NHS spending is higher than ever. Why isn’t it working?

Summary

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Podcast Summary: NHS Spending Is Higher Than Ever. Why Isn’t It Working?

Podcast: The Story
Host: The Times (Luke Jones)
Episode Date: May 4, 2026

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Overview

This episode explores the paradox of the UK’s National Health Service (NHS): despite record-breaking government spending, persistent problems remain. With waiting lists high, staff feeling undervalued, and infrastructure in crisis, the hosts dig into why increased funding isn't translating into better outcomes. Health Editor Ellen Hayward and Data Editor Tom Calver of The Times and The Sunday Times join host Luke Jones to follow the trail of NHS spending, examine where the money goes, and debate what’s needed for genuine reform.

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Key Discussion Points & Insights

NHS Spending: The Scale and Growth

• Historic Increase
  • NHS England's annual budget has more than doubled in 15 years: from about £130bn (2019) to £217bn (2025), a real-terms rise of 30% in just a few years. (Tom Calver, 03:48)
• NHS as “National Health State”
  • "By 2029 [the NHS] will consume almost half of day-to-day spending. So we're basically going to become the national health state." (Tom Calver, 04:29)
• Drivers of Cost
  • Population aging: Life expectancy has risen from 68 years (1940s) to 81 (now).
  • Staffing: “Employing people now is much more expensive than it used to be.” (Tom Calver, 05:26)
  • Pandemic legacy: Temporary “blip” of spending after Covid has become the new normal.

Political “Untouchability” and Consequences

• NHS vs. Other Departments
  • NHS funding has been protected even as court systems and local authorities faced austerity. UK’s health spending has leapt ahead of many European countries, although it remains less than the US. (Tom Calver, 05:57)

Where Does the Money Go?

• Expanded Role
  • NHS now funds more services (e.g., community and mental health care) than ever before.
  • “Mental health spending increased by about a third between 2019 and 2024—£6bn a year.” (Tom Calver, 06:47)
• Decision Making Structure
  • Recent shift: Abolishing NHS England (an arm’s-length body) and moving budgetary authority back to the Department of Health. Spending now set to be driven more directly by politicians. (Ellen Hayward, 07:21)

Spending Breakdown

• Staffing
  • About 50% of NHS budget goes to staff costs.
  • Recent increases: “Half of the new money has gone to pay rises and new staff, mostly pay rises.” (Tom Calver, 09:21)
• Infrastructure and Maintenance
  • Capital budgets have grown but mostly fund repairs and urgent fixes. NHS has a “massive” £16bn maintenance backlog—often not for shiny new hospitals but for basics like roofs and lifts. (Tom Calver & Ellen Hayward, 10:06–12:28)
  • Stark regional disparities: “London teaching hospitals...amazing and state of the art...[but elsewhere] there’s [sic] portacabins, sewage leaks, rats on wards.” (Ellen Hayward, 11:44)

Has More Money Worked?

• Community Care Shift
  • Some impact observed, but pace is slow. Services like outpatient appointments are slowly moving to GPs or community clinics, but "it’s not going to be a quick fix." (Ellen Hayward, 12:43)
• Value for Money?
  • “They’ve got some good ideas, but it’s probably just not moving fast enough and so they're probably not going to hit all their key targets." (Ellen Hayward, 13:25)

Waiting Lists and Patient Impact

• Waiting List Snapshot
  • 2024: ~7.2 million waiting for elective (non-emergency) care—triple the size in 2010.
  • Only 61% treated within the official 18-week target (meant to be 92%). (Tom Calver, 16:05)
  • Some data anomalies: Reductions in waiting list partly due to removals, not more operations. (Tom Calver, 17:22)
• Cancer Care
  • Only two-thirds of cancer patients start treatment within the two-month target—delays can be “deadly.” (Ellen Hayward, 18:54)
• Knock-on for Economy
  • Long NHS waits contribute to record levels of long-term illness and work absences, hampering productivity.

