Labour's record on UK health

Gavin and Jessamy welcome Dr. Hugh Alderwick from the Health Foundation to The Lancet Voice as we explore the impact of the Labour government's health policies since coming to power in the UK. What might the anticipated 10-year plan for the NHS look like? What are the implications of dismantling NHS England? Will any government get a handle on social care?

Hugh also provides expert analysis on the balance between funding and reform, the role of AI in health care, and the pressing issue of improving access to primary care.

Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancet

Check out all the podcasts from The Lancet Group:
https://www.thelancet.com/multimedia/podcasts?dgcid=buzzsprout_tlv_podcast_generic_lancet

Continue this conversation on social!
Follow us today at...
https://thelancet.bsky.social/
https://instagram.com/thelancetgroup
https://facebook.com/thelancetmedicaljournal
https://linkedIn.com/company/the-lancet
https://youtube.com/thelancettv

Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello and welcome to the Lancet Voice. It's May, 2025. I'm Gavin Cleaver, and together with my co-host, Jessamy Bagenal, we're joined today by Dr. Hugh Alderwick from the Health Foundation with the Labor government focusing quite heavily on health. Since coming to power here in the UK, there's a lot to discuss from the imminent 10 year plan for the NHS to the recent decision to dismantle NHS England.

In this chat, we really wanted to look into the challenges of balancing funding and reform. Talk about the role of AI in healthcare and the urgent need, of course, to improve access to social care. I. I hope you enjoyed this conversation with Hugh Alderwick.

Hugh Alderwick, thanks so much for joining us from the Health Foundation today, and we wanted to talk a little bit about Labor's record in government. Since coming to Power on health, a lot of their political capital so far has been spent on health generally. The budget in October was focused quite heavily around funding health at least to a better degree than the outgoing, conservative government.

But I wanted to ask what stands out for you as the most meaningful intervention that Labor have done so far since coming to Power? In terms of health, I. 

Hugh: It's quite a mixed bag so far, and really we're still waiting for what's promised to be the most meaningful intervention. So there's a 10 year plan that government has promised they're gonna produce on the NHS that's supposed to be published around springtime.

You normally add the season when government says spring, so probably more like the summer. And really that's gonna set out their vision for how they want to reform the health service. They've talked about three big shifts like shifting care out of hospital, but a lot of detail is supposed to come later.

And actually the big story has been the narrative about problems in the health service so far. So they came in to power and really emphasized the problems, the depth of the crisis in the NHS. And fair enough they came into power after 14 years of conservative governments in the NHS is in crisis.

People are waiting. Too long hospital treatment. They're waiting for general practice services and public satisfaction is worse on record, so there is a crisis. But they started by RU emphasizing the depth of these problems. They commissioned someone called Aita set out this diagnosis of the issues in great detail.

They've now got to shift to saying what they'll do about it, but we don't have a lot of the detail yet. But then alongside this, there's been this other plot, which was more unexpected, which is a few weeks ago they announced they were gonna scrap the big national body that runs the health service day to day called NHS England.

That wasn't really part of what we expected the plan to be. The timing was again, unexpected. So that's been almost the biggest thing for debate on the NHS, which is not what anybody expected, I think, not what government had expected when they came into power. I. And that's gonna shape what happens over the next few years, as well as these bigger ideas about reforming the health system.

So you've got on one hand some ideas about how you could improve the health service and the tenure plan as opposed to set out what they are on the other. You've got some quite technical. Administrative change is about who makes decisions at the top of government on the NHS, how much a minister is involved, and that's gonna take up a lot of time and energy.

And that's really about structures and organs. Less about big ideas about how you improve our service. 

Jessamy: Hugh, just for our international audience, just give us a brief overview of how N Hs England relates to the NHS and what the sort of budgetary numbers are around the amount that, that this organization is doing or used to do and what it used to cover.

