‘We have to have hope Labour can reform NHS’, says Kings Fund CEO

We were joined by Sarah Woolnough, chief executive of the Kings Fund, and Philip Banfield, an obstetrician and council chair at the British Medical Association.

Cathy Newman: Sarah Woolnough first, Keir Starmer kept on talking about reform, but he didn’t really say what it was. Can you give him any pointers?

Sarah Woolnough: He said they’re going to develop a detailed plan. But as an example, the Prime Minister talked about shifting more care out of hospitals and into the community and primary care settings.

Cathy Newman: That’s a top down reorganisation, isn’t it?

Sarah Woolnough: Well, it doesn’t have to be, but it does require a bit of rewiring. At the moment, hospitals get paid by how much activity they do. They’re incentivised to suck patients in. So if we can rewire the system to make it easier for people and patients to access primary care, to better measure what’s happening in primary care and to give primary care, for example, the technology it needs to make it easier to share patient records. That’s a starter.

Cathy Newman: That’s a very good start. Philip Banfield to do that kind of stuff, does the NHS need more money to kick start that kind of reform, in your view?

Philip Banfield: Well, it does need more money. You can’t suck care out of hospitals and transfer it to general practice without a consequence to it. Either you have to do less work in hospitals temporarily. There’s no doubt, though, that the amount of money that’s been put into general practice has been shrinking as the costs have gone up and that is the key to opening up.

Cathy Newman: Let me just get you to fact check the funding issue, because there’s been a lot of dispute about whether the NHS is underfunded compared to comparable countries. You’ve crunched the numbers, haven’t you?

Sarah Woolnough: We have and we’re neither a leader or a laggard. We’re somewhere in the middle of the pack. Occasionally it’s harder than you might think to compare our funding to other countries. Where we have underinvested there is no doubt, is in capital. So that’s buildings, that’s estates and that’s technology.

Cathy Newman: But not in GPs?

Sarah Woolnough: Well, not necessarily in GPs but comparatively versus hospital doctors, we’ve seen more money of the pie go into the acute sector rather than primary and community settings.

Cathy Newman: I’m being a bit facetious, but you know the BMA has been described as a major drag on reform by Professor Sir John Bell today. Are you the blockers in this prime ministerial plan?

Philip Banfield: We’re really keen for change. We’ve got doctors using computers that are decades old with Windows XP. We’re handwriting prescriptions when they should be electronic. We’ve got operating theatres with ceilings falling down.

Cathy Newman: So John Bell also quoted the example saying that he accused you of blocking this new cholesterol drug because he said GP’s said they weren’t getting paid enough to inject it. Is that the kind of thing you’re up to?

Philip Banfield: I would have a different version of that, having spoken to the BMA president that was present in that meeting. What Sir John Bell did was fail to sell it in the appropriate manner to the GPs. But there are costs to things and what you can’t do is to fund things in hospitals and then not fund them when they’re transferred into general practice.

Cathy Newman: One of the big problems is social care, isn’t it? And that’s always been the heart of the NHS’s problems. And yet again, it’s kicked into the long grass. Talk of a royal commission. We don’t need another royal commission to gather dust on reforming social care, do we?

Sarah Woolnough: We don’t. And it is an area that needs urgent attention. Our social care system is not fit for purpose. The bottom line is there are more people requesting care and support and fewer people able to access it. And the government is pretty thin in this area. So we very much need to see action. We need to see reform. We don’t have the workforce, but we also know that crippling costs mean that families and individuals are simply not able to access the care they need.

Cathy Newman: Social care, is that the sort of holy grail here. If we can get political consensus on that, that will make your jobs a lot easier?

Philip Banfield: It would. The Darzi Report found 13% of beds overall in England were filled with patients fit for discharge. Hugely frustrating for our surgical teams to not be able to admit when the operating theatre’s are free because there’s no bed to put a patient in.

Cathy Newman: Are you confident that Keir Starmer can reform the NHS?

Sarah Woolnough: I think we have to have hope. Public satisfaction with the NHS is at the lowest levels it’s ever been. I don’t think it will be a surprise to people and patients what’s been said today. We need commitment, sustained commitment to kind of re-imagine our care system and our health system because we’re working off a 1940s model in 2024.

Cathy Newman: In a word, are you optimistic?

Philip Banfield: I’m always optimistic. You know, if you provide us with the resources and the facilities, we’ll get on with the job.

Cathy Newman: You said resources. He says, no money without reform. You’ve got to reform first.

Philip Banfield: Absolutely no problem with that at all.