Systemic Problems Blocking Progress

• Physical Infrastructure
  • Crumbling buildings and outdated equipment make care delivery inefficient. (Ellen Hayward, 21:14)
• IT and Technology
  • “Computer systems keep crashing. Patients aren’t getting told about their appointments on time.” (Ellen Hayward, 21:14)
• Prevention vs. Cure
  • System tilts toward treating illness rather than preventing it, despite “everyone agrees that...prevention...costs much less.” (Ellen Hayward, 22:07)

Is the NHS Trying to Do Too Much?

• Expanding Scope
  • NHS’s role in prevention means intervening in lifestyle and community issues—potentially “slapping a Twix out of your hand.” (Tom Calver, 25:14)
• Difficult Trade-Offs
  • New expensive drugs and treatments: Should the NHS fund costly specialist care for a few, or cheaper, broader access care for many? This tension will intensify as medical costs rise. (Ellen Hayward, 25:16)

Lessons from History and Abroad

• Improvement is possible: Previous Labour governments dramatically reduced waiting times with a combination of funding and system reform. Other countries demonstrate more efficient models. (Tom Calver, 23:53)
• “History shows [we can] turn it round. It just seems very expensive at the moment.” (Tom Calver, 24:12)

What Needs To Change?

• Paralysis by Review
  • “Each review has new recommendations, but those recommendations are the same as things that loads of other reviews over the past ten years have found...Maybe if he just got on with it a bit...that would be a quicker way to improve matters.” (Ellen Hayward, 26:13–27:23)
• Staffing vs. Infrastructure: The Chicken and Egg
  • “If all the money is going on pay rises...you can’t afford to buy new MRI scanners...But if you build the new operating theatres but you don’t have the doctors...that doesn’t work either.” (Ellen Hayward, 26:13)

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Notable Quotes & Memorable Moments

• “We’re basically going to become the national health state with all of the consequences that come with that.”
  — Tom Calver (04:29)

• “If you don’t have the right equipment, if your hospitals are falling down, then things are always going to take too long.”
  — Ellen Hayward (21:14)

• “London teaching hospitals, which are amazing and state of the art, but then you go to some, particularly in regions or smaller towns, and there’s...porter cabins...sewage leaks, rats on wards...doctors always say, like, we can’t do our jobs when we're working in a hospital that’s crumbling down.”
  — Ellen Hayward (11:44)

• “We kind of know what the answers are...the same as things that loads of other reviews over the past 10 years have found. Maybe if he just got on with it a bit...that would be a quicker way to improve matters.”
  — Ellen Hayward (26:13–27:23)

• “At the moment, only two thirds of [cancer] patients are seen within that [two month] target. So that means a third...are basically waiting too long...That can be deadly.”
  — Ellen Hayward (18:54)

• “I think we have been here before...The Labour government back then was able to turn things around...So I’m always cautious about being overly pessimistic with all this. I think history shows [we can] turn it round. It just seems very expensive at the moment to do so.”
  — Tom Calver (23:53–24:12)

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Timestamps for Important Segments

• Introduction & context – 01:10–01:59
• NHS spending scale and history – 03:39–04:47
• Political priorities and international comparison – 05:44–06:40
• Expansion of NHS services (mental health, community care) – 06:40–07:18
• Budget decision-making: NHS England vs. Department of Health – 07:18–08:06
• Staffing, pay rises, and capital investment breakdown – 09:14–10:32
• State of infrastructure and under-investment impact – 10:51–12:28
• Has community care investment paid off? – 12:28–13:18
• Are we getting value for more money? – 13:18–13:59
• Current state of waiting lists – 15:52–17:21
• Cancer delays and wider economic impact – 18:54–20:18
• Productivity barriers: technology, infrastructure – 21:14–21:49
• Prevention, public health and system trade-offs – 22:07–24:48
• The case for action—not just reviews – 26:07–27:23

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Conclusion

Despite record investment, the NHS is struggling under the weight of aging infrastructure, a growing and sicker population, and expanding responsibilities. While progress is slow, both history and international examples show improvement is possible—but only if leaders shift from endless reviews to concrete, balanced action on prevention, staffing, and capital investment.

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Transcript

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[Luke Jones]

From the Times and the Sunday Times, this is the story. I'm Luke Jones. We need to reform the NHS to make it fit for the future.

[Tom Calver]

I will deliver a stronger nhs. We should focus above all on the nhs.