Hugh: Yeah this is a organization that. Got set up about 12 years ago, so under something called the Lands Reforms to the NHS. Sorry, I've just lost you. Lemme you, sorry. Yeah the background is, there's big reforms to the NHS in 2012 by the coalition government. They did a bunch of things. They tried to improve, enhance competition and health service, but they also had this idea that you could put the day-to-day management of the NHS.

More arms reach from politicians and that's not a new idea. Since the NHS was born, there's been this debate about what's the appropriate role of politicians in managing health service and then at the top of government, can you split sort of strategy for the health service and the day-to-day management.

So these reforms and NHS Inc. And took that debate to its conclusion. If you argue that you can try and split these things up. And so basically a wango a body full of technocrats has been set up to take the funding that the health service is gonna spend each year, allocate it to different areas, provide guidance, run big programs like screening.

So it's essentially a body that's been set up to manage the health service day to day. So it manages a lot of funding, but it distributes a lot of it to the health service. And so what government has said is that they wanted to bring that back into the Department of Health. So they're scrapping this body, they're merging its functions back into the department, and they're also gonna cut, they say the number of staff working in the Department of Health, and then it's in, in half.

So that might be about 10,000 jobs. It gets even more complicated because this body called NHS England runs regional organizations that oversee the health service in different parts of England. So the government has to work out what it wants to do with those ones too. So the simple idea is. This was supposed to take the politics out of managing the health service in practice.

That didn't happen. So there's some logic to bringing these two things closer together, but the job of bringing it back in is not a straightforward one. It's not just moving a few people around. It means redrawing boundaries about who does what or mean. Legislation and that can always evolve to something that you didn't expect it to be as a parliamentarian.

And it will mean lots of people that are responsible for managing big things in the health service will be reapplying for their jobs or losing their jobs or working out what the new structure looks like and spending less time focusing on improving services. 

Jessamy: Thanks. Hug. I got lots of emails from people in the global health community asking whether we had shut down at the NHS.

Hugh: Yes. I had the same lots of my American friends. What on earth is happening? I know. I saw Impact. Is this chainsaw to the n hs? No, don't worry. It still 

Gavin: exists. But there were actually some polls at the time weren't there. I think something like 30% of people in the UK thought that labor was trying to shut down the NHS as well.

Hugh: And this is not, this is the funny thing about it. On the one hand, no patient not no patient. I'm a patient, I knew about it, but most patients and never can have heard of any single, but the flip side is. Work to abolish it, merge its functions into the department or devolve them to some local body or to set up something else a bit different will take time and energy that those people could have spent on improving services for patients.

So on the one hand you think, look, this is just technocratic changes and we shouldn't worry about them on the other. They will have quite big impacts. And the question is really why now you've got a health service that is in crisis. You've got people that are waiting. Too long for care people in hospital corridors.

Not being able to be admitted to hospital suffering harm. Is this the big issue you really want to focus on? 

Jessamy: Yeah. And Hugh, I wanted to just touch back on something that you were talking about this 10 year plan that everybody's expecting just for people who don't live and breathe the NHS, we've had 10 year plans before.

What do you, what do they, what format do they normally take? Why does the NHS do them? 

Hugh: Good question. Yeah. The nm HS has a long history of producing long-term plans. So in the sixties, for instance, we had a sort of long-term hospital plan for the NHS. Just over the last 25 years, we've had three big ones.

New labor had something called the NHS plan in 2000 that's out this vision for health service. We had something called the long-term plan a few years ago, and so we've got various versions of these and they're opposed to set the long-term direction given that the challenges facing. NHS and other health systems are long-term.

The idea is to get some consensus behind the direction for the health system, but also their political tools. They're sometimes used to lever money outta the treasury. Here's the direction we want to take for the NHS over the next decade, and here's the funding we need to do it. So there's a long history and looking back at that history, you learn a few things.

