329. Question Time: Technology, privacy, and the battle for the NHS

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0:50Welcome to the Restus Politics Question Time with me, Rory Stewart. And me, Anastakamble. First good question, I think, Anastakam, from India, which is it is the hundredth anniversary, as we record this, the fall of the first Labour government. So Anastak, over you any thoughts on the fall of that Labour government a hundred years ago and maybe some parallels that might be interesting for today? Why are we talking about the fall of a government, Rory? We've only just got the Labour government. The only reason I'm kind of aware, even aware of this anniversary, well done, India for knowing that it's the anniversary, is because I spent the Saturday with David Blunkett, who said to me, David's a great one for Labour Party history, and he said it's almost exactly a hundred years since the first minority Labour government fell.

1:39So this was the government led by Ramsay MacDonald, Chancellor Philip Snowden, who went on the two of them went on to be something of almost a hate figures really within the Labour movement because they formed the national government, which relied more upon opponents of Labour than it did of Labour. It is remarkable, I've said to you before Rory, three times as many Etonian Prime Ministers as Labour Prime Ministers, and Ramsay MacDonald was the first, and it yet, a hundred years. So I think it was October the 29th, 1924 was the election, and it lasted about nine months before they fell. This is some interesting things on welfare, interesting things on housing.

2:26He was the first Prime Minister of the Working Class background, had no university education, governed without majority in either house, but I guess the connection that people might be making in Rory, Philip Snowden, the Chancellor, is that he was somebody who fairly left wing, actually came from my part of the world, cowling the Akeethley, and he worked in Burnley for a few years, and eventually became, he was MP for Blackburn, then he lost, then he was MP for Colm Valley. Quite a modest background, his father was a weaver left school at 15 and became an insurance office clerk, and then past the soul service exams, didn't he?

3:03Yeah, people think he was posh because he became a vicarnt, people think vicarnt Snowden, but actually he became a vicarnt after the event of his political career. So he came in, he had repetition being pretty left wing in love with socialism, but then as the Chancellor, he said about trying to cut taxes and tariffs to balance the budget. Yeah, he was pretty orthodox, it's fair to say, it was Chancellor, and that's why, ultimately, he and McDonald, I mean, McDonald was expelled from the Labour Party because of his role in the National Government from 1931 to 1935, but that first, you know, if you're a Labour person, it's quite a thing to think it was just a hundred years ago that that first Labour Government was formed, and actually managed to achieve quite a few things, even though as I say they had no majority, either in the commons or the lords.

4:01So the message for Labour today is when you've got a big majority, you can do lots of things, so let's see them done. It's also the the strangeness of politics in that period because as we went into late 20s, early 30s, the junior Labour Minister who was pushing for high spending on public works to combat unemployment was Oswald Mosley, who then went on obviously to found Braschini fascists. Meanwhile, obviously Snowden was pushing for this very, very kind of austerity policy, and as you say, he was then kicked out of the Labour Party and attacked it as Bolshevism run mad and became the sort of heated vicar.

4:42And talking of Bolshevism, Rory, the other famous thing that happened around that period, and showing that something has never changed was the Daily Mail and Fake News. They published this letter that became known as the Zenovia of Letter, suggesting that Labour was getting ready for the imminent revolution and communism was going to take over. It was amazing that, man, we should do something on that actually because it's a really interesting example of fake news that was so successful that historians had to reinforce again and again and keep pointing out to people today that that was along with the protocols for the Elder Subsireon, which is another famous one of the period, was the massive fortuary.

5:23Absolutely. So the Daily Mail talking spreading lies about Labour. Hey, what's new? Can I tell you a little bit about David Blonke and football? Yes, that is strange because David Blonke is obviously blind. So how do you watch football with David Blonke? So, was Sheffield Wednesday against Burnley at the weekend? We won Rory. We went to the top of the World Cup. And he's a Sheffield supporter, right? So you were supporting different teams. Yeah. So we were disagreeing agreeably as we sat there. He has headphones on. Right. He's got a commentary coming through from the either used to be the hospital radio, then it became the club radio.

5:58And he admits that you know, as you know, I sometimes do the Burnley commentary and it's very biased. Was he having to listen to your bias burnley commentary when he was supporting Sheffield? He had the Sheffield commentary in his one ear and he had me sitting next to him in the other ear. But what's incredible is he really does follow the game. He listens to the crowd. He listens to the songs. He listens to the sort of conversations around him. And he's got the commentary. So for example, just to give you a tiny example, when the Sheffield Wednesday announcer announced the sponsors man of the match.

