Two commissions on the future of the NHS – with Rachel Sylvester and Parveen Kumar

Jennifer Dixon:

Given the obvious pressures on the NHS, it's perhaps inevitable that people ask the question, what's the future of it? Over the last 30 years I've been in policy, there's almost a call every year for an independent commission, and especially before general elections. Well, in the last month, not one but two independent commissions on the future of the NHS have reported, the Times commission in early February and the first of several papers from the BMJ commission at the end of January.

With me today to discuss the findings to date are the commission chairs. Rachel Sylvester, who chaired the Times Commission, which met throughout 2023. Rachel is an award-winning political columnist at The Times who's been writing on British politics for nearly 30 years. And Parveen Kumar, who co-chairs the BMJ Commission on the Future of the NHS, which launched in May last year. Other co-chairs are Liam Smeeth and Victor Adebowale. Parveen is Emeritus Professor of Medicine and Education at Queen Mary's, University of London. Welcome both. 

I think the first question is, why is it so important to carry out a commission? Why now?

Rachel Sylvester:

The Times ran an Education Commission, which I also chaired the previous year, and then health seemed the natural next subject because there is clearly a crisis in the NHS and social care. And there's a lack of ambition from the politicians, really, about the ideas that they're coming up with. So we just thought it was a good thing for a newspaper to do, to take a really long objective, hard look at what's going on and what needs to change, and come up with some recommendations that are not tainted by any kind of ideological baggage, if you like. And learning from what's working, both in this country and around the world, because there are some things that are working brilliantly, but it's just not spread out.

Jennifer Dixon:

And Parveen.

Parveen Kumar: 

I mean, every day we hear some sort of problem in the NHS. We struggle from one crisis to another. But what the pandemic has shown us is, first of all, how well the NHS staff stepped up and provided care in most challenging circumstances. What it also showed us was that the NHS has absolutely no spare capacity and is stretched beyond breaking point, and just walking the wards and seeing how burnt out the staff are. We've got a shortage of skilled workers, we've got demoralised health care workers, seeing the industrial actions. So I think it is the right time to ask fundamental questions about the NHS. And I think particularly and very pertinently, in this year, we have a new government and whatever political hue that might be, we need to understand the facts about why the NHS is in a crisis and also the damage that we're doing to our patients. 

Jennifer Dixon:

Was that the fundamental objective of both commissions really to influence the new government?

Rachel Sylvester:

I was just desperate and determined that this wasn't going to be a talking shop. The purpose of it is to influence the people who can actually deliver it. So that is the politicians, but also the NHS and the professionals. Maybe sounds slightly idealistic, but it's a slightly unusual thing for a newspaper and a journalist to want to do, but it was about informing policy, rather than just reporting on it.

Jennifer Dixon:

And was it the same for you, Parveen?

Parveen Kumar:

Yes, very much so. And also I think we wanted to inform what's going on, because I don't think people quite understand what's going on. When we sat down for the commission, what we wanted to do is to identify key challenges and priorities and try and make recommendations that everybody can follow to try and improve the NHS. And I have to say the NHS is the envy of many across the world. It's just too precious. I guess you probably saw in the first paper we want to go back to the original Bevan principles and make sure that they're fit for use in this century.

Jennifer Dixon:

Yes. And what was interesting for both of the reports so far, at least the first paper from the BMJ and The Times commission, is that you seem very quickly to rule out changing the funding model and the founding principles of the National Health Service. Is that something that you've come to very quickly or was that really in your mind before you even started? I'm thinking of The Times in particular, Rachel, because some of the commentary in The Times has been really to question this model.

Rachel Sylvester:

So we did look with a really open mind at other models and people like Sajid Javid, when they gave evidence to the commission, the former conservative health secretary, talked about how there should be radical reform and he proposed introducing charging for GPs, for example. And others talked about whether you should move towards a social insurance model. But when we looked at it in detail, and we did talk to lots of experts about it, the conclusion that most people drew was that the risks outweighed the potential benefits. So the experts said to us that actually if you look around the world, what matters is how you spend the money, not how you raise the money, and that different funding models have got their pros and cons, but there isn't one that consistently outperforms all the others. 

