was funded properly, you know, compared to now, they averaged 3.9%. It went up to almost 9 or 10 % during kind of the 90s up to 2010. And we saw the wait times come down.

20:41We saw people get better access to their GPs. We saw health outcomes improve as well. So we know that funding works. Efficiencies are important as well. At the moment, we're just not funding it at the level that it needs to be funded at. And there's a lot of shortcuts taking place. Rather than funding NHS infrastructure, we are giving contracts to private organisations to come and work in the NHS and get contracts within the NHS, which is an issue for me. And so the answer lies, as you say, better funding, better efficiencies. But looking at the root causes of health issues as well, at the moment, it feels like we're constantly firefighting.

21:22Bed capacity in the NHS, on average is 94%. So that flow of patients out of hospital so we can get elective care done, so we can actually look after the patients that need it and put patients where they need to be because they don't all need to be in hospital. Over the austerity cuts, we've seen a lot of these intermediate hospitals close and those were really useful. When my patients in particular, when they were done with their acute care, they could spend, particularly my elderly patients or or those living with frailty would spend four to six weeks in a rehab hospital where they had intensive physio OT before they went home so they wouldn't just bounce back into hospital.

22:02That isn't happening anymore because all of those intermediate community hospitals, well I say all of them, a lot of them have just been closed, that access isn't there anymore. So patients go home, perhaps unsafely from hospital because there's a pressure on hospital beds they are supposed to get care at home through these kind of physios and ot's who come home who are themselves amazing but stretched to the max and so they don't get that intensive one-on-one care they might get a half hour appointment with a physio who comes home really comes to their home very quickly and because that physio has to go somewhere else and somewhere else and somewhere else so all of those things are being lost at the moment so we we've had the funding cuts we've had The cuts in community, infrastructure, primary care.

22:48We deliver 90 % of NHS care. We only get 10 % of the budget. We're losing our staff as well. And all that wraparound social and community care has not been invested in. All of that over decades, successive governments just making cut after cut after cut has led to where we are now in the NHS. I confess I hadn't heard that stat until you've just said it. So 90 % of health care is primary care. Yeah, that's 10 % of the budget. That's right. I mean, that's not justified. But has there ever been any justification of why that is? I think we're kind of seen as the runt of the litter when it comes to the NHS.

23:23And so, yeah, of course, hospital care is far more expensive. So it makes sense that they get the lion's share. But that discrepancy between 90 % versus 10 % is huge. And it doesn't take into account all the work that we could be doing in the community. What patients want more than anything is to not be in hospital. They want to be looked after close to their home, close to their loved ones in the community. And that involves primary care, not just GPs. GPs are one part of primary care. We're talking about district nurses. We're talking about home visiting teams. Like we've got brilliant heart failure nurses that go out to people's homes, keep them out of hospital by looking after their heart failure, adjusting their medication at home.

24:03We can do that for so many other systems. You know, respiratory cases, when you look at the winter, we see people with existing respiratory conditions go into hospital because they become acutely unwell. But if we had a system that looked after their respiratory condition at home rather than that once a year appointment they might get with their practice nurse just to make sure they're using their inhalers properly. Practice nurses do amazing more things than that. But it could just be so much better managed in the community. But we are so stretched right now, firefighting, you know, at the moment where GPs are currently disputing the government on the current or this new GP contract that's coming.

24:41That's suggested that we have to see all patients every day, no matter how many numbers come in. We can't cap the number. There can't be we can't we have to see every urgent case, every non-urgent case. We have to deal with it there and then. When we haven't got the capacity to deal with it, where are we going to put those people safely? How are we going to look after those people safely? But we're constantly being battered and firefighting that this long term preventative chronic conditions just don't get the care that they need. And can I ask you, I suppose, as a follow up question about adult social care or social care more generally, because presumably when that's not being funded or managed properly effectively with the patient at the centre of it, you also end up with the brunt of that too.

25:20Yeah, very much so. So, you know, I go on home visits when I'm at the surgery. I will do one or two home visits over lunchtime. and effectively they are housebound patients. More often than not, they're elderly, frail patients. And many of them would be better looked after, even by their own admission, in social care of some sort. So whether that is a nursing home, a residential home, or having carers come in at home, getting access to that is so incredibly difficult. First, getting access to it as a kind of a pre-planned thing, going, right, I think this patient would benefit from some care at home or need some 24-hour care in a care home and the patient has agreed to it.

26:02Organising that, even in a non-acute emergency situation, is really difficult. The amount of admin and phone calls I have to make to make that happen, and it takes days, is just huge. But if there's an acute emergency where someone's wife may ring up the surgery and say, look, I just cannot cope with looking after my elderly husband with dementia anymore. I just can't cope with it. I've had enough, today's the day, that is it. Trying to sort that out in and amongst, you know, a full surgery is, honestly, I can't tell you how much time it takes up. And it's just, there's just no joined up services in that.