6:34It was a guy called Valerie. And David turned to me and he said he didn't play very well, which is amazing when you think about it. And the fact is he hadn't played very well. He was the man of the match because that's who the sponsor chose probably one reason. And the other thing I've written about this in my in my new European column, he said at one point, there was a guy made this pass and he goes, what a great pass. Right. And I turned and said, how do you know? And he said, I heard it. That's brilliant. He heard what was happening. And it was it was a guy called Barry Bannon, who plays for Scotland, as I'm sure you know.

7:10And it was it was an amazing pass. And he heard it, a combination of the sound of the foot and the ball, the crowd, the response. He just said, what a great pass. And it was always somewhat at risk of this show becoming the rest as football. So to remind people that we did a fantastic interview with David Bunkett on leading two episodes back in June, really worth the scene too. And also to plug our current leading, the Archbishop of Country, no less told me that it was his favorite interview that we'd done. So there you go. It was astonishing. And a real kind of again, a reminder of what a considerable figure David Bunkett was and how important he was to that new Labour government.

7:48And how to some extent I feel Kirstalman's government would benefit from having a blanket figure. Yeah. Now, Rory, here's a question you're going to love. This is David Gawke's got a job with the government.

8:04And he uses a political pawn surely would be better if it was handled as a bipartisan issue thoughts. We had lots of questions on on the health, this health review and whether the government shouldn't try to bring in the opposition on it. I think with the NHS and with adult social care and with transport, you're looking at things which clearly need 10, 20 year plans. And therefore, one great advantage of doing cross -party stuff is you're less likely to have it derailed by new government. The second advantage of it, as we found with trying to fund social care, is that funding always requires tax increases.

8:44And the first thing that happened, so Theresa made tried to work out a way of funding social care in immediately was attacked by Jeremy Corbyn, who called it death tax and basically lost the 2017 election on the back of it. We've seen Rishi Sunak's health and social care levy reversed again by the incoming levy government, which I guess they'll probably regressing at the moment because that would have been a very hefty increase in VAT, which could have been very useful for them for funding things. So I really do think these things could happen. And it's also worth looking at Sweden because Sweden is very dramatic in the way that many of the core issues, and you can see this in the way that prisons are running Sweden, you can see it in public health and the way that COVID was done in Sweden.

9:30Big issues removed from politicians and given to independent bodies, which really allow them to take much more radical bold lines that would be pretty difficult for politicians to take. So why isn't the appetite? I mean, there must be a reason why, apart from obviously not liking Rory's shirt, but what's the reason why they're not bringing together big cross -party commissions on these things? I think what we're treating seem to be saying when he set out the process of this review for this 10 -year plan, they've created this new website where people can submit their own ideas and some of them I have to say are quite funny, but some of them I think will be genuinely interesting.

10:12And he did say, I saw an interview he did where he did say, he would more than welcome ideas coming from the conservatives on this. Now, when it comes to it, I think whenever people say, why can't we take the politics out of something, they're basically saying why can't we take the politics out of our lives? Because the truth is that healthcare is a very, very political issue. Education is very political, how we treat crime and punishment, these are political issues. So I think it's more, I would prefer rather than having a cross -party commission. I do think we've talked before about citizens assemblies and so forth.

10:50I think actually building a totally different structure that isn't just about the main political parties would be the best way to do this. And if you talk about 10 years, they're talking about producing this plan by spring of 2025 say, well that gives you quite a lot of time. Alongside that, I'd love to see a citizen's assembly on the future of healthcare. I think that's right. Institution is the thing to think about. When you were talking about citizens' consultations, I think the government should be learning from Audrey Tang, the digital minister in Taiwan that we interviewed on leading. They, in this case, being Audrey Tang, set up a much more interesting system than just a website.

11:32The forms of consultation, they were doing, and actually a lot of it was about rural healthcare, was very clever, partly because of some of the russets going on. So she was able to get junior civil servants to contribute anonymous state to these chat forums and to propose ideas that their bosses had squashed almost by pretending to be ordinary members of the public. And a loss of what they learned through doing this is that the convening is essential. The way in which the citizens are organized, the way in which you use machine learning to group these ideas, the way in which the discussion forums are taken forward is vital.

12:09It's not enough just to drop an idea in from time to time. And then citizens' families, they can agree more. I mean, that's so fascinating because that really does take the politics out of it much more than putting Tories and Labor together on a panel because they aren't elected, because they're not running for election. They can approach the ideas even if they're not great experts, just much more naturally and much more objectively. I also thought, whereas Street was interesting in the way that he talked about, he intends to rely on experts. He was very deliberately making a difference between the Michael Gove with Fed up of experts.