Then as I went and visited other countries, I sort of realised that there's also a danger of muddling up cause and effect. For example, in Israel they have a social insurance system, but actually what's made their health system so effective, this is before the Gaza crisis, is the fact that they're absolutely at the cutting edge of technology. Germany, they've got more hospital beds than us. So it's not the funding method that makes a difference. It's the other things. I went to Ireland as well to look at charging for GPs because that was another issue that came up. The thing that persuaded me that that was not a good idea was that I met a woman who had not taken her son to the GP because it was going to cost 60 euros. She was too well-paid to get the means tested free visit, but not rich. And he'd ended up in hospital with pneumonia. It was interesting that we heard from conservative politicians, particularly I'm thinking of George Osborne, William Hague, David Willetts, all of whom said, ‘No political party is going to touch this. They'd be mad to.’

So we concluded in the end it wasn't going to happen. It might not be the panacea that its proponents hold it out to be potentially, and the risk massively outweighed any potential benefits. And if you think of all the fallout from the Andrew Lansley reforms, changing the whole operating model would be even more disruptive and a massive distraction. And actually there were other things that you could do that would make more difference and make it a more modern service rather than changing the way in which you raise the money.

Jennifer Dixon:

So in fact, the Health Foundation has published two reports on this very question, Rachel, one on Germany, what would it take to move to a social health insurance system? And another one entitled Is the grass really greener? and looking at other funding models of other countries. And we've drawn exactly the same conclusion as you. Even if you wanted to, by the way, it's just very, very costly to do and distracting, as you say.

And Parveen, Nigel Crisp was the main author, former Chief Executive of the NHS, of your first paper where you really underlined the NHS founding principles. Is that something you decided very early on?

Parveen Kumar:

I think the answer is yes. We also thought that really it's all very well how to spend the money. We really need to find out how much does it cost to treat and manage the patients, and go backwards to see how much we need to run a reasonable health service. And as Rachel said, like Rachel, I've been to various countries and none of that sort of fits in. The charging, in a way, when you're charging, you're going back almost before Bevan, you have to pay to be seen, and therefore people won't attend. You have illnesses that go beyond repair, so to speak, and become chronic. So I think there are many factors in this and I'm kind of looking forward to our paper when it comes out.

Rachel Sylvester:

The only thing I think is that you can't be nostalgic for the past. I think sometimes when people say, ‘We mustn't look at all these things,’ the founding principles expanded to mean that you mustn't really reform anything about the NHS. I'm not saying, Parveen, you are suggesting that at all. But I think it's very important that when you talk about the founding principles, that is quite narrowly defined in the sense of free at the point of use and funded through taxation. But from our point of view, for example, we said it didn't matter who delivered the service particularly. So you could have a mix of public and private and doing elective surgery or diagnostic testing. You could have the private sector involved, so long as it's free for the patient.

Parveen Kumar:

I think it's sad that you think the founding principles are not still relevant. I think they are relevant and what we do want is a comprehensive good service free at the point of entry, or the point entry.

Rachel Sylvester:

Yeah. No, I agree. I'm [inaudible 00:09:00].

Parveen Kumar:

Absolutely relevant to a clinical need.

Jennifer Dixon:

Yeah, and I think Rachel's basically saying that the provision doesn't have to be the NHS-owned provision, Rachel. It could be-

Rachel Sylvester:

Yes. Exactly.