26:41But if adult social care was working well and we could say, right, we need a single point of access. This poor woman has been looking after her husband for so long and she's really struggling and he's becoming increasingly confused, perhaps even violent. through no fault of his own. He's got Alzheimer's, dementia. We need something now, right now. And that whole team would just go in there and take care of it. That's the ideal situation. That is not happening right now. It's so frustrating to watch because whether it's the kind of effects of cuts on primary care or even, frankly, the police who are dealing with issues that probably social care could have prevented in the first place, it just feels like the scrimping and saving of money actually creates much worse consequences later on.

27:22Very much so. And people are feeling that. I see it every single day at work, you know, whether it's access to dentists for children. You know, they come in with dental issues to see us as GPs because we're slightly easier to get into than the dentist or anything. All those social care issues. I can't look after my partner or husband anymore. My mental health is deteriorating. All of these kind of things where if we had better community centres, There's better mental health services within the community where people can get same day mental health care. That would just be incredible. And it would take a massive pressure of us so we can spend more time with the patients that really need it.

28:01Those really complex patients with multiple health issues, you know, that actually rather than 10 minutes, why don't we spend half an hour with them and really sort out their problems? And everything else that we were doing that we don't have to do could be taken care of by someone else. For sure. I'd say well put. And so then I want to link to long term health conditions and particularly long COVID. And actually, it feels particularly poignant speaking to you because we had an amazing Green Party councillor, Darren Parkinson from Bradford, who publicly stepped down because he had long COVID. He's still doing amazing work.

28:31He often supports me and like helps us with our communications on social media. So thank you, Darren, for everything you do. And at the same time, I think, I don't want to speak for Darren, but lots of people who do have long COVID just feel they kind of have been left behind and there's nothing for them and they're not in the public discourse. Yeah, very much so. Long COVID is a really poorly understood condition and it's a multi-system complex issue and it will affect everyone differently. You know, everyone has a different version of long COVID because it is so multi-system. It is so inflammatory.

29:02It can cause so many different things to go wrong at the same time. And you're left with these conditions that nobody really wants to touch because there hasn't been enough investment in the understanding, but also the management. and there used to be a long COVID service at most hospitals where it was run by the respiratory team perhaps and they would take care of it. All of that seems to have just melted away and because like I say long COVID can affect your brain, your lungs, your skin, your joints, it can affect so many things, your mental health but also how fatigued you are. We haven't got one group of people looking after it.

29:36If I saw a patient like that I would have to refer them to the rheumatologist just for their joints, I would have to refer them to respiratory people just for their lungs and And it's just not adding up. So not only have we got these people who were really well and healthy a few years ago who are now, you know, very affected by their symptoms. And a lot of them have lost their independence and their ability to earn as a result of it. We haven't got anything in place to look after them. And that, I mean, you know, we're talking about adults, but it can affect children as well. And so it's a real problem.

30:10They come in. I feel really helpless when I see them, to be honest with you, Zach, because I know it's one of those consultations where I know, yes, I can listen to them and yes, I can empathise with them. But there's very limited things I can do to help them because giving them painkillers isn't going to be the long term answer. And we don't know enough about the condition to know which specific medication might help reverse some of their symptoms. And that's that's a massive issue for them. So they have been left with in limbo. But it's not just them. You know, it's other conditions where we've seen a lack of understanding and investment in.

30:41So fibromyalgia being another one, ME being another one as well. All of these things that have such a kind of multifactorial cause. And we can talk about women's health in the same space, can't we really? Endometriosis, adenomyosis, all of those things that haven't been prioritised for so long. People have just been left and it's really hard because we see them, we listen to them, but it's so limited for what we can do. I feel very emotional listening to you because I find it one of the hardest things to handle as a politician when people write to me, particularly with long COVID. But actually, frankly, yes, all of those conditions, because it feels like my obvious first step is to argue for more funding, to look at more steps for prevention, to make sure that it's proper ventilation and building, etc.

31:27But it also just feels like the decision makers very often, unless they've got someone in their family or they've been personally affected by it, there seems to be almost a psychological thing of, oh, it won't happen to me. And that's unfortunate for that group of people. But we're just going to get on. Yeah. And I think that's where the issue lies for a lot of health issues. You know, unless they are in the public domain and of interest to the public, then they don't get the recognition and the funding that they deserve. And there's so many health conditions like that. But that's where I think this joined up health service needs to be better.

32:03It is so fragmented for people who have these multiple conditions or conditions that affect multiple systems. They often get various appointments with different specialists, but nobody's really talking to each other. So I'll speak to a patient who goes, well, I've got an appointment on Monday and I can't come to your appointment or choose it because I've got this letter and I don't really know what I'm going to, who I'm going to see or what I'm going for, but I'm going here. And it must be so difficult for them to go and see a specialist every time. And yes, they're lucky to see a specialist. Well, I say lucky, you know, it's absolutely they're right, but they feel lucky.