12:45He wants experts opinion. There's something about the way where street he does interviews that I really like. He doesn't take any crap. I think there's something very defensive about a lot of the Labour ministers, but Wes just sort of basically says, no, here's what I'm going to say, and here's how I'm going to say it. There's a confidence to what he says.

13:06And he in government now, can you honestly say that through the winter there will not be people lying on Trolley's waiting to be seen in A &E? And he said, worse than that, there will be people right now lying on Trolley's. And that is what we've got to fix. And it's going to take a long time to fix it. You know, I think the other ministers could learn a lot from watching the way he pushes back on some of these interviews. Is he able to use the fact that Rishi Sunak during the campaign had the same vision for healthcare reform? In other words, if you watched Sunak's debates against Stama, Sunak was saying, we've got to move money from hospitals, the front line, we've got to do more preventative care, which is exactly the worst -reaching vision.

13:48Do you think he can use some of that to try to spike the guns of conservative attacks a bit, or is the problem that the Sunak steps down the new Toriyleida will come in and ignore everything that Sunak said? Well, I certainly think that, I mean, it is extraordinary to think that Rishi Sunak is a kind of moderate compared with generic or bad enough. And I think you and I both know that Rishi Sunak did not have much time for either in terms of their politics or their competences as ministers. But I think there isn't a bad thought, actually. I was at this health conference the other day. And the one thing that has definitely got through to that sector, to people working in that sector, I once you've done that, then you can take it to the public.

14:32And I think it is starting to get through. You know, I can now quote the bait him, things that they're saying, they want to move from hospital to community and log to digital, and they want to have a focus on on prevention rather than cure. Now, that's a very, very good frame. So once you've got that framing, if we go back to our Citizens Assembly structure, you would probably say, okay, there's a group over there, they're going to work on the, how do we get from hospital to community? There's that lot. We're going to bring in the tech people because they know how to do this and log to digital.

15:05And over here, we're going to talk about prevention. That's where we talk about mental health, that's where we talk about fitness and obesity and all this stuff. So he's got a big challenge, which came out in the Aarodazza report that we talked about. But I've got a feeling about where he's treating that he's got a plan that he's not fully telling us yet, but he's working towards implementing it. One more thing on health care, when they talk about analog to digital, there's so much that technology can do. I mean, I'm talking to you wearing this aura ring on my finger, which gives me real -time data, not just on how many steps I've taken, but exactly how much REM sleep I got, how much deep sleep I got, where my pulse rate is, my HRV variation, other people, be picking up stuff on VOA.

15:48All of this incredibly helpful because you know, you can pick up early signs of COVID, you can pick up lead indicators on much more serious conditions. But in order to do this and really benefit from the fact that the NHS has this enormous swarm of data, I mean, it's almost unique in the world, and it's just how much data it has. There are some very interesting questions around data privacy that need to be overcome. And the conservative government from 2010 onwards kept saying that the NHS can really leap the world because it has access to all this data. But of course, what happened is when they began bringing in digital companies to try to harvest this data and gather this data, privacy campaigners became very anxious, including your friend David Davis, who we infeed on leading, I remember being a big critic of this.

16:39So one of the challenges I think that West Reading will face is he's going to have to have this very, very old battle, which is the heart of so much of the problem with social media at the moment, which is striking this bounce between the huge benefits that you can get from accessing people's data and using machine learning to go through an on -mise data defined patterns in order to massively improve health against, on the other hand, people's concerns about their privacy. Yeah, well, we've talked before about Palantir and Peter Teal in relation to the access that they have to to our data in their work in the NHS.

17:23And as a result of some of our conversation, the past Palantir asked me to go in and they did a presentation, which was fine, it was very interesting and so forth. But I really worry about this guy, Peter Teal, because he and Musk between them, they are the ones who pushed Vance upon Trump. They are the ones and Musk's behaviour is becoming more and more unhinged. I'm above the law. I can do what I want. And so yeah, I think that is a really, really big problem, which the government is going to have to work through. And the NHS App idea, which West was talking about, and by the way, you know, I've used sort of digital stuff in relation to my own health care.

18:02But I think I would worry about the extent to which that can then be sort of bundled, taken, used in different ways. And so the government has got its work out and explaining that. This is the key, isn't it? There are so many advantages. And how rational are these concerns? And what exactly is it that you're worried about, Alex Stone? What exactly are they going to be doing with this stuff? Is it a sort of, I guess if you were working for Palantir or you were somebody who was much more optimistic about technology, you'd say that a lot of these anxieties are very unfocused and a little bit kind of superstitious.