Jennifer Dixon:

-- a mixed provision, but the insurance system is still a collective publicly-funded system. I think just going back to what you were saying, Rachel, and what George Osborne said, particularly, that no government would want to touch any policy which looked as if the basic principles of insurance by the NHS is under attack. But nevertheless, governments can preside over where this is drifting by default and you just have to look at the proportion of people who are taking up private insurance at the moment in Britain, and you have to look at what's happening in Northern Ireland. There was an interesting piece by the Nuffield Trust on how some general practice in Northern Ireland was charging patients... this hasn't happened in England, by the way, as far as we know, and accepting private out-of-pocket payments from patients. Did you at all get into that in your report, what would trigger more fundamental change if there was a drift towards private paying of health care?

Rachel Sylvester:

Well, the problem is that people are going private because the state system is inadequate and it's not working properly. I don't think that's people are choosing that because they want that or because they think they're going to get a better surgeon. They're just going to get it more quickly, for example. But our argument was really that you need to think about it from the other end of the telescope to really change the priorities of the NHS, so that it's not so much this idea of a national hospital service or national sickness service, but a real, genuine national health service so that it is sustainable under its current model, because otherwise it's going to become quickly unsustainable.

For example, in Denmark, they've reduced the number of hospitals and even cut the number of inpatient beds by putting a much greater focus on prevention, on community care, on social care so that people don't end up in hospital unless they absolutely need to be there. Whereas somehow the system in England, as it's currently constituted, drives people into the most expensive part of the system, which is the hospitals. And you can see that even with people going to A&E because they can't get a dentist's appointment or a GP's appointment. So we said you need to make sure that the care in the community, the diagnostics, could be done in the community, all of that, prevention, anti-obesity, prevention in terms of things like falls, early diagnosis in order to make the system as a whole sustainable.

Jennifer Dixon:

And interestingly in Denmark, they've got the same number of beds per head of population as we have now. They've cut it back down to, what, 200 beds per thousand, is that right?

Rachel Sylvester:

Yes, it's roughly the same as us.

Jennifer Dixon:

Did they decrease the beds at the same time they increase the primary care? In a way, we haven't done that, have we? We've cut back the beds, something like, oh, half over 30 years, but we haven't increased primary care to the same extent.

Rachel Sylvester:

For example there, if you are a hospital and you've got a patient who's ready to be discharged and there isn't a place for them, a social care place for them in the community, the municipality which funds social care has to pay for the hospital bed. So they have a massive incentive to make sure there is provision, whereas almost the reverse happens here. It's the hospital, you know you're going to get a bed, that will be paid for, whereas social care has no incentive to really boost the provisions.

Jennifer Dixon:

This is a question for both of you. I mean, clearly when you gather together a group of great and good who work on these kind of commissions, they're all coming from a different place generally, aren't they? And the potential conflict on certain issues can be quite high. How did you handle that to get some kind of report? The danger could be, couldn't it, that you could just end up with something so bland and anodyne that everyone can sign up to and you don't have a sort of rearguard action by someone else who wants an appendix with their own views in. So maybe Parveen first.

Parveen Kumar:

There was a good amount of disagreement, and thank goodness for that, because otherwise you would've thought we had the wrong people on the commission. We had lots of debates about things that people disagreed about and thrashed it out in the open. But in the end, we did come to a good consensus, certainly about the themes, and we held commission meetings to discuss the drafts and the content. And we didn't really demand that commissioners signed up to every word, but at least we had a clear consensus about the analysis and the recommendations. So disagreement is good, as long as we can delve into what the problems are.

Rachel Sylvester:

We had an amazing group of commissioners and a mixture of surgeons, GPs, nurses by background, psychiatrists, business leaders, economists, a Paralympian, all different backgrounds and experiences and such a privilege to work with them, but all very opinionated and experienced and with huge views, which made the discussion so fascinating for me as a journalist. But again, there was actually a remarkable degree of consensus about the broad principles, which in our case three principles ended up being you've got to shift away from hospitals into the community, you've got to shift to prevention, you've got to deal with social care and you've got to bring better technology in. So those were the kind of three guiding principles. On those, there was agreement from very early on. And then in terms of details, we were very clear that this was a Times report, that commissioners didn't have to sign up to absolutely every dot and comma of every recommendation.