[Luke Jones]

How's that going? Waiting lists are still stubbornly high. Patient satisfaction is low. Staff complain of shortages and rubbish pay. And yet over the last decade, politicians have been spending big on health.

[Ellen Hayward]

It means extra money, significantly more money

[Luke Jones]

going into the NHS.

[Babbel Advertiser]

We believe in putting big sums now into the NHS.

[Tom Calver]

The government is investing record funding into the NHS.

[Luke Jones]

205 billion pounds every year goes to NHS England, more than double what it was 15 years ago. That is growth that massively outstrips inflation or other government departments in need. So why isn't it some fabulous service that everyone using or working in is extremely happy with? We're going to follow the money, The story. Today, we're spending more than ever on the nhs. Why isn't it working?

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What I had in mind when we organized the national health service in 1946-1958 and remember when we did it, you know, you, you younger ones, this is immediately after the end of the Second World War, when we were out. Sir Winston Churchill then said, a bankrupt nation. But nevertheless, we did these things and there is nowhere in any nation in the world any health service to compare with it.

[Luke Jones]

NY Bevan, the Welsh coal miner turned Labour health minister, remembered nowadays mainly, of course, for founding the NHS in 1948. But what we have now is far more complex and costly than what he established. Thankfully, We've two bright colleagues to explain for us.

[Ellen Hayward]

My name's Ellen Hayward and I'm the health editor at the Times.

[Tom Calver]

I'm Tom Calver, the data editor at the Times and the Sunday Times.

[Luke Jones]

Tom, if we can start with you. We're talking about NHS spending and the issues that surround it. What is the scale of NHS spending at the moment? How much do we spend on it?

[Tom Calver]

In England, we are spending an enormous amount of money. So in 2019, just before the pandemic, the health budget was about 130 billion pounds. This year, it's expected to reach 217 billion. So that's quite a big increase, even adjusted for inflation. That's a rise of 30% in just a few years. And look, I think to really understand how much this has grown, we have to go all the way back to the 1950s and think about how health services change, because back then the NHS was spending was about 3% of GDP. Today it's coming up on 9%. So it's basically tripling, even when you adjust for inflation and the size of the UK government and its spending. But there's one really striking stat that I think we should all bear in mind with all of this. The NHS, by 2029 will consume almost half of day to day spending. So we're basically going to become the national health state with all of the consequences that come with that.

[Luke Jones]

And can we blame Covid?

[Tom Calver]

Partly. Look, I mean, the NHS budget soared in 2020 and 2021. Hospitals were converted, there were lots of things going on then, but what was then, a short term blip has kind of just become the norm now. So obviously there was a lot of expensive recovery after the pandemic. So billions and billions of pounds was plowed into the NHS to get waiting lists down. We're also getting a lot older as a society. When the NHS was founded in the late 1940s, you were expected to live to about 68. Now it's 81 and pushing onwards, especially higher for women. So that's a lot more years of potentially living in ill health and needing care at the end of it. And I think another factor that's often not talked about is just the fact that paying people, employing people now, is much more expensive than it used to be. And so all of this comes together to really push up NHS costs over that time.

[Luke Jones]

And of course, government spending as a whole, correct me if I'm wrong, isn't necessarily ballooning to keep pace with that. So actually it's just the nhs, arguably taking money away from other things like defence, education, the money given to local authorities and the rest of the.

[Tom Calver]

Yeah, the NHS is politically almost untouchable, at least up till now. It's almost like we will sustain spending on the NHS at a cost to everything else. So we saw this during austerity, for example. You know, the courts and justice system, prisons, all suffered, but the NHS budget, particularly towards the end of the 2010s, was largely protected. And I think what's really interesting on this is, you know, yes, every country is going through some of these demographic challenges that we've just talked about, but the UK has recently really jumped up the rankings in terms of spending. So we've gone from being a country that spent quite average amounts on healthcare by international terms, and now we're pushing up towards the higher end. So still some way below the Americans, but above a lot of European countries.

[Luke Jones]

Tom, in terms of the ballooning NHS budgets and the money going in, where is it going? What parts of care are growing most?

