In The Loop: the BIG Questions

In the latest In the Loop Podcast, Greater Manchester Mayor Andy Burnham reveals that the government has agreed to appoint a new Health Commissioner who will be jointly accountable to the Mayor and to the government for health and social care services. 
The Mayor said that the Commissioner would have dual accountability, as the ICB chair for NHS purposes and as a health commissioner to the combined Greater Manchester authority. 
“I'm really excited about that.” he says.  “Finally it feels to me we're getting close here to (an integrated) model of commissioning, priority setting and direction setting. The rest of the Greater Manchester system now is highly integrated, our other public service work as one, but the health service has become an outlier. That's been worrying us greatly and we think this might solve it.” 
In a wide ranging discussion with Niall and Roy, Andy Burnham says we will never know whether he could have won the Gorton and Denton byelection, but insists he would never asked to stand unless he thought he had a good chance, and he rejected the idea that if he had won, the Mayor role would have been at risk. Instead he suggests that if he had won the byelection that would have created a positive momentum for Labour in any Mayoral election.
Among many insights in the podcast, Andy reflects  on how he began to move away from the New Labour health  agenda while serving as a minister in the Blair administration in the mid-2000s. As for the current government, he commends them for starting to get a grip on the challenges facing the NHS but laments the delay in tackling social care. “How much longer can we keep flinching from that challenge? It’s got to be faced. There will no marked improvement until they grasp the nettle of social care reform.” 
There is also a frank assessment of the state of current services, in which he points to the vast number of older people trapped in hospital beds, to their and everyone else’s detriment. Andy’s father has dementia and he talks about his frustration at a care system which seems determined to dial 999 at every opportunity and send his father into A and E, when that is the last place where he should be going. 
But he is optimistic that his model of integrated services focussed on prevention can in time release resources and create a much more responsive community based set of services.  He claims his ‘LiveWell’ revolution in Greater Manchester will mean doing prevention in a way that has never been tried before, diverting significant resources into voluntary and community organisations and letting them be first port of call. In time he believes it will create services that keep people healthy and create wellbeing, transform health and social care and  take pressure of the NHS and other public services.

Have older people got it too easy? In their latest ‘In the Loop’ podcast, Niall and Roy have a fascinating exchange with Paul Farmer CBE, the leader of Age UK, Britian’s largest charity campaigning and providing services for older people.

 
Little more than a generation ago, pensioners were seen as among the poorest and most vulnerable groups; today the vast majority have never had it so good. Yet Paul argues that is a dangerous narrative which ignores the two million or so older people who either experience poor health, financial insecurity or loneliness. And he rejects the idea that this is just about deprivation, suggesting we have not faced up to the enormous challenge of living in an ageing society.  When challenged on the cost of the triple lock for pensioners, Paul says he  welcomes the debate about the future of the state pension, including the possibility of means testing. But he warns that successive governments’ record on means testing has been extremely poor.  

 
On social care another warning - because of chronic and persistent underfunding he suggests something terribly bad could easily happen and that solutions offered in the past will need to be revised given the parlous state of services today. Paul argues not only that social care needs significant extra funding but also a long-term view; the question is who is going to play for these reforms?    

 
As for the NHS, he points to fact that in the last year more than fifty thousand patients in their 80s ended up hospital corridors, and that we need to start looking at the health service through the lens of older people. He is challenged on how much of Age UK’s income actually goes to local branches that provide direct services, as opposed to lobbying and other national activities. Paul responds by saying they have begun to give more to local branches and have plans to do more.  Listen too to Niall and Roy’s reflections on this absorbing exchange with one of the most influential leaders advocating for older people in the UK.

Niall and Roy in conversation with Nicola Ranger, the General Secretary of the Royal College of Nursing
In the latest podcast, Niall and Roy delve into the besieged world of nursing with the leader of the world's largest nursing union, Nicola Ranger.
In a frank exchange, Nicola reflects on the recruitment and retention crisis, the fact that nurses spend too much time on pointless tasks, the unprecedented levels of low morale, and the possibility of strike action. And she says there is an urgent need to reform nurse education, including, in her personal view,  a national exam for every nurse wanting to join the register. 
This is a clarion call for reform within and beyond the profession, and a warning of an existential threat to the NHS if the government does not invest and start valuing nurses. 
This is an open, honest and thought‑provoking exchange — one well worth listening to.

The British Medical Association are never far away from the headlines but what is their real game? In their latest In the Loop podcast, Niall and Roy have an in depth discussion with Dr Tom Dolphin the BMA chair who leads one of the most powerful trade unions in the country, if not the most powerful.
In a revealing exchange Tom reflects on the growing militancy of doctors and their willingness to strike, as well as the changes affecting General Practice which for some GPs is making their lives less satisfying and more transactional. But he insists the partnership model, in which GPs run their own businesses, can survive if it is properly supported, in spite of many younger doctors choosing to take on salaried roles. 
Tom also doubts the value of revalidation, the system that requires doctors to show they are competent and up to date and he blames the NHS for making doctors undergo pointless statutory training as part of that process.  And he is deeply concerned at so called ‘doctor substitution’, whereby tasks once performed by doctors are being carried out by professionals with new roles such as Physician Assistants, and he reveals talks are underway with the Royal College of Nursing about the expanding roles of Clinical Nurse Specialists.  
As the seemingly existential duel with the UK government goes on, this is a chance to hear the leader of Britain’s doctors as he reflects on the battles ahead for the BMA, but also to hear his take on the wider and fundamental challenges facing the medical profession. Tom insists the BMA and the UK government are aligned in their ambition for the NHS, but there is little sign in this exchange that the union will back down. Indeed he issues a warning that if things don’t go their way, further strikes are possible from other doctors including consultants, the most senior doctors on the front line.

In the Loop – the BIG Questions 
Niall Dickson CBE and Roy Lilley with their latest guest David Gregson founder of BeeWell
 
To start 2026 Niall and Roy make a departure from their usual management and political interviews and explore the worrying state of our young people.  The awful reality that youngsters in the UK appear to be unhappier than nearly all their European counterparts. 
 
Their first guest of the New Year is David Gregson an entrepreneur and philanthropist has embarked on an ambitious and innovative programme called Beewell. Its aim is to improve the wellbeing of young people throughout the country, starting in Greater Manchester and a few other areas of England. Working with the Mayor Andy Burnham along with schools, local authorise and the NHS, the Beewell approach s already claiming to have made a significant impact, affecting the lives of thousands of school children. 
 
But can this programme, which demands action and a mind-shift from statutory and voluntary services, really be the catalyst to change the prospects of the next, generation? The current position is dire. In a fascinating exchange, David Gregson points to weaker family relationships, restrictions on child freedom, and the fact that adults often no longer understand the world in which their youngsters live. He applauds moves by the UK government to raise the profile of youngsters’ wellbeing and its support for idea of conducting surveys in every school but wants them to go further and faster.