32:35But nobody's really talking to each other and it's not, it's just not joined up in the way that it should be. And then I'll start with personal stories in a moment. but my partner who's a physio so shout out to the allied health professional yes i watched his father slowly disintegrate um because he had pulmonary fibrosis and there's an amazing group called action on pulmonary fibrosis who do a lot to to educate particularly doctors who can miss the symptoms at the very beginning of it this isn't just about pulmonary fibrosis so i suppose there's lots of conditions as a gp how can you possibly know about every condition but there's a more that politics could be doing maybe or is it this very much within the health sector about education?

33:13I think there's a number of things there. Yes, as a GP, we can't know about everything, but we should be able to recognise when, even if you don't know what it is, that something is wrong and needs further investigation. I certainly don't know every condition and how every condition is going to present, but I feel like I owe it to my patients to know, actually, this isn't normal, so let's do some tests and find out. And if I still don't know, I should be able to hand over that patient to an expert who might know the answer. I think where it can fall down is if you don't know the answer, but you don't investigate it either.

33:47And so that is important. I think, yes, absolutely. We probably do need some more training in certain conditions. Women's health, I'm really passionate about women's health and I know it doesn't get the attention it deserves, but we can say the same for lots of conditions and whether not just the undergraduate medical training needs looking at in terms of that because you know you shouldn't just do four weeks of women's health you know but they make up 50 of the population we should be doing a lot more than that but the GP training as well you know how are we actually making sure that these conditions are being taught is it you know are we just leaving it to the trainers in those tutorials are they getting any formal teaching in it how is it all being examined it all we need to make sure that women's health does get examined at every opportunity.

34:35We need to make sure some of these rarer conditions, these students and GP trainees or resident doctors know that they could get a question on that. And so they do need to learn about it. So I do think that, but all of that comes hand in hand with politics, right? Because the changes need to come from policy and pressure from policymakers so we can make those changes. We're all amenable to it. We want to learn more, As clinicians, we're always wanting to learn more. But it's finding the time and the space to do it and making sure everything gets a fair footing. It doesn't have to be equal footing because some things present more commonly than others, but there should be a fair footing.

35:17And you stole my next question, which is great, which I was going to say women are over 50 percent of the population. Why is women's health not being prioritised or given 50 percent of the attention? Where do I start with that? Well, historically, everything's been done by men, right? So all the studies on medical conditions, whether it's heart attacks or pain management, all of that stuff has been done on men. And so we've just assumed, I say we, not you and I, but men before us have assumed that women are just small men and we can apply the same outcomes that we found on men to women. That is absolutely bollocks.

35:55It's just bollocks because women are a completely different, have a different biology to us, you know, with their hormones, with their pain receptors, with their anatomy, everything, you know, all of that is different. The way oestrogen affects almost every part of a woman's body will mean paracetamol will affect her differently to what it would with me. So that has not been really investigated or understood or wanted to be understood until quite recently. And we've got to give a shout out to all the people and mainly the women who have been pushing for this. all these kind of gynecological issues like endometriosis or fibroids, adenomyosis, all of these things where women have been just told, well, that's just being a woman put up with the pain.

36:44It's just part of the cycle and you've just got to get on with it. Actually, no, you know, yeah, periods are normal, but very painful periods are not normal. Bleeding in between your periods isn't normal. Heavy periods are not normal. All that pain that you get because of these underlying gynecological conditions where it's just been put down to, oh, he's just a woman. It's not normal. And so women have just been gaslighted in believing that they're very painful, very debilitating symptoms are just part of being a woman by men for years and years and years. And of course, the studies that we have for lots of things have just not included women.

37:22They haven't included pregnant women. They haven't included breastfeeding women. So our fallback is, oh, well, a pregnant woman can't have that or a breastfeeding woman can't have that because it's unsafe. And that isn't necessarily true. It's just that we don't have the data because we haven't done the studies on pregnant or breastfeeding women to say that they can or can't have something. And so women's health now, I think, women are standing up quite rightly. We're talking about vaginas and vulvas and all of that stuff quite rightly. We should be. and we are hoping to be working towards, I'm hoping, women's health hubs in the community where we can look after women from cradle to grave and really, you know, so a mum could take her daughter or her own mother to this same place and they could all get treated at the same time for whatever thing they have because women's health is so much better understood.

38:14I'm feeling really fired up listening to that. I imagine other people will and there might not be something obvious but are there any campaign groups or obvious places that people can go to to find out more about that and support it. Womenkind Collective is a really good one. And there's a lady called Dame Leslie Regan who's doing a lot of work in women's health. And I would urge you to see what she's writing about because she's the champion for these women's health hubs. I'll definitely check that out and hope other people will too. I'm not trying to pull you into very complex conversations, but I'm interested in the process.

38:43So I was on a podcast on Monday in front of a live audience and the podcaster took issue with the fact I'm vegan and started to ask me, you know, do I miss the taste of meat and all sorts of like pretty offensive questions that it was a comedy show so I kind of kept a smile but a little bit me was like this these are odd questions to ask but the bit I found more interesting was that was that they had recovered from cancer and said that their doctor had told them to start eating more chicken because it was going to help with the cancer there's also a group I'm very aware of called the plant-based healthcare professionals or a group of doctors nurses well healthcare professionals we're losing the title who are pushing for more plant-based options, particularly in healthcare settings, but more widely.