[Tom Calver]

I think what's quite interesting is that the NHS now is being expected to pay for things that it never normally had to in the past. So increasingly we're seeing more funding for aspects of community care, which is things like services to help people live independently on their own. You know, NHS mental health spending increased by about a third between 2019 and 24. So that's a lot of money. It's about £6 billion every single year. So all of these different aspects of health support are having to be funded by that same health budget.

[Luke Jones]

Ellie, if we're thinking about the money, who's actually deciding where it goes?

[Ellen Hayward]

It's quite an interesting question, actually, because that's changing at the moment. So it used to be outsourced a bit to NHS England, which is this, like, arm's length quango that runs the NHS day to day. And that was set up in 2012. And the idea was that the NHS would be free from political interference and would be able to sort of get on with the job and decide what's best for patients. Anyway, Wes treating in. Keir Starmer last year announced they were abolishing NHS England and bringing the budget back under the direct control of the Department of Health. And that process is currently ongoing. So basically from now on, spending is gonna be much more determined by politicians and the Department of Health rather than this, like, separate body of nhs.

[Luke Jones]

And either way, at the top, NHS England or Central government, are they literally telling individual health trusts how much to pay staff, how much to pay for certain procedures and the rest or is there some level of autonomy as you go further down the chain towards hospitals?

[Ellen Hayward]

Yeah, there's a bit of autonomy for things like staff, obviously, that's set on a national level, so doctors get paid the same. I mean, if they live in London, they get a bit of a bonus. And there's also tariffs for treatment. So a hip operation, a hospital gets paid the same amount wherever they are in the country. But then hospitals trusts do get a bit of autonomy in terms of where they spend their budgets, how they allocate it. And there's been so many different restructurings and different reorganisations of NHS over the past 10 years, and I don't even understand it. It's things like integrated care boards who get a set amount of budget and then can spend it on some community clinics, some hospital trusts, sort of. They could decide how much goes to gps and things like that. But, yeah, in general, most of the key things are fixed. And then individual hospital trusts get a bit of autonomy in terms of deciding how much money to allocate to different things.

[Luke Jones]

And, Tom, how big a slice of the pie is staffing? Because that's what we sort of seem to hear a lot about whenever there are debates about NHS money.

[Tom Calver]

Yeah, but staff costs are about half of that entire budget. And I think it's interesting to break this down. Right, so the NHS budget has increased by about 75 billion pounds between 2019 and 2025. So you adjust for inflation, that's about 40 billion. And about half of that 20 has gone on pay rises and new staff. Actually, the data seems to suggest that it's mostly gone on pay rises. Pay per person has gone up more than the number of staff, which is quite interesting, I think. So that's one big chunk of it, then. You've also got things like capital budgets. They've increased by about £4 billion in real terms over that period.

[Luke Jones]

And that's to do what? That's to new hospitals or repair a wing of a hospital or buy an MRI scan. Exactly.

[Tom Calver]

Building stuff, buying equipment, repairing stuff. And, you know, I think before we get excited about any new hospitals, however, the NHS has this massive backlog, this massive maintenance budget of about 16 billion pounds. So, you know, a lot of this, it's not going to. I remember Boris Johnson talking about 40 new hospitals. A lot of it isn't going towards new hospitals, it's actually going towards just fixing stuff. And a lot of those fixes are quite urgent as well.

[Luke Jones]

And in the same way that a lot of the extra cash that's gone into the NHS has gone into paying a lot of the staff that's already there. More, actually, in terms of the capital investment, just trying to keep pace with the buildings repair that they need happening. What kind of state of disrepair is NHS infrastructure in around England?

[Ellen Hayward]

How bad would you say it is? It's really bad. There was a big report shortly after Labour came into power by Lord Darcy.

[Luke Jones]

I've worked in the NHS for more than 30 years, but I've been shocked by what I found during this investigation.

[Ellen Hayward]

And one of the key findings of that was that one of the main reasons for NHS underperformance and low productivity is because since austerity in 2010, basically capital investment in the NHS has been starved by about 37 billion. So that means things like quite simple repairs, say a roof has broken, a lift isn't working, hospitals just haven't had the money to spend on that.

[Tom Calver]

We get caught up frantically trying to

[Luke Jones]

find beds that being axed or using it that is outdated, or trying to work out how to get things done because operational processes are overwhelmed.

