HealthTech Hour · 2026-07-24 · 48 min
Key moments - from our scoring
Substance score
60 / 100
Five dimensions, 20 points each
Paul Gallagher brings two decades of healthcare journalism experience to examine whether the NHS can reform without compromising universal care. The discussion centers on concrete operational problems: a backlog of 7 million procedures waiting (up from 4.4 million pre-pandemic), with 25-30% of hospital beds occupied by medically-fit patients awaiting social care packages. Gallagher highlights the disconnect between NHS and social care systems, staff shortages exceeding 100,000 vacancies in England, and the ethical implications of recruiting healthcare workers from developing nations like Spain and Africa rather than training domestic staff. The conversation addresses how technology - smartwatches, pharmacy blood pressure checks, at-home health assessments - can shift care toward prevention, but reveals uptake challenges: the NHS Health Check reaches only 1-1.5 million of 15-20 million eligible people annually. Steve Roost of Pocdoc shares data showing an SMS intervention achieved 80% uptake for home-based health checks among serial non-responders. Gallagher examines the politically charged privatization debate, noting that roughly 7-10% of NHS services already run through private contracts, yet the fear of 'selling off the NHS' prevents substantive reform conversations. The episode explores why elected officials face accusations of wanting to 'privatize the NHS' whenever suggesting operational changes, even modest ones like charging for missed A&E visits - preventing the difficult policy discussions both speakers argue are necessary.
As of the pandemic's impact, waiting lists reached nearly 8 million procedures, down from a peak but still well above the pre-pandemic level of 4.4 million routine surgery procedures in England alone.
Approximately 25-30% of NHS beds are filled with medically-fit patients waiting for social care packages, contributing significantly to system delays and creating infection risks for elderly patients.
Uptake is limited by structural barriers - the program requires 2-3 in-person appointments during work hours for eligible people aged 40-74, many of whom are employed full-time; data shows single-touchpoint interventions (like pharmacy blood pressure checks or SMS-offered home assessments) achieve 4x higher uptake rates.
Approximately 7-10% of all NHS health services are delivered by private companies through trust outsourcing arrangements, though this reality is rarely discussed in public debate about privatization.
There are roughly 100,000+ unfilled vacancies across the NHS in England, a staffing shortage the system has historically tried to address through international recruitment rather than domestic training expansion.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains moderate insight density with several substantive points about NHS structural issues, funding models, and healthcare reform - particularly the discussion of bed-blocking (25-30% of beds), the comparison to European insurance models, and specific data on clinical trials for Alzheimer's. However, there is significant filler: lengthy introductions, commercial breaks, tangential anecdotes (Spanish nurses, wife's dentist visit), and repetitive circling back to the same problems without resolution. The host often validates rather than pushes deeper, and many claims lack supporting specifics.
1 in 3, 1 in 4 beds are filled with people who are medically fit to be discharged but there's nowhere, there's no package in the community
roughly 7 or 8% of all NHS health services are run by private companies
The episode treads familiar ground on NHS reform - the privatization debate, waiting lists, workforce shortages, and social care integration are well-worn topics in UK healthcare discourse. The comparison to Belgium and Japan systems offers some freshness, but the conversation lacks contrarian insight or first-principles thinking. The Alzheimer's clinical trials discussion is more novel but remains largely descriptive rather than offering original analytical frameworks or challenge to conventional thinking.
It's an idea that's got into the nation's head that privatization equals sell off
the problems across the NHS are enormous
Paul Gallagher is a credible, experienced healthcare journalist with 20 years of coverage and recent work on Alzheimer's policy (ADI report). He has written extensively for major publications (Times, Telegraph, Mirror) and brings genuine domain expertise. However, he is primarily a journalist and commentator rather than an operator who has actually run or reformed healthcare systems. His value is observational and analytical rather than from direct execution experience, which limits his caliber for a B2B audience seeking operator insight.
20 year veteran of healthcare journalism
I was a health correspondent for the iPaper for 10 years
The episode provides specific numbers in places: 4.4 million NHS waiting list pre-pandemic, 7-8 million post-pandemic, 4 million blood pressure checks annually, 20-30k pounds per year for Alzheimer's treatment, 2,000 midwives short, 40,000 nurses short, 50 million projected dementia cases globally by decade's end. However, many broader claims lack specificity: the 25-30% bed-blocking figure is cited but not sourced; the comparison of healthcare systems relies on anecdotal evidence (relative in Belgium); and policy solutions are discussed in abstractions rather than concrete examples.
going into the pandemic, the waiting list was already at 4.4 million
they delivered 4 million blood pressure checks in England
The host asks reasonable opening questions but rarely follows up with sharp pushback or challenge. When Gallagher makes claims - about the lack of NHS debate, the ineptitude of NHS leadership, the inevitability of tax increases - the host largely validates or agrees rather than testing the assertion. There are few moments of productive disagreement or intellectual friction. The host does occasionally ask clarifying questions (e.g., 'Why are they a fan of it?') but mostly allows the guest to monologue. The conversation meanders and repeats points rather than building argument linearly.
That's a good question
Yeah, I remember that
Computed from the transcript - who did the talking, and the words that came up most.
What would meaningful NHS reform actually look like - and why is it so difficult to discuss? In this episode of Health Tech Hour , Steve Roest speaks with veteran health journalist Paul Gallagher about the pressures facing the NHS, including waiting-list backlogs, workforce shortages, delayed hospital discharges, social-care gaps and the political sensitivity surrounding reform. Paul draws on two decades of healthcare reporting to examine why the NHS repeatedly falls into short-term crisis management, how public expectations compare with the amount the UK is willing to spend, and why discussions about restructuring are so often reduced to fears of privatisation. The conversation also explores the role technology can play in moving care from hospitals into communities, improving prevention and making services easier to access. Steve shares how a single SMS offering an at-home health check generated 80% uptake among previously unresponsive patients , illustrating how service design, not patient apathy, can determine engagement.
Transcribed and scored by The B2B Podcast Index.