39:21The bit I'm less interested in is, should everyone have a plant-based diet? Because I think we could do a whole hour on that. Where should people be going for information, I suppose, and who should they be listening to? That's a good question. I have to declare that I'm vegetarian as well. And I think either as a vegetarian or a vegan, you can get all your nutrients from plant-based food. There's no doubt in my mind about that. yes it's also possible to eat really unhealthily as a vegan and a vegetarian isn't it so i'm right i won't tell you about my diet but you can absolutely get all your nutrients from from from plant-based foods you just got to understand how to do that and that's important in terms of of where you can get information from it's it's always trusted sources isn't it you you will always go online and you will find people who look amazing go to the gym all the time and they claim to be on certain diets and they're doing this and they're doing that.

40:17And because they're so physically appealing and they're talking with such authority, it feels like what they say, if I do what he or she says, I will look like them and I will feel like them. It's just nonsense. They are showing you one thing that they want you to know, not the whole picture. And I think if you really want information, go to proper healthcare professionals. And I'm not saying that's doctors because we don't know everything about nutrition. We certainly don't. A lot of my knowledge comes because I am a GP with a special interest in diabetes. So I had to do a whole module around nutrition when I was doing my postgraduate diploma in that.

40:53However, I would say that most doctors have quite limited knowledge in nutrition specifically. And so a dietitian or a nutritionist is your best bet. And they have loads of there's lots of people online who give really clear advice on nutrition. and whether that is if you want to do more plant-based stuff, plants are great, loads of vitamins, lots of minerals, lots of polyphenols. Honestly, walnuts, berries, legumes, they're like the triangle of good health for me. But I have to say, I have to say this as a doctor, you know, when I'm talking to my patients about food and I know they're not vegetarians, which is absolutely their choice, I will say, talk to them about the benefits of fish.

41:35I will talk to them about the benefits of lean meats like chicken, But I will also tell them, you know, eating too much red meat can increase your risk of bowel cancer or processed meats as well. And so I do have to be fair when it comes to that because fish is a really nutritious thing. For me, it's not about the nutrition. It's about the ethics of eating fish. And so I do have to be very clear. But, yeah, nutritionists and dieticians are your best bet when it comes to nutrition advice. My response is always I'm a politician, not a health care professional. But I can be more specific now about who people should go and see.

42:08So last week I was at a report launch for Trans Actual, who are a trans rights organisation, who are talking about the kind of discrimination that trans people are facing across the board. But one of their particular asks was around health care, but not trans-specific health care. But actually, when you go and see that your GP, the GP understanding that a trans person is a person too. And if they've got a broken arm or a leg, it's not necessarily because they're trans. But also the same need as gender affirming health care. What more do you think needs to be done? I think there needs to be very specific training in this.

42:39I've had zero training in looking after people from the trans community. I would like to think I do it well when they come and see me, but I'm just guessing I do it well. I haven't had any feedback based on that. You know, we will always ask them how they, you know, what they'd like to be called. And I like to think I look after them as a person rather than a trans person. But I don't know. And the issue I have with that is that I haven't had any training. None of my trainees have had any training. I don't think we get any at medical school either. You know, I work closely with Leeds Medical School and I'm not sure.

43:18I can't say for sure, but I don't think there is any in there. I think it's kind of optional. Oh, if you see a patient, then write about it and reflect on it. I think it's that kind of thing. But I do think definitely the medical curriculum, the nursing curriculum, you know, all of the health care curriculums, undergraduate and postgraduate, should have some training done by trans people, delivered, written by them, delivered by them, not by people like me who's just guessing. It has to be done by them so we can treat them with the exact kind of care and dignity that they deserve and they want more than anything.

43:51It's really beautiful to hear that. I suppose it's for nothing about us without us. It feels quite simple, but so often is missed. You mentioned earlier that lots of doctors are thinking about leaving the NHS. And this is one of the rebuttals I often use when people say, if you bring in a wealth tax, lots of wealthy people will leave the country. And I'm like, well, I'm actually more worried right now about the people who run our NHS who are leaving. The opposite argument to that is this kind of concept of a right often push of health tourism. Does health tourism exist? So for people who don't know, health tourism is people who are coming into the country to use our NHS who aren't entitled to the NHS.

44:24And the long and short of it is, yes, it does exist. But is it crippling the NHS? And the answer to that is no. Health tourism takes up about 0.3 % of the NHS budget. So anything that takes up 0.3 % of the NHS budget is not the reason the NHS is under pressure. Lots of people will point at it because it's dog whistle politics and they'll say, oh, look, there you go. It's them who are doing it. And they often point to people like myself of colour and people who might look different to them. What I would like to say is people like me, you know, second generation immigrants or people from historically marginalised groups, make up a massive proportion of the people working in the NHS.