[Ellen Hayward]

I visit quite a lot of hospitals in this job and you do see some, like big London teaching hospitals, which are amazing and state of the art, but then you go to some, particularly in regions or smaller towns, and there's like, porter cabins. Also there's things like sewage leaks, rats on wards, and doctors always say, like, we can't do our jobs when we're working in a hospital that's crumbling down and, you know, it's just bad for everyone. And Labour have tried to reverse some of that since they came in, I think. Rachel Reeves, the first budget in 2024 prioritized capital spending in the NHS massively. But they're still playing catch up on this decade of underinvestment. And it's something that takes a while to fix as well. Like building a new hospital takes years and years, it can't be fixed overnight.

[Luke Jones]

And some of the money that's been pushed increasingly out into the community to try and ease the pressure upstream on hospitals. I mean, has that had any impact on reducing waiting lists, improving productivity, any of that?

[Ellen Hayward]

Yeah, I think it is having a bit of an impact. The main aim of the Government at the moment are shifting care from hospital to community. The idea is that, you know, outpatient appointments, things that traditionally you'd have had to go to a hospital for, will instead be done by your GP or in new community clinics or using technology that means it can be done at home, done remotely, but again, that's something that's going to take ages. So I think, you know, it's not going to be a quick fix. You can't just suddenly stop people going to.

[Luke Jones]

It's a big picture. Ellie, would you say we are getting value for the extra money that's been going into the NHS or not?

[Ellen Hayward]

It's such an important question because Labour obviously they were elected on fixing the nhs. It was their key election pledge. And I think the general conclusion people are coming to is that they are doing well, they've got some good ideas, but it's probably just not moving fast enough and so they're probably not going to hit all their key targets. So when you look at hospital waiting lists, which is one of the key things people focus on, the situation at the moment is still catastrophically bad compared to where it was 10, 15 years ago.

[Luke Jones]

So has the government actually managed to bring down waiting lists like they promised? And why isn't this extra cash actually improving the situation in wards in operating theaters? That's next.

[Tom Calver]

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[Luke Jones]

Ellie and Tom we're talking about the NHS in England and some of the issues that persist even though we're putting in enormous amounts of money increasingly into this system. Tom, what is this current State of waiting list. And when we say waiting list, what do we mean?

[Tom Calver]

So we're basically talking about anyone waiting for non urgent consultant led elective care. So things like hip replacements, cataracts, diagnostic tests after a GP referral, and you're basically meant to have 92% of these done within 18 weeks. That's the sort of standard that the government has had for a while. And the current figure is about 61%. So we're not anywhere near meeting that. I think it's worth also looking at the overall size of the waiting list, because that's almost like become a bit of a benchmark for how the health system in this country is doing. So go all the way back to 2010. The NHS waiting list was about 2.3 million. Then it sort of crept slowly upwards throughout the 2010s and, you know, perhaps a combination of us getting slightly older and sicker, and it went to about 4.5 million at the start of 2020. Then it soared during the pandemic to 7.8 million at its peak. So it's only come down to about 7.2 million in that time. So it's come down, but it's still in the 7 millions. So it' it's more than three times as large as it was a decade and a half ago. So it's really, really slow progress. And I think as well, you know, that that's also with some slightly suspicious data patterns going on. Oh, go on.

[Luke Jones]

In what way?

[Tom Calver]

So the Health foundation has basically looked at those trusts, the key hospitals, where waiting lists have been very, very high, and they basically found that waiting lists were only really falling because people were being taken off the waiting list. It wasn't happening because those hospitals were actually doing more treatment.

[Luke Jones]

And Tom touched on it there. But what exactly is the government's target to waiting lists? What should we be holding them to by the next election?

[Ellen Hayward]

So most people think that to reach this key 18 week target, which is the one that Starmer and Streeting have sort of tied themselves to, then the overall waiting list is going to have to fall to about 4.4 million by 2029. You know, they're going to have to really speed up progress.

[Luke Jones]

And that is to get what all people, most people, treated within 18 weeks of saying, you need that new knee or hip or what have you.