Speaker A: Hi, this is Steve Roost and you're listening to HealthTech Hour on UK health radio. Each week we give you the best news, views and interviews from the health technology world. From CEOs and founders to entrepreneurs and clinicians, the companies and people that are shaping the future face of healthcare,
Speaker B: all
Speaker A: on the world's number one talk, Health Radio. Hello and welcome to this week's Health Tech Hour with me, Steve Roost. Each week we bring you the best news, views and interviews with the founders, clinicians, CEOs, leaders, investors and this week, journalists who are changing the face of healthcare in the UK and beyond. As regular listeners know, I am the CEO and co founder of a health tech business myself, which is called pocdoc. Pocdoc has developed a set of technology, including our, uh, flagship Health Heart Check, which enables you to give yourself the equivalent of the NHS health check at home within 10 minutes, wherever you are. If you want to have more information about that, please go to POCDOC Co. That's P O C D O C Co. And thank you to pocdoc for supporting the show. As always, thank you also to the amazing UK Health Radio for the live platform. We love, love, love being on UK Health Radio. There are some amazing presenters on the station. It's not just the Health Tech Hour, some incredible shows, so please check them out. Thank you. Also, if you are listening on demand on your podcast channel of choice, we get downloads now in over 50 countries every month. You could say that with the expanded World cup format of Health Tech Hour podcasts. If you are, if you're following the football. Um, and thank you. If you are watching this on our YouTube channel, which is HealthTech Hour, or on our, uh, Instagram channel, the HealthTech Hour, or my own Instagram, which is Eiverous. So thank you so much for being part of our journey and thank you to our guest today, Paul Gallagher, who is one of the leading journalists in the healthcare space in the UK, having been or is currently a sort of 20 year veteran of healthcare journalism. Um, that you told me that. So you can't blame me for. You can't blame me for outing you on that one. Including writing for the Times and the Telegraph and the Mirror. Um, he is also the lead writer on, um, the upcoming annual report of. For the Alzheimer's Disease, um, Association International Alzheimer's Disease International, um, which is focused on clinical trials this year. So, um, there's quite a lot to get into. But Paul, welcome to the show. Sorry for messing up that bit about the Alzheimer's.
Speaker B: No problem. At all.
Speaker A: Um, we don't edit anything in the show, so that will go out. So that's good to know. But apologies, good to get corrected. Um, so there's a lot to get into. You've been in this healthcare, you've been talking, writing, thinking about healthcare in the UK and beyond. Because I know that you've got connections into Japan, having spent time there. Where do you think we are in 20, 26 versus where potentially 20 years ago you thought we might be.
Speaker B: That's a good question. To kick off things off with. I mean, I covered healthcare. Um, I was a health correspondent for the iPaper for 10 years. So I saw a lot of changes within the nhs. Obviously the impact of the, the pandemic. Mhm. Um, which set things back, has set things back a long way compared, um, to where we were when I first started out covering health. Um, there has been huge issues within the NHS in particular for a long time. I think fundamentally one of the main problems in the UK is that for people in the uk, they generally want to pay us levels of taxation, but expect Scandinavian levels of public services back. And that's been a fundamental issue for quite a while. Um, there's a disconnect there in terms of people, what they pay into public services and what they expect to get back out. I mean, when we went into the pandemic, the NHS waiting list, which I've covered many, many times over the last.
Speaker A: Yeah. How many articles you reckon you've written on that?
Speaker B: A couple of hundred.
Speaker A: Really?
Speaker B: Yeah.
Speaker A: Wow.
Speaker B: I mean, going into the pandemic, the waiting list was already at 4.4 million for.
Speaker A: Is that across all four?
Speaker B: Routine surgery. Routine surgery. Um, that's just in England.
Speaker A: Right.
Speaker B: Um. And then obviously the pandemic came along and it skyrocketed up to well over 7 million, almost touching 8 million, um, procedures that people were waiting for and some people waiting for more than one procedure. So it relates to about 7 million patients. It's come down slightly, but that is at the heart of what we're seeing across the nhs, the backlogs. If there's a problem in one area within the NHS and not just the NHS within social care, because everything is so interconnected, it has a knock on effect everywhere else. So I'm sure you're well aware of all the problems that we have in social care as well at, uh, the minute.
Speaker A: It just feels like that whole area is so complicated and has been orphaned.
Speaker B: Yeah. And it's very much separate to the NHS as well. So, um, it's going to be fascinating to see what Andy Burnham does when he inevitably becomes prime minister in 10 days. However many times it is because he's obviously coming from Greater Manchester, which has had a reasonable amount of success with integrating the NHS and social care. So it's going to be fascinating to watch what he does on the national level.
Speaker A: Mhm.
Speaker B: Because a lot of people have been calling for a long time that the two do need to be integrated. I mean, at any one point within the NHS, there are something like 1 in 3, 1 in 4 beds are filled with people. A lot of people don't like the phrase bed blockers. People who are medically fit to be discharged. But there's nowhere, there's no package in the community because they're generally older people, people with comorbidities, lots of things wrong with them. Uh, there's no package available for them because of issues with social care. So essentially you've got 25 to 30, 33% of beds filled with people in hospitals who don't need to be there.
Speaker A: And about these, about these individuals, these patients who are in hospital, they have problems, they have conditions, they have that they're in hospital for good reasons, if that makes sense. What happens? Do they stay there indefinitely or like what is happening on the ground like that? You've discovered through the course of writing about this because, because 25 to 30 is a statistic. But that's uh, literally millions of people.
Speaker B: Yeah.
Speaker A: So are they just. Are they there indefinitely? They're there for three days, not four days. Like what are we talking about here?
Speaker B: Essentially they just delayed. They're there for, for longer than they need to be. Obviously in the past there have been issues with infections in, in hospitals, the mrsa, superbug, things like that. So the longer hospital, um, the more likely it is that you would. You're slightly more open to risk than
Speaker A: you would be, particularly if you're elderly.
Speaker B: Exactly, absolutely. But of course, before somebody, an elderly person can be discharged, they have to be. There are certain things that have to be put in place so they have to be discharged to somewhere where everybody knows they're going to be safe, if that's their own home. Have to be all kinds of risk assessments carried out, um, at, ah, the home by, um, a social care workforce team to make sure they don't just send them home, they trip on the rug, break their leg and they're back in hospital for six months. So assessments need to be made at home. Um, and it's.