45:07And when it comes to doctors, we make up nearly half of the doctor population within the NHS. When it comes to nurses and midwives, we make up about just over a third of the numbers of NHS midwives and nurses that you see. So we are not the reason that you can't get an appointment. We are not the reason you can't get that scan or we're not the reason you're waiting months, if not years, for your hospital appointment. We are the reason you can get an appointment. We are the people who are working to ensure everyone gets equal access to health or care when they come in. And so it really does pain me to hear about that because it's just not factual.

45:51And all it does is isolate historically marginalised groups of people. And there's so much of that going on in the NHS, outside of the NHS, in the media, wherever you look. and that is just another example of it and it's so painful because the opposite is true

46:11chris packham here chief ecologist for ecotalk it's been a big day for me because i've come to answer to the boss if we were a conventional company chris we'd be talking about turnover rates of return shareholder dividends all of that kind of stuff but you know that we're not a conventional company and our bottom line is a very different one it's about nature it's about birds, bats, bees, ponds, beavers. Tell me, how are we getting on? Well, I'm pleased it's not the former because I don't know anything about that, but I can tell you that EcoTalk is paying massive dividends for wildlife. Yes, the ponds are in, the trees are in, the wildflowers are in, the bird boxes are up, the barn owls are prospecting in the boxes, and we've got beavers and more beavers coming.

46:49Dale, the company is booming. Fantastic. And subscriber numbers are booming too. I mean, I think we have quadrupled in six months we're at 20 000 people and this is what's powering the whole venture people's mobile phone bills allowing us to do this for nature i love it it's absolutely fantastic do think about joining up ecotalk.co.uk slash bold politics the hustle doesn't have to hurt if performance pressure is making it hard to breathe grow therapy helps you navigate stress set boundaries and actually feel like yourself again. Whether it's your first time in therapy or your 50th, Grow makes it easier to find a therapist who fits you, not the other way around.

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48:20We're talking a week or two after the Gorton and Denton by-election where Hannah Spencer won and we're actually speaking the day after her maiden speech and they're just watching it. It just kept welling up over and over again. For anyone who hasn't seen it, there's a section where she names every trade person under the sun and just says this is for the posties, the plumbers. She just keeps listing them and it keeps going on and on and on. But I just know from knowing Hannah that she'll have sat there for a long time and thought, oh, this group of people and this group of people are not wanting anyone to be left behind and these jobs that are so rarely seen or heard about.

48:50It just felt really special. Amazing. Amazing. But I remember being on TV the morning after. I think it might have even been Nagamanchetti, actually, but it might have been someone else who said to me, why did you put out leaflets in Urdu? And I genuinely wasn't trying to be sarcastic, but I just said, I think we put out leaflets in Urdu because we wanted to communicate with people who speak Urdu. And just pausing and going, actually, it's no more complicated than that. Honestly, it really blew my mind because in the NHS, for cervical screening, for bowel screening, breast screening, immunisations.

49:21If we know a certain household or a certain population don't have English as their first language and they're more comfortable speaking or reading in another language, we send them a leaflet in that language because I don't care what language you speak or read. I want you in for your breast screening. I want you in for your immunisations. You know, that is the overriding thing. And it is the same in politics. You know, it doesn't matter what language they speak. This is it drives me mental. So I was watching you during some before and after that. And there was a real push for from from people saying, well, do you not think you just got the Muslim vote or this was all about one single condition?

50:02Like Muslims are one homogenous group that only care about one thing. We care about the exact same things that everyone else cares about. It doesn't matter what language we speak. It doesn't matter the food that we eat. We still care about the cost of living crisis. We still care about how good education is in schools. We still care about access to the NHS. We still care about our environment. We don't have one single issue that is Gaza. Of course we care about Gaza. Well, not all Muslims do. I certainly do. I can only speak for myself. I'm not going to speak for a whole group of people. But I care about all those other things as well.

50:33And lots of Muslims I know feel like I do. And it drives me mental when I hear them say, oh, well, the Muslims only have one issue that they care about and you're doing that just for them. Honestly, we care about everything else. I want the kids in my family to have a great education. I want them to be able to be safe when they play outside. I don't want them to breathe in dirty car-ridden air. I want them to be able to go to the woods and see wildlife. I want them, you know, all of that stuff. I want the same as anyone else from any other background. and I want that for children right across the world and that is why we care about some of these other issues as well.

51:11And so, yeah, I did see all of that and it really, it didn't get me angry. That isn't the right word. It just made me really sad that we haven't, that they can't see us in anything more than that very tunnel vision version. You know, I feel it deeply too as a Jewish person that it's often more referred to as the Jewish community and I'm like, there is definitely a diversity of opinion among the Jewish communities and it's exactly the same in Muslim communities, right? Yeah, very much so. You know, if you go to my mum's house on a Friday night where there's a load of them all congregated together, they will all have, they'll just be arguing about different issues because they've all got different opinions on things.