[Ellen Hayward]

Yeah, 92% of people to be treated within 18 weeks. There's an interim target of 65%. Well, which is for March, but we don't get the figures on that till May. It's a bit up in the air whether they'll hit it or not. I mean, most people thought they wouldn't, but now, because they're doing this big last minute drive, like really pushing hospitals to meet it, I think some people think they might have just got past it, but we won't find out till May for that one.

[Luke Jones]

What is the impact on patients of all of this? If you're one of these seven or so million people languishing on these lists waiting for a new hip, I mean, you're not just sitting there without any extra harm happening to you. I mean, it might be painful, you might develop other issues because of that problem.

[Ellen Hayward]

Yeah, it's really, really bad. One area which kind of sticks out, which the NHS has been doing really, really badly on for about a decade, is cancer treatment. So cancer is obviously one of the most time sensitive conditions because the quicker you get treatment, the more likely you are to survive. And even delays of about a week or two weeks can actually have an impact on survival. So the key NHS target is that people should start their treatments or start chemo or have surgery within two months of going to their GP with cancer symptoms. But at the moment, only two thirds of patients are seen within that target. So that means that a third of cancer patients are basically waiting too long to start treatment. And that can be deadly. And it's also horrible if you're waiting, if you've been diagnosed with cancer and you're waiting to have an operation to begin chemo, you know, with your family, you just, often they just want to get on with treatment and start, and it's really terrible. And then things like hip operations as well, which is the classic one we always give as an example. But if you're waiting for hip operation or for, you know, if you've got really bad muscle pain or you're struggling to move, it often means people are signed off work. So these long waiting lists as well, they're having an impact on economic productivity. And we've seen figures showing this. Rates of long term sickness, the number of people being signed off work is pretty much the highest ever at the moment. And so, you know, tackling NHS waitingness can also maybe help with things like unemployment rates and productivity and economic growth

[Luke Jones]

within the NHS as well, I guess, because to take your cancer example, if your treatment starts later than it should do, you might need more treatment as a result of that, which means more NHS time, not be heartless about it, which means more money and personnel needed to help work on you.

[Ellen Hayward]

Yeah, exactly. And like with cancer, early diagnosis, which is another thing that NHS does badly on. Yeah. Like you said, if you get a tumour caught before it's spread outside that organ, then treatment's, like, relatively simple and relatively cheap compared to if your cancer doesn't get caught until it's spread around your whole body and you need terminal care. So it makes sense from so many different perspectives to treat people as quickly as you can.

[Luke Jones]

Timely diagnosis from you. What do you think the issues are that are stopping them actually getting on top of that waiting list and being more productive and getting through all those elective procedures a lot more quickly than they are currently doing?

[Ellen Hayward]

I think the capital investment point is really important, which is if you don't have the right equipment, if your hospitals are falling down, then things are always going to take too long. Technology is another big one. I mean, every time I speak to anyone working in the nhs, they'll be like, oh, yeah, the computer systems keep crashing. Patients aren't getting told about their appointments on time. And that is something like. I mean, every single Health Secretary I've ever covered has always promised to improve technology, but I think that's one area which, if implemented properly, could really help.

[Luke Jones]

It sounds like it all comes down to money, then just more money is needed and it's not a ludicrous figure that is currently being pumped into. It might be that it's just not enough because of all these issues, historic underfunding. But also we're all getting sicker and older, sort of.

[Ellen Hayward]

But then also there's loads of things that can be done that aren't money, including changing where that money's spent. So another thing that every health secretary always says is moving to prevention, which is you prevent people getting sick in the first place and that costs you much less money than having to treat them when they become sick. And the government, again, are trying to do that. I don't know how effective it's being, but, you know, that's one thing, that it actually saves you money rather than costing money, and if you can shift to things like preventing obesity, preventing severe heart disease, then that in the long run will save a lot of money. So the government are trying to do

[Luke Jones]

that, but in their efforts to try and meet those targets, Tom, would you say, looking at the data that you combed through, that actually the numbers aren't going in the right way for them or as quickly as they might like them to?