There weren't any major bust-ups about the final report when it produced it in draft. And then if people had concerns about particular phrases, we listened and thought about it. But what I found really interesting is when you and I talked about it, Jennifer, right at the beginning of our process, it seemed incredibly daunting and I had no idea how we were going to reach any kind of agreement or consensus. And there seemed to be so many contentious issues. But actually once you start doing it through the prism of, ‘Let's look at the evidence, let's talk to other people,’ we held fortnightly evidence sessions and started going to see other programmes and projects around the country and abroad, it sort of fell into place and there was actually a remarkable degree of consensus.

Jennifer Dixon:

So let's turn to what you actually recommended. Just talk us through, Rachel, the main themes.

Rachel Sylvester:

One of them actually is already crossing over with something Parveen's committee I think has already in your first report mentioned, which is this idea, we called it a healthy lives committee. This would be something that would have a legal commitment, our version of it, to improving healthy life expectancy by 5 years in a decade. And it would be similar to the Climate Change Committee and an independent group of experts who would hold the government of the day to account. And our argument is that you need a long-term strategic approach. It can't keep this kind of short-term cash handouts. So that was one thing I was really interested to see that that was one of your first findings, Parveen.

Parveen Kumar:

Having somebody totally independent, and with governments, as we all know, to keep their jobs, their elections, you have too much money when there's a crisis and then there's none. So really we wanted somebody independent with responsibility to provide expert assessment of NHS plans and policies, which would not be up and down. At least we've had long-term funding and a stable background, which the office would obviously be responsible and accountable and the government can ask us questions, but that's up to them if they wanted to take it up or not.

Rachel Sylvester:

Our recommendation was for what we called a patient passport, so a digital health account for everyone that would link up the data from all bits of the NHS. So at the moment, even within one hospital, different departments often can't see the patient records for different bits of their care. And we said, that's madness. That is actually coming, linking up of hospitals. But we said it should go much further and you should have GPs, pharmacists, social care all integrated into a single record. And I was really pleased to see that actually on the day that we published our report, Keir Starmer promised that if Labour got in, he would introduce those. And that does involve having a grown-up debate about privacy. But we did polling which showed the voters were overwhelmingly in favour, 80% roughly backed the idea of the digital health account, and a big majority in favour of the convenience of that over the worries about privacy.

There were sort of the things that you could do immediately and things that would take a long time. So the things that you could do immediately is we said for tackling waiting lists, you've got to start churning through the waiting lists at weekends. So there are these brilliant things at Guy's and St. Thomas' that they call HIT lists, high intensity theatre lists, where they get through a week's operations in a day and they have two operating theatres going at once. They say it's a bit like a Formula One pit stop. You've got to do much more to tackle retention as well as recruitment in the NHS. And we suggested that you should write off student loans for people who stay within the NHS. We said, if you stay 3 years, you should get 30% off your loans, 5 years 50%, and if you stay 10 years, you get 100%.

And I was at King's Cross station yesterday and they've got adverts flashing up next to the departures board from British Columbia, saying basically, ‘Come and have a fantastic medical career.’ And we heard that the NHS and the taxpayer are funding these doctors, nurses, midwives through their medical training and then they're going off to work abroad and we're ending up having to hire £3bn a year on agency fees. So that seemed like a sensible idea. We also said you needed to have a much greater focus on social care, that we said there should be a new national care system. That was one area where we had a discussion with the commissioners. Some commissioners thought we shouldn't call it a national care service because different to the NHS, but there'd be a central booking system. There'd be a cap on care costs for individuals as already legislated for under the Dilnot plans, and better paying conditions for care workers. That was the one with the biggest cost attached.

Jennifer Dixon:

And just to pause on that for a minute, you quote in the report the figures about how much all that would cost, which of course run into the billions, and some of that was our work actually at the Health Foundation. You also very helpfully suggest where that money might come from.