So one is that the context. For the plans is almost more important than the content. So for example when labor will last in power and Blair was the Prime minister brown was in the treasury. There was a long term plan that was produced, but there was also nearly 7% growth in NHS spending year on year.

And that really enabled the NHS to improve. The ideas in the plan were important, but really the resources were the big driver of spending. Right now, there's far less resources likely to be invested in health service, which will constrain what any plan can deliver. Another lesson is. Just the starting point.

Often, a lot of the detail comes later. So again, if you look back at the plan under Blair. Lot of the big reforms to the NHS over the decade that followed weren't mentioned in the plan, and they came later. This is a starting point. But they're used for different reasons. This plan is probably gonna be published around the same time as something called the spending review which is a process in government where the treasury will set out what each department will get over the next few years.

So there'll be, here's the money and here's the plan. So it should really set the tone for the NHS. Can do. But we've got the plan, but we've also got the political priorities and we already know what they are. So government's already said they're one big target on the NHS. So over the next five years is to improve.

We'll reduce waiting times for routine hospital treatment. So whatever the plan says about shifting care of hospital, preventing disease, we know that's their big priority and we know achieving that's gonna take substantial resources. There's a big target for 92% of patients to be seen within 18 weeks of being referred from their gp.

I haven't hit that for a decade. Meeting, it'll take substantial resources. And even if you just focused on doing that, it'd be hard enough. So there's gonna be a, what's written in the plan and what's the actual reality of what politicians are going to prioritize 

Gavin: talking about these plans. I wanted to ask as well, how different is the situation that 2024 Labor inherited from the situation that 1997 labor inherited?

It's 

Hugh: a really good question. It's actually similar. So you think about in the nineties and now labor's inheriting an NHS with a waiting list problem. A big difference there is labor also had a. Economy that was growing at that point and could invest the, we don't have that now. We've got sluggish economic growth and we've got public services beyond the NHS that also require investment.

Similar challenge in terms of addressing a waiting list crisis and improving the performance of the NHSA big difference in the resources that are likely going to be available. But if you look back, labor was successful over that period at reducing the waiting list. It shows what's possible when the NHS is given.

The resources and the staff. A big increase in staff working in the NHS in that period. It can deliver, it can get itself out of these crises, but it needs to be supported, not just through good policy ideas, but also investment and a long-term objective to try and do something like reducing the waiting list, chopping and changing makes it more difficult.

Gavin: I wanted to ask actually what your opinion was on reform versus funding, because there's been a lot of talk of I think ki said no funding without reform for the NHS when labor first came to power. But a lot of what people talk about are the need for increased resources, beds hospitals, scanners, all that sort of like it.

They're very boring investments generally. Yeah. What are your thoughts on the sort of reform versus investment? 

Hugh: I think it's a really good question. You clearly need both. You need to have an idea for how you want to improve the health service and some policies that align behind that idea.

For instance, you might wanna increase activity in hospitals and maybe you'll change the payment system to help that happen. That happened in the two thousands. You might think that collaboration is the only way that hospitals are gonna get out of this mass. Then so let's introduce some policies that reduces com competition between hospitals that tries to measure their performance.

Collectively in shares waiting lists across the geographical area. So there's policy matters, ideas matter, but reform is way overplayed as the big driver of improvement in the health, service, and investment is way underplayed. Again, we look back at the two thousands, there was big ideas for how you improve the health service, some reforms targets.

Targets and tarot is what's often called clear targets performance management to achieve them. That clearly helped make use of more investment. The story of how the MHS improved in the two thousands doesn't really make sense without the investment. So we can look back and learn the wrong lessons. We can look back and think the payment system changed.

The targets changed. The organization and management changed. Yes, those things did happen, and they likely helped. But the big driver seems to have been the increase in resources during that period. 

Gavin: One political commentator said recently the kind of dangers of of succumbing to the reform fairy, the idea that we can wave the ferry's magic wand of reform and all of our problems will be fixed. But I think you're exactly right. And investment is massively on the plate in this issue, isn't it? And so I wanted to ask what you thought of the spending increases in that were given in the October budget for the NHS.