Speaker A: And those assessments need to talk to the hospital team.
Speaker B: Yep, absolutely.
Speaker A: Which that's definitely non trivial. No, it sounds easy, but it isn't.
Speaker B: No, exactly. Everyone's rushed off their feet. Yeah.
Speaker A: Also, where does that report go? Who does that go to? Like what?
Speaker B: Well, this is an issue with, uh, continuity of care. I mean, one of the problems that I found over the years is that there's no. Often there's no one person, one medic in charge of that patient's, um, overall healthcare. There are as many as between anything upwards of 10 or 12, um, medics looking after the one patient, especially if they're elderly, especially if they've got more than one issue. So it's often slow, there are lots of delays within the system and everything just gets backed up. Um, there's been a staffing issue. I mean, staffing has been one of the main problems that the NHS has had for years. Uh, still around 100,000 vacancies across the NHS.
Speaker A: Yeah.
Speaker B: In England, we've slowly cottoned onto the fact that we need to train more staff. For too long, we've relied on hiring staff from overseas, not training enough people here. Um, and Brexit had an impact with that, with staffing levels as well. Um, I remember doing a story for The Independent over 10 years ago now where I was covering. I was at my local hospital in Bedford and there were 44 Spanish nurses starting on the same day. Wow. So I went down and did a piece talking to them about why they've come. And that's kind of an issue that never really gets discussed too much within the nhs, because for good reasons, the NHS is praised for its diverse diversity of its workforce. People from, I think the House of Commons library did, uh, a report saying how many countries are actually where you have people coming from to work in NHS? It's over 100.
Speaker A: Yeah, I would have said over 100,
Speaker B: um, have people represented within the NHS. But the ethical issue, which rarely gets spoken about, is when the NHS hires large numbers of staff from much poorer countries, because what does that do to those countries over there who are already struggling? We allow those countries from Africa or South Asia, wherever it may be, to spend all that money in hiring their staff, but then we go over and recruit them. I mean, the NHS has gone over and held recruitment fairs in Lisbon, in Spain, um, in other countries around the world to try and essentially poach staff to come and work here, because if we didn't, we'd have even more problems with, with vacancies and workforce. But you rarely. That's rarely a topic that's discussed out of interest.
Speaker A: Why From a journalistic perspective, is that not covered? Is it just not. It's. No one will publish it because it's kind of a no murder type concept.
Speaker B: It's possibly seen as more of a controversial issue because perhaps newsletters in the past have felt you open themselves up to accus of racism.
Speaker A: Yeah, that's going to be complicated.
Speaker B: British staff for British patients. Um, it's an easy. Yeah, you set yourself up for perhaps a bit of critics, unwanted criticism. So it's therefore easier not to. Not to. Interesting talk about that. But it's an issue that's been going on for, since, well, for decades now, um, as the population has surged, um, especially over the last 10, 15 years, as we've become a much more age older society, um, with, as I say, with many more people having comorbidities. We're not the fittest society in the world. I mean childhood obesity levels are extraordinary. Um, so generally a lot more people are needing help, um, within the NHS and we just don't have the staff numbers, um, available to look after them.
Speaker A: And how do you. Where does technology come into all of this? Because technology is often thrown around and I say this as a health tech entrepreneur and founder. Co founder. So I'm sort of slightly biased, but I'm being deliberately extreme for the sake of the conversation as the sort of quote unquote solution to everything.
Speaker B: Yeah.
Speaker A: So actually don't worry about the workforce issues because there's an app for that. I'm being very glib.
Speaker B: Yeah.
Speaker A: You know what I mean. But you see where I'm going.
Speaker B: Right? It has a massive role to play. I mean, especially as we move from what the rest treating. The former Health Secretary said was moving towards prevention over cure. His ethos was very much moving care into the community, getting people much more aware of their own state, of their own health, um, and of course preventing people from needing hospital care, um, in the first place. Moving it out of hospitals and into these, um, regional clinics, clinics within town centres, um, and technology now people have so much more access to their own health. You can, on your smartwatch you can see, check your blood pressure. I was told somebody at Apple recently the latest version of the AirPods are going to be able to monitor your heart rates.
Speaker A: Cool.
Speaker B: Um, as well.
Speaker A: Well, what, from your ears?
Speaker B: From your ears.
Speaker A: Oh, that's cool.
Speaker B: So there are huge advances and, um, I think it. But there's an individual responsibility there, isn't there? Because how many people you have the NHS free, um, the midlife health checks now where you can go in NHS Health Check. We can go and get your blood pressure done, but how many people actually take advantage of that?
Speaker A: So I do know the answer to that, actually.
Speaker B: Okay.
Speaker A: Yeah, I actually do know. So, um, so there are two programs which you're probably kind of referring to. One is very snappily titled the NHS England National Hypertension Case Finding Service. Rolls off the tongue and that's actually the ability that you have to go into a pharmacy and get your blood pressure checked.
Speaker B: Okay.
Speaker A: In any pharmacy. It's been a hugely successful national program. So massive credit to NHS England for doing this and all of the people in hypertension and CVD prevention and community pharmacy that delivered this in the last year on record. They, um, they test. I'm just going to try and get them. They, they delivered 4 million blood pressure checks in England.
Speaker B: Yeah.
Speaker A: So that's the scale of that, but that's just bp. And then the NHS Health Check, which is more of where Pocket comes in and our technology can help deliver the health check is your, um, includes your lipid markers, your overall risk score, your BMI and so on. That's about at a million 1 million to 1.5 per year.
Speaker B: Okay.
Speaker A: So. But out of an eligible population of more like 20 million. 15 to 20 million.
Speaker B: Yeah, yeah.
Speaker A: So those services, whilst being really well meaning, are really just scratching the surface.
Speaker B: Yeah. But they're fairly new. Reasonably new.
Speaker A: Hypertension has been around for about four or five years.
Speaker B: Okay.
Speaker A: Yeah. So and then NHS Health Check's been a lot around for a lot longer.
Speaker B: Yeah, yeah.