51:46Same as everyone else. It is exactly the same. And this kind of differing of it. The original question was about the leaflets in Urdu. Who cares? Genuinely, who cares? Should we only send English leaflets out to people who might miss their screening as a result of it? Is that what this person who asked wants? Is that what he or she wants? So, oh, well, you don't speak English, so we sent you a leaflet for your bowel screening. You didn't come to it. You got bowel cancer. It's your own fault. Is that what you want? It's crazy. And I suppose it's a deeper question. Definitely I'm not talking about one individual here and I'm certainly not asking you about your colleagues.

52:24I'm not trying to get you cancelled here for a second. I'll put you in an awkward place. But when people ask these questions, particularly if they're people of colour, presumably they know what the answer is. So are they asking the question because they feel like they need to go through the motions? They're being told to ask the question? It's kind of laziness? I genuinely don't know the answer to that. I just wish that they would think a lot more about what that means for so many people who are listening to the question, understanding the undertones in that question and what it means long term.

52:57Because even the questions like, why did you send them out in Urdu? Or is there only one issue? Has really kind of wide ranging consequences over a long period of time for all of us. And it's really important that journalists understand that. There's lots of other groups where that question would be dealt with with a lot more sensitivity. But it feels like there's a particular, like, is Islamophobia, you know, I think it needs to be named. and I think there's a lot of Islamophobia on our media and in our public discourse. Yeah, I think there is. I think there's so much division across religion and colour and class and yes, we can talk about Islamophobia because that is a big one but I don't want to talk about that and then ignore the others as well because you're Jewish, anti-Semitism is on the rise as well and that absolutely needs to be recognised.

53:45They are both just different sides of the same coin. If you tackle one and not the other, you're not actually helping anyone in that situation because the other group will feel isolated and feel like you're not you're not doing anything for them. And so it's so important that any kind of prejudice gets called out or at least recognised for what it is. And I do, you know, both Islamophobia and anti-Semitism are on the rise. You know, a good example is, you know, recently, I can't remember exactly where it was, but an explosive device was found in a mosque and it just it wasn't even news. It just didn't make any of the any of the news until days later.

54:27But if that had been anywhere else, it would be the number one headline everywhere, as it should be. You know, in any church, any synagogue, any temple, it should be the number one because any religious hatred is absolutely disgusting and should not be tolerated. but it should be equally not tolerated across the board. And with that, we're hearing about worrying rise of racism within hospitals or to healthcare staff of people being intolerant of people with brown or black skin or who have an accent. What does the NHS need to do? I mean, as I'm asking, it's very obvious that zero tolerance, but I guess is there anything?

55:04Apparently we have zero tolerance, right? Right. And it's just not being... I've been in meetings where a patient has been, has said very clearly racist things to a colleague of mine. They have brought it up in the meeting and everybody has, not everybody, a lot of the people have said, oh, well, you know, let's just move on from this and we'll learn and we'll send him a letter saying, don't do that again. I just among staff. I was talking about patients to staff, but it's happening staff to staff as well. Well, that was a patient to a staff, so it came to our meeting. But racism is on the rise.

55:35intolerance is on the rise you know all of those things that affect us who work in the NHS is on the rise but at the same time it's being normalised so people feel emboldened by what they're seeing on television by some of the conversations that are happening within politics and by certain politicians and so when it is normalised when people feel actually no it's alright for me to say that the P word is not that racist really isn't it? It's just shortened for Pakistani, that's the argument and so when they say it they don't realise the history behind it or they do and they don't care and so they are emboldened to say it the NHS goes well actually you know we have a duty of care to that patient so we've got to look after them you know let's just give them someone else who looks after them rather than you but they have a duty of care to us as well as people who work there and zero tolerance should be zero tolerance and I think for a lot of the time it is I don't want to say that this is happening everywhere For a lot of time it is, but not all the time.

56:36And it should be all the time. Yeah, I think it's, you know, even if it's just one incident, we know it's more than one incident. The idea that it would just be brushed under a carpet or seen as, oh, this person behaves in that particular way. Yeah. Just really challenging those concepts. Yeah, very much so. And that isn't happening. And people need to know that if you use those kind of words anywhere, anywhere, it doesn't matter whether it's in the NHS, outside of the NHS, there should be absolutely no tolerance for it whatsoever. However, you know, we grew up knowing that that kind of behavior was unacceptable.

57:07Suddenly it's become acceptable again. Right. And it's been such an insidious process. And we've got to a point now where whether you're black, white, brown, whatever, you know, there's a chance you could be verbally abused for the color of your skin. You know, everybody will feel different about it. You know, I will think, oh, you know, brown and black people will feel discriminated against. But obviously, you know, there are some some people from white communities who feel they're discriminated against as well. And yes, we've got to understand that. But I feel like when it happens there, it's like, right, let's try and understand it.