Rachel Sylvester:

Yeah, we asked the Resolution Foundation to cost... as you'd costed the costs of social care, we asked them to cost potential options to pay, and we suggested that half of the cost... and there were a range of options. We didn't set back which one it should be, but half of it should come from older people because about half the social care budget goes on care for the elderly. Then we also said that there should be a much greater emphasis on tackling obesity and we suggested that the sugar tax should be expanded. We suggested that there should be the ban on free watershed advertising of junk food should definitely go through that's been shelved, and also that there should be new controls on packaging. And the example I loved in this was that in Chile they have banned Tony the Tiger from their version of Frosties, which are called Zucaritas, and instead of for the cartoon, they've got a sort of black hexagon with health warnings about the amount of sugar. So we got to do more to help make the healthy choice the easy choice.

Jennifer Dixon:

Clearly there's a big debate about the nanny state. I know everyone rolls their eyes at that, but a lot of the suggestions, which I personally support actually, a lot of them, did look a bit like nanny.

Rachel Sylvester:

I'm absolutely fine with nanny. One of our commissioners was Henry Dimbleby who set up the Leon restaurant chain and was also the government's food advisor. And he said, the trouble is we've got a political class which is full of people who had nannies and had a complicated relationship with their nannies. And actually the public in the polling that we did and the focus groups that we ran were overwhelmingly in favour of the government doing more. By a factor of 3 to 1, they said they wanted more government intervention to help tackle obesity as opposed to less government intervention. And I was surprised by that. We did focus groups in Blackpool, Esher and Walton, and Stevenage, and the message came through loud and clear. People feel really worried about the kind of bombarding of healthy (sic) products at our children. I think there's been a real change in the public mood and the politicians who are worried about this nanny state label are slightly out of touch with where the voters are.

Jennifer Dixon:

Parveen, you mentioned themes earlier. Can you just go through what we can expect from the BMJ commission?

Parveen Kumar:

The way we worked it out in our seven themes, we would also have cross themes going right the way across with things like child health and mental health and so on. So the first one, as you say, is published and it's really we want to have a commitment to the NHS with its founding principles, engaging all parts of society, and this goes back to what Rachel was saying, getting the community and the population involved in their own health. We want to create a cross-government and cross-sector strategy for health and wellbeing, develop better ways of connecting patients, public, community groups, because at the moment we seem to be working in silos and one side never sees the other side, which doesn't really help, and often is duplicated across a patient's pathway. We also really give priority to tackling inequalities, both in access and in outcomes. And what we're finding in hospitals is racism, which is suffered by ethnic groups, both for staff and also by the patients. Also providing additional funding to support some of these early improvements in commissioning for sustainable future things that we're going to do.

So that was really mainly in the first paper, which was setting the scene. And then the other themes with the cross-sections were how to deliver health and equity and really with provision and access falling need so that everybody gets what they need. The funding, which Rachel's already talked about, obviously much needed. It has to be affordable. How do we decide, how do we best pay for it? We still have to consider that, and there's a group working on that at the moment. Workforce, and that is just so important and something which was going through my mind, Rachel, when you were discussing your 20% for the consultants' time off and so on. We haven't got a workforce. We are really short of staff and short of skilled staff. And at the moment the staff we have got and the reason they're leaving is that they are dissatisfied and what we need is a really motivated, committed, happy staff who are appreciated and valued. And I often get comments from the juniors saying, ‘We try and we work very, very hard, but then nobody says thank you,’ and they walk away dissatisfied.

Rachel Sylvester:

Yeah. One of the things that shocked me most, actually, talking to clinicians was the culture in the NHS is just really bad towards staff, and you think it's a very caring institution and caring employer, but actually it's shockingly bad. Things like people saying, ‘There's nowhere to get a cup of tea.’ You are doing a night shift and you can't get a hot meal. People weren't able to book a day off for their own wedding, even a year in advance. It's madness.