Speaker A: Um, yeah.
Speaker B: Which is quite surprising in a way, that they aren't. That therefore more people don't take advantage of that. And I think perhaps this is what, um, we'll come on to, perhaps talking about privatization issues and things like that. You know, is there an assumption that people, if they find out there's something wrong with them, it's going to have some kind of cost or lifestyle changes or it's, it's not just about finding out what's wrong with you, it's about making those changes. People generally know if they're in good shape or not.
Speaker A: I, I, you know, I don't, I don't know if that I completely, uh, uh, the way I think about these things is that there's no kind of silver bullet around. Like, it's definitely like this or it's definitely like that. It's just 70 million people in the UK.
Speaker B: Yeah.
Speaker A: Really wide range of backgrounds, ethnicities, locations, communities. It's all different things. The one thing that we've seen consistently at POC to be true is that there are definitely some people that don't care about their health. Like that's definitely true, but it's not as big as you think. So one of the things when we started Pock talk we were told was like, oh, people will either get their health checked or they won't. There's nothing you can do about it. You can't influence the numbers. They either care or they don't care. And I didn't believe that to be true. Um, I thought it was more around making sure that you could reach the right people at the right time in the right way and that's proven to be true. So it actually looks like it's more around finding the right way to reach people. In a really busy society, everyone's under lots of economic pressures. For example, like a really good use case is the NHS health check is from 40 to 74. Okay. So really the majority of that age range up to 65 is when people are working.
Speaker B: Yeah. Right.
Speaker A: So 40 to 65 people are generally in full time work of some kind or you know, some, some element of that's your work career before you retire. So um, but the, the kind of age range on the health check skews massively older. So actually it's really around the fact that when the health check, in order to get your health check you have to be able to available to go for two in person appointments, if not three in person appointments during work hours. That's going to be a massive blocker on uptake, just like straight out the gate. So I think that there's more to it uh, than just kind of than being simple. And one thing that we saw at POCDOC for example, is we worked with uh, a primary care network which is like a collection of GP surgeries, about 50,000 patients. And we said, look, why don't you send a single SMS to your serial non responders? So the people that hadn't responded to the letters inviting them to the health check for the last five or six years. So, and the primary care network in question was like, this won't work, they're not going to do it. We never hear from these people, they're just dead. They don't respond. So he sent them one SMS saying, you can come in, we're inviting you again to come in for your health check or you can click this link and have a healthy heart check sent to you at home and you can do it at home. We got 80% uptake off of a single SMS. And so our conclusion, uh, from that and other things was actually if it's the right intervention in the right way, there's a reason, for example, why there's four times as many blood pressure checks being done than the NHS health check is because you can go into any pharmacy on the high street and you can walk in and it takes 15 minutes and it's a single appointment. Like that seems a pretty clear data point to me. So before we get into the next step, I have to stop for a commercial break. So we are going to be right back with the next part of today's Health Tech Hour with my guest Paul Gallagher, who is one of the UK's leading writers and journalists in the area of health. We will be right back. Hello and welcome back to the second part of today's episode of the Health Tech Hour with my guest, Paul Gallagher. So, Paul, where do you stand as a writer, uh, having looked at the kind of arc of the development of the healthcare system around this issue of privatization? So privatization of the NHS comes up in every election, every single election, every week, in every newsroom, every single time any politician talks about the nhs. It seems to be a thing that they say, uh, that they're against.
Speaker B: Absolutely.
Speaker A: What are they against? What do you think they're against? What are they trying to communicate or what are people worried about?
Speaker B: It's an idea that's got into the nation's head that privatization equals sell off. The NHS is very much our sacred cow. It's what, 75 years old now, 76 years old now. This idea of universal free healthcare, free at the point of use. Um, and anybody who comes along and suggests so much as restructuring that or selling off little bits of that, you know, should be hung, drawn and quartered. It's. But I think what people don't know is that lots of parts of the NHS are privatised already. Um, lots of trusts outsource, um, blood services or other areas of the healthcare. I think it's. Last time I checked was roughly 7 or 8% of all NHS health services are, uh, uh, run by private companies. Right. Something like that. Um, maybe close to 10% now. But there's just been this wave of fear that anybody so much as suggests NHS reform and m. It's particularly aimed at the Conservatives.
Speaker A: Okay.
Speaker B: The Conservatives seem to be the ones. It's a common attack from the Labour Party that the Conservatives just simply want to sell it off, privatize the NHS to their rich friends. It's just been one of those political attacks that have been going on, um, for years. Um, I think people. People are afraid that if you introduce any kind of private health care reform, they will start having to pay for things, pay for a GP appointment or make some kind of contribution.
Speaker A: Right.
Speaker B: But of course, everybody, unless you are, um, reasons not to, everybody makes a contribution towards their medicine with the pharmacy charge.
Speaker A: Yep.
Speaker B: £9.90 now or something like that. So every. When they go to see their NHS dentist, you have to pay towards that, depending on what level of care you're having with the dentist. I mean, I just took my wife and two children dentist the other day and it was just a checkup and it was something like, um, best part of £100 for the four of us. So there is an element of being used to paying for health care here. But for whatever reason, there is an assumption that the Tories in particular are going to sell off the entire NHS and that standards are going to fall, standards are going to plummet and there will be no more free universal health care. And that's just a fear that's ingrained with millions of people around the country, I think.
Speaker A: Do you think the fear is. Is fundamentally that it doesn't. It stops being free at the point of use?
Speaker B: Yeah, absolutely.
Speaker A: And therefore, if you don't have some, if you're not paying for it, then you won't get it.
Speaker B: Yeah, I think so. I mean, uh. I, uh, think Jeremy Hunt, when he was Health secretary in the mid 2010s, suggested that something like one in three people, um, who turn up at A E don't need to be at A E. There are huge numbers of people who don't turn up for their GP appointment.
Speaker A: Yep.
Speaker B: Um, and that has a cost and this all adds up. And the NHS isn't awash with money, um, despite the fact that its budget is absolutely enormous.
Speaker A: 130 billion.