Brings 

Hugh: the growth and spending a bit closer to the historic average. So if you look back over time, the NHS generally gets between three and 4%. Spending growth in real terms every year. And that helps keep up with changes in the population, new technology. And it hasn't got that over the decade going into the pandemic.

And that's one of the reasons why the health services under strain. But the funding, settlement was a short term one. There was also a bit of a boost in spending on capital buildings, equipment, it, which was welcome, but really the big decisions on health spending haven't been made yet. They're gonna be made in the summer.

For the rest of the parliament. So the question is spending gonna grow about that rate to enable the service to improve, not just stand still or will it be constrained and the economic context is challenging. So that's a decision not just about what government wants to put into the NHS, it's a decision about the balance of resources going into the NHS.

The other parts of the public sector though, are also under massive pressure. Social care services, public health services, the welfare that we've had, cuts in welfare spending announced, which will harm health. So this is not just about the NHS, the environment is highly constrained on your reform point too.

Yes, governments are going to want to have a narrative that reforms important. And of course it is, but you still need to have some ideas. To guide that reform and it's not clear at the moment, what are we nine, 10 months into the labor government, what their guiding ideas are for how they want to use public policy to improve their health service.

It's been a mixed bag. We've had some announcements that feel a bit like new public management competition, league tables, hospital tools, sacking managers that don't make the grade. We've got a health system actually that was recently reformed. Based on collaboration being the guiding principle. So it's hard to see actually when you stand back.

What's the guiding ideas that are gonna drive the health service area over the next five years? What does this government think? Are the roots to improvement? Is it about equipping frontline lead? Is it about new technology? Is it about slashing administration? It's not clear at the moment and that does matter.

So reform is important, but you need to have some ideas guiding it, and that needs to go with investments so you can direct it in the right places. 

Jessamy: And I just wanted to go further on that and just, and see whether we can try and pull out some trends or some idea about what some of these guiding principles are.

Because obviously the. The government came in last summer and West Streeting very quickly, made a deal with junior adopters, much more friendly on striking, we've had a, we've had a real problem with unions and poor pay in the NHS, and there was a good agreement that was made.

They moved very quickly on that. Straightaway commissioned Dazi report to say everything before now is not our fault. This is the terrible way. And now this is a sort of fresh start, good things. I think in, in, in general then we've had this very sort of heavy top-down NHS England announcement.

We have some aspects which are like this recent announcement, the hospitals are gonna be paid to remove people from the waiting list. Anybody that's actually worked in the NHS knows that there's gonna be a lot of room for danger here, like the NHS administration. I. The way that data is handled is really difficult and challenging.

There are gonna be a lot of people that are gonna be removed because the incentive is to, the hospitals will get money, an unlimited amount of money for how many patients they can remove from their wasting list because their treatment is no longer necessary. There's gonna be huge room for mistake there.

So what are the some of the kind of. Ideas or trends that we are getting about how this government is approaching health. They've obviously made it a priority. They're this mission led government where none of us know what these missions are. There's lots of chat about it, but what can we extrapolate from what's happened so far, do you think?

Yeah, 

Hugh: as you say. Very quickly resolving industrial action, which was important and changing the tone. And part of that was emphasizing the problems that were caused by the previous government, not them, and trying to work with staff. So that was important and good, but then we've had a set of measures that seemed to be about pushing the system to work harder and trying to encourage.

Competition. So league tables have been announced we're gonna probably have ratings for new bodies at a regional level. And so there's a bit of a new public management style targets and terror approach that seems to be part of the policy ideas and that's got some similarities to. O2 thousands, and some of the advisors that were working for Blair then are working for Streeting.