57:43Let's figure out what's gone wrong when it happens anywhere else. That same level of understanding doesn't doesn't occur. I think that's totally right. I was going to say separate subject. But to be honest, it's the exact same subject, which is mental health. And that's about the mental health of the staff. But more widely, like there felt like there was a push a few years ago to mental health to have parity with physical health. have we got there and if not what more needs to be done? No we definitely haven't got there you know a lot of the consultations I do in primary care are have a either you know are all mental health or have a mental health kind of vibe to them or an angle to them because their physical health is affecting their their mental health and I know that if I refer someone for a community mental health service either it's going to get rejected because they're not they're not bad enough or it's going to be really hugely delayed.

58:33And in the meantime, they can go online and read this website. And that's really sad. You know, I know that patient's going to leave the room and I'm not going to be able to do the best thing for them. And then the question around, you know, what more can be done? Yes, we do absolutely need more accessible mental health services, but you need to look at what's causing all these mental health issues. And it can't just be, you know let's just tackle the top end we've got to go right right down to the root and a lot of it goes I think I'm a big fan of of community I'm a big fan of of people from different backgrounds coming together learning from each other but also working together in in things like youth clubs and community centers all the things that we used to well I don't know how old you are if you're around my age we had growing up and and I remember going to the youth club and playing pool with people that I would never have met otherwise.

59:25And it was a real, it was a great pleasure, but it was also a great learning experience for me in hindsight. Obviously, I didn't know that at the time. I was very young, but now I do. And we just don't have that anymore. And so I think getting back to community, getting back to that kind of it takes a village mentality is really important. And I think certain groups have that. You know, we certainly have it within our South Asian community. and it really helps. I know when my father passed away many years ago, what got my mum through it was the community. And, you know, that idea of social isolation doesn't really exist for my mum because she's always got someone there who we know she can go to or someone's always round out the house.

1:00:10And so I love that for her and I want that for everyone. And I'm going off on a tangent now, but mental health affects so many people at different levels, you know, within school. What are we doing within school? what you know school nurses are incredible but they they're so stretched they're only in a school maybe one day a week and then they go to a different school in a different school so what why don't we have a a someone based out of school who who looks after the children's mental health all the time they can just knock on that door and say look miss or mister i'm i or sir i am feeling a bit stressed today or this exam is feeling overwhelming or this homework's feeling over can i just talk to you about it rather than having it all bottled up but to get access to a school nurse it is you know oh she's only in on a monday or he's only in on a wednesday so you'll have to wait till then and by which for a child that's really hard um and then as we get older and older different things affect our mental health so you've got to look at again i go back to the cost of living but that's a massive cause of of of pressure on people's minds so what are we doing to to take that pressure off right now absolutely we're doing the opposite are we because we're going to well oil prices are going to go up and that's going to cause a nightmare for for people who are already struggling right now, food prices are going to go up and that's already going to cause a massive pressure.

1:01:22That's going to mean that people can't afford fresher food and they're going to go to more ultra-processed foods and then their health is going to get worse. And it's just a horrible, vicious cycle of doom. But there are things that we can do, which I'm hoping you have the answer to. It's so funny how you talk about grim things because you're so smiling and positive. You're talking about the collapse of civilisation, but with a huge smile on your face, it's all going to be OK. I'm crying on the inside. and there's a brilliant social scientist called kate pickett who co-wrote the spirit level um a few years ago well a few years ago a few decades ago now um but she's just written a new book which i just kind of read the first draft of and she has this amazing metaphor in it which is a cliff edge and says very often people have fallen off a cliff and so much of our intervention in health care is the safety net like what do you do after people have fallen off a cliff yeah she said a few years ago we started to focus more on like when someone's about to jump how do you talk them down from it But she was like, what if we just didn't have a cliff?

1:02:15And what actually if we help people so they didn't even need to feel like they're even in that place in the first place? And I feel like you just described that. Yeah, I think that's right. Because we always encourage people to talk about their mental health, don't we? Talk about it, talk about it, talk about it. But what are you going to do about it once I start talking about it? And as you say, how do we stop people from getting there? There's so many layers to it, but it has to start young. That support for mental health has to start young and carry on through to adulthood. I feel like everything we've spoken about so far is encapsulated a little bit in Palantir, which for those who don't know is the US tech spy firm that we have given contracts to with the National Health Service.

1:02:51It does have a break clause next year. And obviously, I've been pushing for the government to take that break clause. Where do you stand on Palantir? I was going to say, how concerned are you? But that's a very leading question. How much do you love Palantir? I don't love it at all. I have serious concerns about it. it has been given this huge contract 330 million pounds which is massive and and what it is is supposed to do it's it's a data it collects massive amounts of data doesn't it yeah federated data so we can it can be used and you know it's an operational use of of data and they've been given an nhs contract so they can do that to our data our patient data uh and the idea behind it is, you know, we might be able to manage waiting times better, discharge outcomes better because we've got all this data.