Speaker B: Yeah. I think it's something now. I think it's 40% of all public spending is Department of Health. Right. That's. That's. It's just enormous. Um, so goes back to what we're discussing earlier. Why does it have so many of these problems? But it's, um. It's. Nobody has worked out how you stop that, how you prevent people not turning up for their appointments under the current system, um, or how you stop people going to A and E. So I think Hunt floated the idea that, well, why don't we start charging people for that? And immediately he was shouted down as being this Tory he wanted to privatise.
Speaker A: Yeah, I remember that. And it. Yeah. And look, I mean, no fan of. I think universal healthcare for all is amazing. The thing that I dislike is the inability to have the people that we elect.
Speaker B: Yeah.
Speaker A: To have difficult discussions about things are hamstrung from having those difficult discussions because there are things that you're not even allowed to sort of talk about or debate.
Speaker B: Yeah, yeah.
Speaker A: Uh, that concerns me in any sector, not just health.
Speaker B: Yeah. But it's surprising because there, I mean, the problems across the NHS are enormous. I mean, I don't know when the last time you tried to get a GP appointment is, but certainly when I've m tried for myself and my family, you're lucky to get one within 10 days. Everybody knows how important continuity of care is and seeing the same gp, but I can't remember the last time I saw the same gp or anybody I know saw the same gp. Two appointments in a row spread apart for two different things. You see somebody different every time you see, um, the gp. Um, you wait months and months to get referred to, to asbestos if you need to. Um, these are huge problems, the structural problems that aren't going away. I mean, I wrote about the NHS winter crisis. Every single winter for 10 years we'd write about the NHS winter crisis and it's all short termism. So lo and behold, whoever was health sector at the time would inject X hundreds of millions of pounds extra over the winter just to see us through the winter. Um, but then you'd be back to square one, sort of the following autumn, depending on how bad the flu season was, for example. Um, and you're just going around in circles as well, um, with the level of care within the nhs. And now you've got to add to the fact that we've got this enormous backlog, um, of people waiting and we know that the longer somebody has to wait for their operation, the more likely it is they're going to get sicker and need a more serious operation, which is going to cost more. Um, but nobody's really talking about a fundamental reform of the system. I mean, there are lots of different healthcare systems across the world.
Speaker A: Yeah, let's talk about that. As I was going to say, so what, who are we aiming to be? Who are we comparing ourselves to?
Speaker B: So, I mean, we just want to compare ourselves to countries that have the best outcomes, I think.
Speaker A: Okay.
Speaker B: I don't think now, even if you had to start a new healthcare system from scratch, I'm not sure how many people would set up an NHS style system. Looking at the problems that we have, I imagine they'd set up Some much, uh, more of a European based system where everybody has a level of social health insurance. Um, I've got a relative in Belgium who's lived in Belgium now for more years than they have in England and they're a huge fan of that kind of system.
Speaker A: Why are they a fan of it?
Speaker B: Uh, because the level of healthcare coverage, the lack of delays when they want to see, um, the local doctor or if somebody needs an operation, there isn't that level of backlog.
Speaker A: And why is. But like this, it's a much smaller population.
Speaker B: I should have.
Speaker A: Annabelle, I think this is a really interesting. And I think this is one of the things that concerns me about the lack of ability to debate these different models, uh, in public, uh, or for the elected leaders to debate them with some safety, about not being pilloried in the press, uh, about being anti NHS and things like that, because it stifles things. So what is it about a social insurance model that helps reduce backlog? It's a genuine question. I don't actually know the answer.
Speaker B: No, I mean, from talking to Mark, uh, by the sounds of it, it just seems a better funding model.
Speaker A: Okay.
Speaker B: So that it just seems to be a cleaner reimbursement. Cleaner reimbursement model. Um, funds are spread much more evenly. There's no postcode lottery like we have here. I mean, I think people assume that with the NHS it's universal health care. It's the same level of health care all across the country. And that's completely not the case.
Speaker A: I mean, and that's even before you get into Scotland and Wales.
Speaker B: Yeah, I mean, just in England alone, like you say, you're twice as likely, you're twice as likely to die of a stroke in the rural parts of the country than you are in the city. Just because the length of time it'll take somebody to get to you by an ambulance. I mean, you mentioned about the rest of the uk. I mean, a few years ago I had an uncle in Belfast, a family in Belfast, who in the winter popped out at halftime for a football match, slipped on the snow, compound fracture of his leg. And the ambulance said, could you please get somebody to take you into the hospital because we don't have any available. This is Belfast.
Speaker A: Wow.
Speaker B: City of 1.2 or over a million people. Um, and it's disgusting. This is graceful. Um, and I don't know why people aren't more open to discussing. Well, it's partly because if you were going to change something, I had a conversation recently with, um, a very senior member, um, within the nhs. And I floated this idea. It was off the record.
Speaker A: No, don't say who it was.
Speaker B: And I asked this idea, why don't we have this. Even look at, have a Royal commission where you would look at changing the entire system from a current system to say, European style system or part private, part public, um, system. And their argument was, well, we could do that. We'd spend three years looking at all this and spend hundreds of millions of pounds on it and end up with the same system. Because the politicians aren't. No one's gonna drive through that level of reform.
Speaker A: Yeah, it's super tricky. Right. Because in some ways, in many, many, many ways, the NHS does this incredible job. Yeah. And I don't think there's anyone in the uk, well, maybe, I don't know, that would choose the US system.
Speaker B: No, the UK system. And that's also. But that's one of the problems. Everybody brings the US system up and says, if you go into question time or something like that and NHS reform comes up, you'll immediately get a handful of people in the audience saying, we don't want to become the us. But, but nobody suggesting, has ever suggested moving to a US style system. I spent a couple of years in Japan, I used to live in Japan. They have a different system themselves where pretty much everybody spends whatever procedure you have. If it's just a general appointment with the GP or a major, uh, cancer, uh, surgery, you contribute roughly 30%. Mhm. To everything. And that country we mentioned, Belgium's much smaller than the uk. Japan is twice the size in population terms of the uk.
Speaker A: Okay.
Speaker B: And their health care outcomes are much stronger than ours.
Speaker A: Um, and what about people on low? In low or.