Now, you've also got these ideas about yes, cross government approaches to improving health. That's been largely rhetoric plus reality at the moment, I'd say. So they got elected on the idea that they were gonna have this mission led approach where health would run throughout government. That means not just the NHS thinking about health, but also social security, influencing health housing, influencing health.

We haven't really seen what that means in practice yet. And then we have a set of ideas that are about what they want to do with the balance of resources in the health service. So they've talked about shifting care at hospital. Boosting prevention and they talked about investing more in primary care as a proportion of resources to hospitals.

So a nice set of ideas. But again, how that will happen in practice and how that matches up with the big political targets to reduce hospital waiting times is what we'll have to see over the next couple of years. So those seem to be the guiding ideas, but then you stand back and I think there's a political set of realities, which are.

Money's constrained. Access is poor and it's gonna be election in a few years time. And so improving access is likely to be an overriding priority when people come back to the ballot box. And there's a question about whether they'll let labor have the second half of their tenure plan for the NHS.

And so the reality is government does need to focus on. Tackling hospital waiting lists, making it easier for people to see their gp, some of the basics of delivering a high quality health service. And so these bigger ideas about reform are likely to be longer term ones, and the reality is likely to be drawn to these shorter term challenges about improving access.

And that might be why these measures like financial incentives on the waiting list. Targets for reducing the waiting list with strong, top-down political management of them are likely to be a feature of the next couple of years, whatever government says about shifting to prevention and joining up with other departments over the long run to improve health good ideas, but they're faced up with a big reality, which is long waiting lists and port access.

Now, 

Jessamy: the health foundation I know has, been thinking a lot about AI and health tech in the NHR. And I've been struggling recently to really think about what the benefits are that we've seen over the last 15 years. Obviously, there's an enormous potential here, and it's something that the NHS must embrace, but when I look back to say 2010 when I was a junior doctor and all of the hype around how AI and health tech was gonna completely revolutionize things, and there was a topal review and how we all needed to be retrained.

I don't see any of that really in any transformation or sense. What's your thoughts? Where, what's going on? 

Hugh: My, my take is that we need to shift the way we're thinking about AI and health service at the moment. It seems to be expectation that there's this amazing wizzy stuff happening somewhere.

At some point we can receive, adopt, and it's gonna transform the way we work. It's quite passive. It's quite based on the market coming up with cool stuff that will just work and we can implement. I think we need to flip that around and say how does government, the state, the NHS, shape the development of new technology?

So it benefits the health system and meets the very real practical challenges that we face right now. So a good example is there are some examples of these technologies which could free up clinicians time to be able to provide more direct care. And those are based on technologies that already exist.

For instance, in general practice, I. It seems to be, there's some technologies that could do some administration tasks that could free up GPS time more. Fantastic. So what do we do to invest in those technologies? Test them to see if they really work. Spread them across the NHS, and that requires being much more active in.

Having a strategy for how AI will be used in the health system, not just letting it come. So the idea that government's got this shift, we're gonna shift to use, towards using digital technologies. I think we need to actively steer to make sure that these things do benefit the NHS and they don't.

Focused on the worried well, rather than the people that have complex conditions that they don't exacerbate inequalities, which we already know are deep. The problem I think, is at the moment, the development of these technologies is rapid and we haven't caught up with how we want to govern them and steer them for public benefit.

Jessamy: I I totally agree with you and I think there are some good examples in the US aren't there, where, there's a sort of. Health tech and AI is built into the system and generated from that system and is context specific and built for a particular local application. And there are other examples in Singapore or in China Hong Kong.

We don't seem to have any interest in trying to build the kind of internal expertise that would facilitate that. So in the absence of that, and in the absence of us probably being able to, really think about shaping AI and health tech from its development, but trying to buy in expertise or buy-in programs, how do we.

How do we best utilize it? How can we make it work? Do you know what I mean? Because it seems like such a shift that we would have to go, but go under to have thatty type of internal expertise where we are generating these programs, we're generating this technology, we're implementing it in a context specific kind of way.