[Tom Calver]

Yeah, I think on so many different ways, the alarm bells are ringing at the moment and, you know, it's not Just the kind of the data that, like Ellie mentioned cancer, for example. But it's also things like A and E delays, for example, like you should be seen within four hours of being in A and E, and there's a sort of 95% target to be met in that time. At the moment it's about. About 74%, 75%. So a quarter of people are not being seen within four hours in ae, when it should be practically nobody. What I will say, though, from a sort of historical perspective, I think we have been here before. If you go back to the late 90s, early 2000s, NHS waiting lists were very, very high then. If you sort of look at whether people are satisfied with the nhs, obviously they're not happy now, but they also weren't happy in the late 90s, early 2000s. And the Labour government back then was able to turn things around. And yes, it took a lot of money, but it also took some of the things that Ellie's talking about, so proper investment, reorganization, so it can be done. And, you know, there are loads of examples around the world of, of countries with more efficient health systems. And I think, you know, in. In other ways as well. We can look at things like smoking rates, drinking rates, they. All these signs of the sort of general health of the population. While we're seeing some worrying trends in mental health, there are some physical signs which are improving. So I'm always cautious about being overly pessimistic with all this. I think history shows turn it round. It just seems very expensive at the moment to do so.

[Luke Jones]

Are we slightly expecting too much of the nhs? I think it was one of your pieces, Tom, that you quoted Nye Bevan saying at the foundation of the nhs, that just people would just never be happy with what was being provided, would always want a bit more. And we're at a state, Ellie, where actually it does so much. Is there any thought being put into. Well, maybe we need to step back from certain areas to actually make sure that we achieve what we need to on the key things.

[Ellen Hayward]

Yeah, it's tricky because on the one hand, if you are going to prevent people becoming sick, everyone agrees that kind of requires the NHS overreaching a bit, in that the NHS has to go into communities and address things like drinking and smoking and housing, because that's where prevention is, it's in people's homes. But then, you know that that really is like the national health state. If you've got the NHS interfering in all these other elements, slapping a Twix out of your hand.

[Tom Calver]

Just as you.

[Ellen Hayward]

So that slight overreaching is actually where the solution might lie. I mean, another aspect that I find interesting is treatment and hospital care and new drugs are getting more expensive. And I think that's one of the big challenges facing the NHS that someone needs to make a decision on. If you've got, you know, new drugs coming on board that cost hundreds of thousands of pounds sometimes should NHS patients be able to access them when that hundreds of thousands of pounds could be spent instead of treating one person with cancer, it could be spent on treating thousands of patients in a GP surgery. And those trade offs is something that the NHS is going to have to grapple with as care becomes more and more expensive.

[Luke Jones]

What is the one thing you'd advise West Streeting to do if you're in charge? Ellie or one of his advisors?

[Ellen Hayward]

Yeah, this debate of, like, whether money should be spent on staff or on upgrading equipment, upgrading hospitals is a bit of a chicken or egg question, because if all the money is going on pay rises for doctors and nurses, then you can't afford to buy new MRI scanners, you can't afford to, to build new operating theatres. But if you build the new operating theatres but you don't have the doctors to do the surgery, then you know, that doesn't work either. In general, I think people, we saw huge staffing shortages after Covid because so many people, nurses, doctors, were just burnt out and quit altogether. You know, with doctors, for example, they've been striking for three years, you know, so it's pretty damaging for efficiency and for waiting lists. I think one thing I'd say is that we kind of know what the answers are and some of them are quite simple. One thing that's frustrating me about words, treating and in general, I think he's doing quite a good job, is that he keeps commissioning these new reviews to kind of find out more about what the problems are. And each review has new recommendations, but those recommendations are the same as things that loads of other reviews over the past 10 years have found.

[Luke Jones]

At CC social care was one on gun on that level.

[Ellen Hayward]

Exactly. And there's a social care review going on, there's a big maternity investigation going on and I'm just, I just can't really see what these reviews are going to find that we don't already know. So maybe if he just got on with it a bit instead of, say, looking into where it's going wrong in maternity and social care, then that would be a bit of a quicker way to improve matters.

[Luke Jones]

That was Eleanor Haywood, Health editor at the Times. And we also heard from Tom Calver, data editor at the Times and the Sunday Times. That is about it from us today. The storyatthetimes.com is how to get in touch with us. The producers were Mikhaila Arneson and Callum Martin. The executive producer was Tim Walklate and sound design and theme composition was by Maula Satan. So I'm Luke Jones. See you soon.

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