Speaker B: No, there is, there is, um, an insurance model as well. Yeah, exactly. A basic level of healthcare. But by and large, everybody in Japan makes a certain amount of contribution to their health care. And again, um, you don't. You walk into Japan and if you see the hospitals there, they're generally a lot better condition, um, than ours. We can talk about some of the state of the hospitals which we've covered. The capital backlog, the capital spend, the amount of money the NHS needs to improve the level of hospitals is something like it's gone up, goes up every year. It's about 15 billion pounds that the NHS now needs, which is what, 12, 15% of its budget just to repair the hospitals to the standard they should be. Everyone's scrambling around for cash, um, for staff.
Speaker A: How do we. So, I mean, how do we go for. Because it seems it does. When you put, when you portray it like that, it does seem somewhat insurmountable. So what's, how do we make current system? How do we make it?
Speaker B: Burnham's coming in now and the first thing, the first line of attack against him is that he was a left of the Labor Party. He's going to raise taxes. And you think a lot of people, if the, if it was spent wisely, the tax, very few people would say, look, we're gonna, this is the level of, uh, we're something like 15th of 16th of OECD countries in terms of cancer outcomes.
Speaker A: Okay.
Speaker B: Which is pretty poor given we're the sixth richest country in the world. If you could say, look, I'm gonna raise taxes by this amount and spend it on building X number of hospitals, improving our level of cancer care, hiring 20,000 more surgeons, midwives, um, he perhaps would get a lot of support for that. But it's just, it's one of those frequent attack lines where, no, he's going to raise our taxes, he's going to take our money and in the current climate where everything has become much more expensive, the cost of living crisis that we live in, it's an impossible job.
Speaker A: Can they actually, as a slight aside, are they actually able to ring fence tax like that?
Speaker B: National insurance is effectively a ring fence tax for, for health.
Speaker A: Is it?
Speaker B: Yeah.
Speaker A: Okay.
Speaker B: I mean, Norman Baker, when he was a health minister, advocated a hypothecated tax outside of that. So raising the level of tax by 1% and saying that's just for, um, the NHS and the Department of Health. But again, 40p in every pound of taxpayers money is currently spent, um, towards the Department of Health. Ah. And NHS England. So you could keep on raising taxes.
Speaker A: To your point earlier though, about the British people wanting subconsciously a kind of Scandinavian quality, but pay us tax for it. How much? What's the difference between tax rates in the UK and Scandinavian countries? Like, what's the difference we're talking about?
Speaker B: Oh, I think if you're on sort of, um, our, uh, lower bracket of 20, 25%, I think it's equivalent. I mean, people in Scandinavian countries would pay well above 40, 45% if you're on an average income.
Speaker A: So it's significantly higher.
Speaker B: Significantly higher. Yeah. Yeah, it is.
Speaker A: Wow.
Speaker B: Um, but they have significantly better public health services. I mean, you look at sort of these annual surveys that are done about who are the happiest people on earth, it's inevitably the Norwegians or the Swedes or the Finns always tend to come up on top. And because health is so interconnected to everything, uh, health and well being, mental and physical health. And there's no great surprise that they are.
Speaker A: And what role does the media have in driving this debate or the honesty around this debate or sort of. Because the media can often be driving this short termism.
Speaker B: Yep, absolutely.
Speaker A: Particularly at, ah, a political level.
Speaker B: Absolutely, yeah. It's kind of that circle where the politicians are responding to the 247 news agenda and the media simply putting newspapers out, broadcasts out every day. So they're responding to what the politicians are saying. So there isn't, there's a lot. A lack of long termism in the media as well. And of course bad news is good news.
Speaker A: Yep.
Speaker B: For the media. Um, you only have to look at what's gone on with the latest maternity scandal in Nottingham. I mean, I started as health correspondent writing about the fallout of what was going on in Morecambe Bay M and the maternity scandal there. Then we had East Kent and the maternity scandal there and then we had that, moved on to Shropshire. Now we've got Nottingham. There's a lack of learning within the NHS itself. I mean that, that report, it was heartbreaking to read. It was scandalous. No one's named, so there's no. Is there a level of accountability that we're missing here? Uh, no one's named in that report.
Speaker A: Is that right?
Speaker B: Yeah.
Speaker A: Were they named in the other reports?
Speaker B: You know, um, I don't recall anybody, certainly not off the top of my head, whether there was any of the senior managers that were directly responsible for the poor care were named. But that's generally been the case with, with NHS reports. It takes a long time. Inevitably you read one of these reports and there'll be a new chief exec will have come in by the time that they realize they're under investigation. Because of course these investigations can take quite a long time, um, to complete. And the standard response is, well, we've moved on, lessons have been learned, um, but they clearly haven't at the national level. Because why have we had four major maternity scandals in the last 12, 13 years if lessons are being learned, but they're not?
Speaker A: Yeah, I don't have a solution to that.
Speaker B: Yeah, it's the nhs. One of the problems is it's, it's been, there's been a, it's terrible about opening up when there is a major scandal and with, you know, add mid
Speaker A: staffs to that and do you. Sorry, you're saying that from your perspective as a journalist, when you've been Covering these stories. Yeah, Trying to get them to open up has been difficult.
Speaker B: Well, most of these stories, a lot of these stories have come about because of journalists finding out there's been really, really poor health care, especially with Nottingham. A lot of great work was done by, um, the Sunday Times in terms of highlighting the problems. And it's often a last resort. These families are going through complete heartbreak and they want an internal report to be carried out into the death of their baby. Um, but it doesn't happen. So they often go to the press as a last resort. And so the press writes the stories about these issues and then somebody, um, a politician says, right, this is, you
Speaker A: know, the local mp, for example.
Speaker B: Mp, raise it with the Health Secretary. If the Health Secretary looks at it and says it's bad enough for a, um, serious investigation, independent investigation, like the ones we've seen recently that I named just there, that will happen. But people just want. Whenever there's big scandal, they want those lessons to be learned, not just within the regional trust, they want them to be learned nationwide. And I think that's part of the problem, especially maternity, which. There's this national review going on that west street and commissioned, um, a few months ago, which is yet to report back. Um, and it is difficult to see why these lessons aren't being learned and why those overall level of care, not just with maternity, but with social care that we've mentioned already, these improvements that people want to see aren't, um. M. Coming through.