What's the sort of middle path, yeah. 

Hugh: There's pockets of good examples in different parts of the country where innovative leaders grip this stuff or there's an idea that's come up in a local trust, or like in London, they're interested in some of these new technologies. So the task is to take it from pockets.

Where there's interest and there's expertise and to make it more systematic. And also to use the benefits of a single payer system to be able to identify potentially totemic innovations that could help support the implementation with the scarce management resource we have the NHS is undermanaged, not Overmanaged, and we're cutting management further to evaluate rapidly in a real world setting and then just see if this stuff is.

Nonsense. So it's gonna help. And some of it is nonsense and some of it will help. So I think it's about becoming far more national in our approach to thinking about this work and supporting the local examples. But it links to another part of the government's agenda, which has been, I. Stripping back management costs and so as well as scrapping HS England and merging it into the department and cutting their staff.

We have regional entities called integrated care boards. Lots of jargon in the NHS but they're basically regional planning groups, and they're also likely to see their management costs cut in half. So who's gonna be doing the planning? Who's gonna be doing the support for implementation for New Tech?

New Tech isn't just a thing, it's a human social messy process that requires people to support it to understand whether it works to work with clinicians. So I worry that we're cutting back on in the attempt to reduce deficits in the short term. We're cutting back on the scarce management resource we have when we really need to be boosting it.

Making change happen is very complex, very hard. The NHS has not always been good at it. So cutting back on the managers we do have at a local level is only gonna make that harder. 

Gavin: I wanted to ask a very difficult question you, which is I don't think we could talk about this whole topic without talking about social care.

The last few governments have all gone, yes, we're gonna do something about social care. And then just at the last minute, gone, you know what, this is gonna be very difficult. We'll do something about social care at some point in the future. What have labor said so far about reforming social care and what are your opinions on what needs to happen with the system?

So basically 

Hugh: it's the same pattern so far, unfortunately. So labor came into government with a manifesto that said they wanted to have a national care service. Vague on what that meant, but implicit in a much more comprehensive national approach to delivering social care services. Right now, the system is a thread bear safety net with publicly funded care only valuable to people with.

The highest needs and the lowest means lots of people fall through the gaps. There's a high reliance on unpaid carers and the system is broken and it needs fixing, as you say, successive governments have promised to reform the system over decades, then ducked it, and so far what we've seen from this government is they came in actually inheriting some quite limited but important reforms to the social care system that were introduced under the last government.

Introduce a cap on an individual's lifetime care cost at the moment, those could escalate and be catastrophic. They rode back on that cap. So that will now not be implemented. So they've gone backwards on some reform and then they've set up deja vu, an independent commission. To look at policy proposals for improving the system that's gonna have an interim report in not too long, a year and a bit, and then a final report in about three years, I think conveniently after the spending review period and just going into an election.

Health Secretary said that social care plans and elections are not a good combination, and he is right. The problem is they're likely to go into an election just having formed a plan for social care reform. I really hope that I'm wrong about this. It's easy to be skeptical and the glass half full version is they've set up an independent review because they really want to change the system and they want to get expert views and maybe it'll report much sooner and maybe reform will happen.

But we've been here many times before. We've had a long line of independent reviews, commissions, proposals. There's not that many new ideas on the reform need in social care. The problems are well known, the solutions are well known. The missing ingredients have been political will and investment.

And so those are the things we need Less, more ideas, but hopefully this review, Louise Casey is running it. She's tackled some complex public policy problems in the past. Hopefully this will help catalyze the change we need. But history suggests we should not be optimistic. 

Gavin: Yes. I think governments have been spooked, haven't they since, especially since, theresa May's sudden reveal of a carer reform policy during the election campaign, which essentially upended her entire campaign, doesn't it? And Burnham faced the same challenges 

Hugh: too. So there's a long line of these debates. The problem is the public don't really understand the social care system.