Parveen Kumar:

Every time we talk about this, I don't think it's always the money. The problem is the conditions they're working in. It's the stress. They're all the time on duty. Some disciplines, the nurses are quite good at making sure their staff have lunch breaks and tea breaks. If you're a medic on the wards, if there's patients ill, you just don't get that. You carry on. And somebody said, ‘Well, actually, I only had a cup of coffee at 02.00 in the afternoon’ or something. The workforce at the moment is not happy. And just going on from that, the other three things we are also looking at is the wider determinants of health. In other words, prevention and, Rachel, you said we need a national health service, not a sickness service. So go into public health and really the relationship with the health service between all these areas.

We talked a little bit about one health and care system and that's really important because at the moment we've got so many silos. You're in primary care or you're in secondary care, and from secondary care you can't go back into primary care without social services coming in between. This just seems, as you say, I hate the word ‘bed blocking’, but we do have people waiting to go home and they can't get there because the social services own a different system of payment. And I remember years ago... sorry, I've been in the NHS for a long time, it all worked very smoothly in that had a patient who's ill and ready for discharge, somebody mentioned [inaudible 00:26:47] the home all in one budget and got the patient a... had a handrail put on or something and they were there. Now it just doesn't happen because it's all budgetary breakdowns.

One of the big things we really have to do is to try and get patients and the population involved with their own health, and we talked in various commission meetings about how can we get them involved so they actually are part of the decision of what happens, and I'm sure this will make for a better health service.

Jennifer Dixon:

One of the enablers to that we talked about in the Times Commission is through information and data and making things easier for patients. So there's a lot in the Times Commission report about data, as Rachel has described, and particularly the use of the NHS app through the digital passport and so on. Technology does seem to be a source of hope, doesn't it, for the future?

Rachel Sylvester:

I think technology really has the power, though, to empower and enable patients. So there's one example in Milton Keynes where they're handing out Fitbits to the diabetes patients... or no, not Fitbits, Apple Watches. And if they do a certain amount of exercise every day and they keep their fitness levels up, then they get to keep the Apple Watch. And the Chief Executive there said if they avoid a single amputation which would've resulted from the diabetes, then they'll have paid for the entire programme. There's that sense of empowering people, and again, through information, if you can say to somebody, ‘Over time, genomics will come into this, that you'll be able to give people a predictive risk assessment, that you may be susceptible to a particular illness, so therefore you need to take control over your own health in these ways.’ And so the mixture of wearable technology, data, predictive genetics, it's amazing.

Parveen Kumar:

But what really is giving them a stick for what they do. All this is known. The public know that if you eat too much, you get fat and if you eat too much sugar, you get diabetes and failures and whatever. They know all that and it's the incentive, but how do we make them follow that? And I think that's a major problem.

Rachel Sylvester:

If people feel kind of enabled and have a sense of agency over their own lives, then they're going to take all responsibility. I was really interested. I spoke to Amanda Pritchard, the head of the NHS who said, you've just got to remember we in the NHS, I'm paraphrasing, but we only account for 10 to 20% of people's health and actually the whole of the rest of the environment is responsible for the rest, including us as individuals.

Parveen Kumar:

You're right, it's only 10%, but poverty and inequality, which will shown up so well in the pandemic, it's all very well making people better at home, but then they go back to the same situation and they're back to eating what they can afford to eat and back living in damp accommodation. I think it's got to be a holistic approach to health. It's not just the NHS, it's the community, it's the population, education, it's schools, it's housing. Somehow we need to tie it all together so we then do have a national health service, which would then of course flourish very well.

Jennifer Dixon:

Yes, I suspect there's rampant agreement, Parveen, between you and also from many people listening. Some very similar trends and themes, I think I'm hearing from both of you. Given the objective, which is to try to influence government policy and that there's still a long list of recommendations, certainly from the Times Commission and maybe the same from the BMJ, where do you think the priorities should be for a new government, and also given the level of public debt and squeeze there is on public funds?