Speaker A: Yeah, I don't know why not. I mean, I think it's one of the. It's a. And it's not just in maternity. I think it's one of the big questions about how to. How. How can the NHS continue to improve.
Speaker B: Yeah. And it comes back to funding, which is what we started talking about, you know, whether or not this funding model that it has at the minute is. Is that enough that it just comes through general taxation, or is there a new model that we need?
Speaker A: Because, you know what's interesting? And again, I'm not an expert on those cases, those really tragic cases, so, um, I guess I'm talking more generally, and this is an impression that I had, so it's highly subjective. So considered what I'm about to say, heavily caveated. Um, there doesn't seem to be, in those reports and reporting and the statements about those incidents, a real open admission, which is that we just don't have the right resource levels. We. We just don't have. We used to have this many staff.
Speaker B: Yeah.
Speaker A: And we just don't have that stuff. It always seems to be about the, the, the training or the we should have done this and we should have done that. Which could also be true. Yeah, but if you had more staff.
Speaker B: Yeah.
Speaker A: More better staff. I don't know. There might, that might be. It doesn't ever. It almost seems to be like the resource issue, which is a money issue and a training issue. Just seems to be a bit like a bit of a white elephant here or a bit of a kind of no go zone.
Speaker B: I think generally when you dig into the reports, it's generally a, of the two, it's the lack of resources, but then it's also the personnel issues. Because with the Nottingham case, there was one particular part of that report which stood out, which was whenever there was a particular difficult, um, pregnancy, a lot of the senior midwives would think it was a bit of a laugh to put the really newly qualified midwives in charge of that lady's health, um, care. I mean these extraordinary cases that came up time and time again within the, the Ockham.
Speaker A: That's cultural.
Speaker B: Yeah, exactly, yeah. Because it went on for that length of time. It's a cult, it's a cultural issue. Um, but there is a shortage of midwives, roughly two, with roughly 2,000 short. Yeah, 40, 000 nurses short across England.
Speaker A: Um, that's going to have an impact.
Speaker B: And it was only towards the end of Rishi Sunak's time that we, he put to his government, put together a long term workforce plan which looked at the next five, 10 years, how many extra doctors, nurses.
Speaker A: But that's how you have to, that's how long you have to think.
Speaker B: Yeah. And it didn't go. It hadn't happened for so long. It was him, he put it in place. But that's what, three or four years now? So like with anything within healthcare and nhs, it's going to take time to kick in.
Speaker A: Yeah. So let's, we have to go for our final commercial break and then after we come back, I want to talk about your work with the Alzheimer's in, in the Alzheimer's area. So I think it's uh, well, it's gaining ever more traction in the media, quite rightly, along with its sort of, I guess, Sister mnd, you know, there's getting more and more high profile cases, more and more investment into drugs and to treatment, um, more and more highlighting of what we don't know. Um, so we will be right back with the final part of this week's Health Tech Hour with my guest Paul Gallagher, um, who's one of the leading healthcare writers in the uk. Hello and welcome back to the final part of this week's Health Tech Hour with me, Steve Roost and my guest today, Paul Gallagher, who's one of the UK's leading writers around health and healthcare. So what was your journey like into the area of Alzheimer's? Because I know that you're deep into, well, very close to publishing a, ah, really exciting seminal document report.
Speaker B: Yeah, it was really interesting actually. So I'd been health correspondent at the I paper for 10 years and then like all newspapers, um, around the country, we've been feeling the squeeze in recent years with sales and income and so there were a level of redundancies that were made last, um, year. And I was one of a number of senior staff that, um, decided to leave, um, the Eye, and fortuitously I was offered this role with Alzheimer's Disease International, just, um, towards the end of my time at the Eye, um, to write their annual report, um, for Alzheimer's Disease International. They produce one every year, usually internally, but occasionally in the past they've got a health journalist on board. And so I've been spending the last six, seven months talking to, um, scientists, researchers, clinical trials participants all over the world. Because the focus of this year's report is on clinical trials in Alzheimer's disease, um, and other forms of, of dementia. And it's been a fascinating process because the, I think the longest article I ever wrote in the newspaper was something like two and a half, 3,000 words, whereas this is going to be 130,000 words, but 150 page, um, report. And like with any area of international health care, there's imbalances, um, but with Alzheimer's in particular. I mean, the one, um, interview I did which really stuck in the mind recently was one scientist based here in the uk, but also works in the us, called it a pandemic. Oh, that's interesting because of the level of, not only the level of, um, unmet need for patients who are already been diagnosed with Alzheimer's, but also the number of people who will inevitably get a diagnosis in the coming years.
Speaker A: What's the incident rate? What do we think is currently tracking at?
Speaker B: So it's over a million people have been diagnosed with Alzheimer's in the UK. Globally, it's something like 50 million, or it's projected to be 50 million towards the end of this decade. Wow. Um, and it's only going to go
Speaker A: up because, of course, we're aging.
Speaker B: We're aging for an aging, uh, World and countries across Africa and South Asia are aging at a faster rate now than us. And so the instance over there is going to be a lot higher, um, in the coming years. Um, and what I found specifically is that there are only sort of a handful of areas in the world where those clinical trials are taking place. And that itself is quite a big issue, because Alzheimer's disease is incredibly complex. I mean, there's still no consensus exactly what causes Alzheimer's disease.
Speaker A: Is that right?
Speaker B: There are issues with, um, the two main proteins that are believed to be largely responsible, Amyloid beta and taurus, um, but whether they're solely responsible or they are a cause of the disease and not a, um, symptom is still an ongoing debate, really. And there's a big breakthrough a couple of years ago when we had these drugs, new drugs that came onto the market, Lecanemab and Donanemab.
Speaker A: Uh-huh.
Speaker B: And the big conference in San Francisco which announced this. They were the first ever disease modifying therapies for Alzheimer's disease. They were the first ever drugs which were proven to slow down the progress, um, of the disease. And so you'd been looking at sort of 30 years of failures, although scientists don't like to call it failures, because every time you have a clinical trial which doesn't perhaps prove its hypothesis, you learn something.