18:36And the benefits are obvious. Jim Waterson posted on Twitter to bring another voice into the Q &A conversation. I hate doing personal posts, but when my mum was dying last year, NHS data sharing failures and prioritising GDPR, that's the data protection over pain relief, repeatedly left her an agony. In desperation, I began to build a Google doc of her records linked to a QR code for doctors to scan systems broken. And that got 2 ,500 likes on Twitter. And that was actually him replying to worth treating. Okay, Rory, quick break, then back with more questions.

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20:28Question from Jenny, which I'm going to self -interestedly arts myself. So Jenny asked what can we learn from the Tory leadership candidates about how Parliament and politics is changing. And here are a couple of things I noticed which maybe political commentators haven't made enough of. The first is that generic and bedlock are very recent MPs. I mean, I was only Alexaed in 2010, but I was in before them. I was in a parliament before them. Secondly, they were both people who were very much not on the Rishi Sunak plan. So generic was not put into Rishi Sunak. It didn't make him a section of state and he resigned in protest at Rishi Sunak's Rwanda policy.

21:14It thought it wasn't tough enough. And bedlock famous years we kept saying wasn't really rated by Rishi Sunak. And there was a huge briefing war between them. So I think one thing we can learn is that the old days of politics were often leadership candidates were people who'd been in politics for 20, 25 years and were senior loyal figures in previous people's administration in the way that John Major was in relation to Margaret Thatcher or Gordon Brown was to blower maybe the loyal bits pushing it by a foe suddenly a senior trusted member of the administration or even trees are made to David Cameron.

21:53Has been replaced by a very, very strange new world where British politics begin to feel more like Dutch politics where a lot of the leading figures have been in parliament for such a short time. Well, Kirstaarmer only coming in himself in I think 2015, Rishi Sunak in 2015. And why is that? What does it tell us about politics that whereas in the past that the people making it to the top had often been in parliament of a Macmillan or Eden or all these kind of people or let alone Wilson Callahan or Heath? I don't know what it says. I don't I really don't know. Does it say that people are constantly looking for the new?

22:29Does it say that people get bored with people more quickly than they used to? I don't know what it says. I don't think it's very good though. It isn't good because you would have thought the obvious candidates and the conservative context would have been Jeremy Hunt, you know, in parliament long time had a lot of big cabinet posts last charged with the Xchecker but instead of which you have these people who are relatively junior. I'm definitely junior. I think the Tories are making a terrible mistake. I could be wrong about this but I think whichever they choose a bad luck in general. I just don't think they're very good.

23:02I think their ideas are kind of plot losing. I think they exacerbate the problems that led to the Tories losing rather than address them. And they give a gift to Kierseh Amidant. They because if he's struggling with his narrative and if he was elected largely because people were fed out with the Tories, getting a non credible Tory leader in as a fantastic opportunity for him to keep reminding people every week in parliament at least I'm not this lot which he can't and hasn't been able to do for the last few weeks. I mean, really soon, I really have sort of vanished from the scene, hasn't he? I mean, he sort of pitched us up to prime minister's questions.

23:40He clearly is a bit of an odd deal. He's really not really putting the hours in. Let's be honest. Means testing benefits, Lewis Craven. Would the recent change of the winter feudal alliance to become means tested? Should the government be looking at personal independence alliance and disability living allowance as the next two benefits that should be mean tested? Can I just come in on that? There's an amazing figures now coming on disability living allowance. The number of people who are now receiving disability benefit has doubled since 2019. And this is not you might have thought it's just because of COVID, it's a long COVID story, but it doesn't seem to be because it's not happening anywhere else in Europe or in any comparable state.

24:27It may be something to do with the cut in other welfare benefits, which makes the disability living allowance that much more valuable, but it is a huge problem for the Labour government going into the budget, working out how they're going to pay for it because the welfare bill is going up and up and up and they really want to get those people back into work. But presumably that's going to be pretty unpopular with a lot of the Labour back bench, is if they try to push ahead with Tory plans on how to do that. I think this thing about getting people back into work, that was the other big thing that came through the DAZ report and also through what was treating was saying yesterday is the health service playing a more productive role in actually helping to get people fit for work.

25:10Just on the, you talk about the budget Roy, the other thing that happened last week that I had sort of sent shivers down my spine was when the inflation figures came out and they were better than expected. And then it was announced that this is the set of figures when we have, when we talk about index linked benefit payments, this is the set of figures that will decide those rises in benefits. And the reason why it's sort of set the shiver down my spine is because one of our, one of our most difficult periods early in government was when we were passing ourselves on the back about how well we'd done to keep inflation low.