Rachel Sylvester:

The idea of a patient passport and using technology and data to enable patients and reduce bureaucracy for clinicians is just a no-brainer and actually would end up saving money in the end. We heard for every pound you spend on technology in the NHS, you get four pounds back. Even if that's not quite right, they can't avoid doing that and it would be madness to not do that, whoever's in charge. And that's not an ideological thing, that's just a practical thing. The next government has got to do something about social care and that is a cost, but without that, the cost to the NHS will just become unsustainable. They've got to tackle obesity and that's not a cost. They could do that without money. And I would do something on the workforce retention. I would do this, a loan forgiveness scheme for the graduates, something to give a boost to the workforce beyond just having endless rows about pay.

Jennifer Dixon:

And Parveen, what are you able to say?

Parveen Kumar:

I think mine would be very similar, but I think the BMJ Commission has been much more on a sort of systemic view. I think probably the priority would be really on the wider determinants of health. I think that's where prevention, public health relationship, and along with that health and inequalities, unless you get both of those right, we're not going to get anywhere. Rachel talked about the workforce. Yes, I mean, if you haven't got a workforce, how are you going to treat anybody? Must get that right and get it right soon because we are bleeding.

Jennifer Dixon:

And Parveen, just for clarity, the Times has obviously got some very crunchy suggestions. Do you think the commission is aiming for that too?

Parveen Kumar:

Yeah. I mean, we're doing both, because within the systemic one, obviously we are going to deal with children's problems and maternity, diabetes, obesity, all the usual things. And remember what we haven't mentioned today is climate change and what that's going to do with sustainability and the effect it's going to happen on the NHS, and indeed diseases and new diseases. And of course that's sorting out with emigration and migration as well. I think we need to focus on the wider determinants and inequalities and staff.

Jennifer Dixon:

I think what this shows is the value, to me anyway, of independent analysis on the state of things as well as some suggestions coming out of, not the system necessarily, but coming out of that analysis as to what might be the way forwards. And all of that will provoke thinking regardless of what is immediately taken up or not. Is there anything that you didn't say that you would like to have said?

Rachel Sylvester:

I'd just like to say that we spend a lot of time worrying about the NHS and in the sort of sense of doom and gloom about it. But actually, having done this commission, I feel really optimistic about the potential and the future, both in terms of the amazing staff that are already doing an incredible job, but also Patrick Vallance talked to us about that we're entering a new age of cures, that medicine really is on the verge of this huge number of breakthroughs and mixture of genomics, AI, new techniques and technologies, are really going to transform health care, and I think it's actually incredibly exciting.

Jennifer Dixon:

Yes, and actually that brings out something I wanted to say, which is actually what you were describing there, Rachel, and Parveen, you've been describing, are really about front-line acceleration of take-up of new technologies. If you think of the future that way, then you have a totally different way of policymaking and actually a totally different narrative to give hope and to use staff as assets and not treat them as knaves who are resistors, which may well be one of the biggest messages I hope for an incoming government, especially in the absence of money. You have human capital in front of you, who are your troops. That includes the public, by the way too.

Parveen Kumar:

There's lots of stuff ahead of us, with AI and new technologies, new drugs, the genomics and so on. But at the moment, we really have got a national health and care emergency and I think society somehow needs to deal with what's going on. And it's no good having a couple of wonderful commissions unless you can actually persuade the government to take note.

Jennifer Dixon:

So we must leave it there. Thank you very much to Rachel Sylvester and Parveen Kumar for all their insights today on those commissions. Links to both the commission findings to date can be found on our show notes, as can any other links to reports I've mentioned. Next month we will be turning to the state of Britain, its economic prospects and how it might best recover, but importantly what all of that means for our health in future. So with me will be Torsten Bell from the Resolution Foundation and Dame Diane Coyle who leads the Bennett Institute for Public Policy in Cambridge. So meantime, a very big thank you to Leo and Sean at the Health Foundation, to Paddy and colleagues at Malt Productions. And it's goodbye until next time from me, Jennifer Dixon.