Speaker A: You do. Yeah.
Speaker B: But these drugs were shown to have an effect, but only if you got those drugs to the patients quick enough and early enough into their, um, Alzheimer's journey.
Speaker A: Okay, how early?
Speaker B: Uh, roughly mild cognitive impairment.
Speaker A: Oh, really?
Speaker B: Really? Yeah, exactly. Wow. And so one of the central issues, of course, is the delays in getting a diagnosis, because it's still seen, even in countries like the uk, as a natural part of aging, even amongst the medical community. That's one of the biggest frustrations that the scientists and researchers have that I've spoken to is that you just have this level of not only a stigma because it's very, very difficult for somebody to come out and admit once they've got a diagnosis that they have it because people are worried about the reaction that others have. We saw that in Jon Snow, who was recently diagnosed, who, um, recently announced his diagnosis, but he'd had it for a few years prior. Um, but there's a problem with actually getting treatments in the first place. Um, so people either not being diagnosed or they're being diagnosed too late for any of these treatments to have an effect. And of course, with those two drugs in particular, they got a license in the uk, but because of their expense and because there was an issue with side effects, they were not given, um, the green light for use on the nhs.
Speaker A: That was it, was it, I think, hit the news. There was a big. Wasn't there. There was a big hoo ha about that one. Because it got, um, regulatory approval.
Speaker B: That's right.
Speaker A: But it wasn't accepted by Nice.
Speaker B: That's right.
Speaker A: The NHSdog to be reimbursed under the NHS.
Speaker B: That's right, yeah.
Speaker A: But other countries did.
Speaker B: Yeah.
Speaker A: Which created this. It was a very tense media moment for the healthcare system.
Speaker B: That's right, yeah. That was, that was quite controversial because it has a minimal effect. I think something like a year's treatment is 20, 30,000 pounds. And, um, because it's so difficult to get it done, to get an Alzheimer's diagnosis here in the uk, you'd have a PET scan or a lumbar puncture.
Speaker A: Oh, wow.
Speaker B: Although now we're seeing the dawn of blood based biomarkers which hopefully will improve
Speaker A: kind of the liquid biopsy.
Speaker B: Exactly, yeah. Make it easier for people to get diagnosis. But at the minute that's kind of the gold standard of getting a diagnosis.
Speaker A: And I bet it's not quick to end up in a PET scan.
Speaker B: No, exactly.
Speaker A: There's probably quite a few steps you have to go through.
Speaker B: Yeah, very much so. Um, so there are all these kind of issues which we're trying to bring in, um, to adi's report this year and ultimately we want to come up with a number of recommendations to, um, to improve, um, those clinical trials, not just in the UK but, but worldwide as well.
Speaker A: And what are the, you said before the show, without wishing to kind of give too much away, there's some really exciting things and there's still some really challenging things in this space.
Speaker B: Yeah, absolutely. I mean there's just a conference, um, Alzheimer's Association International Conference going on in London as we speak right now. So we've got the world's leading experts here discussing that, hopefully making some announcements today and tomorrow about new drugs that are about to come on the scene. I think because we've seen in oncology once there is that initial breakthrough of cancer treatments that you kind of see a snowball effect and that's what a lot of people are expecting and hoping to see with Alzheimer's over the next, um, few years. Ultimately, from my conversations, the thinking is that the treatments, you're not just gonna have a single treatment for Alzheimer's, you're probably going to have something that's targeting more than one issue within, within the brain.
Speaker A: Right.
Speaker B: Um, it'll be a combination of treatments, personalised medicine, um, because Alzheimer's affects different people depending on their backgrounds, um, sex, um, ethnicity, um, as well.
Speaker A: And do they know why those differences occur or they've just observed that there
Speaker B: are differences they've observed. So it could partly be the genetic makeup. If some people have got two copies of this gene, the APOE4 gene, they're much more likely, um, in fact pretty much guaranteed to get Alzheimer's at some point during their lifetime. Some people just have one copy, some people won't have the any of copies. So it's a genetic makeup as well. Um, but anything involving the brain, hugely complex. And so there's all this research going on around the world. It's a fascinating time and lots of great research going on. Um, and it's only become going to become more important with the number of people who are going to develop Alzheimer's in the coming years.
Speaker A: Yeah, I think it's going to be, it sounds like to me it's going to be one of the really hot areas to solve for. Um, and so do you. It sounds like you get a lot of personal value from being involved in that.
Speaker B: Yeah, absolutely. It's been a real challenge. As I said, it's on a scale of writing that I've never done before. It's quite different to um, what I've been used to. But it's been fascinating to really get into that level of detail with such an important issue because you rarely meet somebody who hasn't been affected by Alzheimer's, a relative or a friend, um, who's had it and then once you talk to them about it, there's a huge amount of frustration that the level of support, treatment or delays it took to get them a diagnosis or they might not, might not have been given any kind of post diagnostic care, um, as well. And there's a sense of. For so long there's been a sense of hopelessness. It's been a case of uh, that's the one disease that nobody wants to get because of a lack of treatment and a lack of care, lack of awareness. But that thankfully is starting to change slowly but surely. And hopefully now that we've had this initial breakthrough there'll be a lot more investment, um, a lot more pharmaceutical companies putting a lot more effort into producing new treatments now that we know we can make a difference, hopefully we'll start to see that in the years ahead.
Speaker A: Great. Well look, um, Paul, that's the end of the show, but thank you so much for coming on thank you.
Speaker B: Great to be here.
Speaker A: Thank you very much to everyone listening. And we will be back again next week with another show. Thank you.
Why Outpatients Should End | Tom Whicher, CEO of DrDoctor82 / 100
How Remote GPs Could Save the NHS | Julian Titz, CEO of Asterix Health63 / 100
Navigating the US Healthcare System for UK Founders with Demi Radeva, CEO of Across62 / 100
Tackling Health Inequalities with Data and Innovation with Sam Fay, CEO of SISU Health67 / 100
From the NHS App to Eight-Figure Exit - Rachel Murphy on Building What Lasts