1:03:40That's the idea behind it. However, there are serious concerns. I think the first thing that I would say is that the Swiss army said no to Palantir coming into Switzerland because they were concerned that they would share Swiss data with the US government. and also I'm very concerned that Palantir are hugely involved with homeland security in the US and particularly with ICE and the deportations that we've seen and they've used the data they have to identify people for ICE to target to put into these awful detention centres and then subsequently deport and split these poor poor poor families apart.

1:04:22I'm also concerned because Palantir have very clearly said they are working with the IDF in Israel and they are helping them collect data. And that has had devastating consequences for the people of Gaza and beyond. And a company like that has no business being in the NHS. It has no business. We don't know what they're going to do long term with our data. Of course, the government will say that there are safeguards in place and the data doesn't belong to Palantir, it still belongs to the NHS. But we've all heard of data leaks. We've all heard of these, you know, dark, dark companies that can do all of these things.

1:05:05I don't think, and even if you don't know about Palantir and you don't care about those things, I've just said, if you're a, you know, why are we using foreign companies to come and to mine our data? Why can't we use a British company? Also, can I just say that Palantir has also got links to Lord Mandelson as well. And that can't be a good thing because we all know now that he was linked to Epstein even after he was convicted. And so there's too many red flags here for us to say safely, actually, no, let's have this company mine our patient data. We don't know what's going to happen in the future.

1:05:44They may use that data for lots of different things. what if they do start using it to profile people and target them and all of this stuff in the future? I just don't think it's a company that belongs in the NHS. And if we leave it too long to sort it out, we'll become entirely dependent on them. The NHS will become entirely dependent on them and it will be too hard to unpick it at that point. I mean, listening to any one of those red flags sounds like a really, really bad idea. And you put them all together and you go, this really is catastrophic. Looking for some of the nuance in what you just said.

1:06:15so they're looking to bring all the data together. Is that presumably that in and of itself is not a bad thing? No, that's definitely not a bad thing. You know, I will say right now, the NHS data systems are not talking to each other. For example, you know, if I see a patient who has not long been in hospital, often I haven't got the information from the hospital by the time they come and see me. And so there's a lot of ringing around to send an email so I can see it. So we do need a system within the NHS where a patient goes into hospital And I can see that live on my system as well, what their bloods are doing, what their oxygen sats are doing.

1:06:49And I know they're coming out on this particular day. So I might say, OK, right, that's someone who is coming out of hospital, probably needs an extra bit of support from our community matron. Let me put that in place. So, yeah, we need all of that to happen. We can't have delays in those kind of things, but we need an ethical company to do it. And I think that that's the issue. That makes total sense. And so if anyone's concerned about this, what kind of do you want them to do about it or how can they get involved? You can write to your MP and just say, I'm concerned about Palantir having my data, my own personal NHS data.

1:07:22You can write to them and say that and get them to act on your behalf. I've just realised I should promote too. I've done a petition with 38 degrees. So if you search Palantir 38 degrees, also please sign the petition as well as writing to your MP. That's really, really important. Finishing up, and this has been amazing, thank you. I really, really enjoyed. I feel like I've been absorbing and learning in real time whilst enjoying the conversation. So hopefully everyone else has tea. You're Minister of Health. What are your priorities? What are the first things that you think need to happen? So the first thing, oh gosh, right, let me think about this.

1:07:54So the first thing I would do is try and understand why the staff in the NHS are so unhappy and whether that is pay and whether that's working conditions and what we can do to support them and over what length of time. I understand there isn't a magic money tree that we can give everyone the pay they need, but is there increments we can work towards so they know that it's coming? And what can we do in terms of looking at investing in staff, looking after their mental health so they stay within the NHS and they're able to give patients the care that they need? I think that's my number one priority.

1:08:26I would also look at how we can support primary care and community care so patients can be looked after at home. So I go back to what I said, you know, so primary care is such a multidisciplinary team of people looking after patients in the community. So let's work with that. So if a patient rings up with a certain problem that's best suited to a physio or an OT or a nurse or a district nurse, we send them directly there. But then the GPs who might need to look after a more complex case have the time to do that. And so we give them the longer time and space to do it. And if patients do need looking after at home in terms of these really specialised services like the heart failure nurses, but we look at all of that, you know, frailty nurses, falls teams, all of these going out to people's homes to really minimise the risk of them coming back into hospital or needing hospital, I think is key.

1:09:19And that long-term preventative chronic disease management plays a massive part in that. I would also look at the infrastructure of the NHS. It's a crumbling kind of thing at the moment. We haven't invested in infrastructure for so long. That is the physical buildings, but also the IT systems, as you've described. And then you can't have a good NHS system without good social care either. And so they need looking into and that bed flow, making sure that patients who don't need to be in hospital are not in hospital. I would invest back in community hospitals again, where they can have all that rehab.

1:09:52And then I'd invest in social care. So that flow from hospital to intermediate care, to social care, to home, happens seamlessly. Yeah, that's what I would do. I mean, it all sounds like a pretty amazing agenda. Dr Khan, or Amir, as you told me to call you, thank you so much. It's been an absolute joy. My pleasure. Thank you.

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