Many people expect it's gonna be free and available to them like the NHS. And so mobilizing public support for change is also challenging when understanding of the system is. But the arguments for reform are convincing. We have a system now where, as I say, it's a thread bear safety net. We need risk pooling across the population where people who need care get it where resources are available and they're not having to rely on friends, families, or their life savings.

We don't really have a national system at the moment. We need to move to something far more comprehensive. We also have a problem in. Social care workforce where many care workers live in poverty pay is low. So there's a bunch of different problems that need to be addressed but they're well known and solutions to them have been implemented in other countries.

The question is, the politicians want to do it, and are they willing to invest in improving the system? 

Gavin: Perhaps we could finish up then by I wanted to as well mention primary care while we were on the call and yeah. The public's biggest complaint quite a lot of the time is the difficulty of getting a GP appointment.

So what changed on that in the 2010s under the conservative government and what's Labor said about addressing it and so far in the, since they took over? Yeah 

Hugh: We run public polling every six months with the representative sample of the public and for the first time recently. Access to general practice is their priority for improving the health system.

It's a complex picture when you look at access, but national survey seems to suggest over time people have found it harder over the last decade to get through to their GP practice on the phone and get an appointment when they want to. They've also found it harder to see their named doctor if they have one, or the doctor they want overtime.

So you've got a. Problem of declining access or experience of access and declining continuity of care, which we know is really important particularly for people with long-term conditions. So what's happened over that period? Investment has stalled over the 2010s and before labor came into a power's also been slowing, and then actually a decline in full-time equivalent gps working over that period.

There's been an uptick recently because of a boost in training. So activity's gone up. GP numbers haven't, and there's been this mismatch between appointments and the number of gps available to deliver them. But also access is not just about supply and demand. Patients have problems with booking systems, complex routes to access general practice, not always knowing who they're gonna see.

Increased complexity in just trying to get an appointment. So that's the problems. In terms of the solutions, what we've heard so far have been that. This government wants to shift the balance of resources. Primary care in the community. So an expectation for increased investment. It said it wants to bring back the family doctors.

So presumably that means trying to enhance continuity of care and it's stripped back. Some of the targets for gps, there's a long list of things they can get extra additional payments for to try to simplify the system, but we still don't know exactly what they want to do to reform. Primary care.

And that's gonna be one of the big things to look out for in the 10 year plan. And really primary care is the jewel in the crown of the NHS, this sort of comprehensive system that can treat people and their families from cradle to grave. So the big question is, will that system have the resources and be supported to evolve, adapt with new technology to more closely integrate with other services in the community?

Or will government try and do something radically different? That would probably not be wise. We've got a model that can work if supported, but we'll wait and see in the 10 year plan for what 

Gavin: government wants to do. A good way to finish up would be to ask you if you were a betting man, what would you think was going to be in the 10 year plan?

I think in the 10 year plan, probably 

Hugh: The big set of changes will be how do you support this shift towards more services being delivered. Hospital in primary care in the community. That's not a new idea. It's not a new set of challenges, but it's something that the NHS has struggled to do to match the policy rhetoric of doing this with the reality of the system changing.

So I expect the big proposals. In the plan to be around how government's gonna encourage, for instance, gps to work more closely with mental health services, social workers for a broader range of services to be delivered outside of hospital. I think that's gonna be the big set of changes.

There's likely to also be something that's got to be something about what the NHS is gonna do to. Identify promising technological innovations and integrate them into how it works. But I think the big game in town is primary community services and how they can be supported. 

Gavin: That's a good place to finish and it ties together a lot of what we've talked about on this podcast.

Hugh Wick of the Health Foundation, thank you so much fa, for joining us on the podcast. Thanks so much.

Thanks so much for listening to this episode of the Lonzo Voice. Please subscribe and leave us a review if you haven't already, and we look forward to seeing you again next time here on The Lancet Voice.