New-found freedom allows former health secretary Sajid Javid to talk honestly about NHS big picture

Published

3 years ago

December 15, 2022

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A politician for 12 years, in government for nine, and a secretary of state across six different departments, Sajid Javid has been at the top of the political tree in the UK for the best part of a decade, serving as our chancellor, home secretary and health secretary.

He knows a lot about government and a lot about what’s really going on behind closed doors – a seasoned political operator, he also knows how to dodge a question in an interview and when to toe the party line.

But now that he’s decided to quit politics in 2024, he used our conversation in Beth Rigby Interviews to do something quite different: speak honestly about the NHS and how he thinks it needs to change.

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When he was appointed health secretary in June 2021, no-one envied the job. He was tasked with trying to clear the NHS backlog that had ballooned during the COVID crisis.

When Mr Sajid took up the post, the waiting list was 5.3 million. It is now 7.2 million, and this former health secretary tells me that he thinks it will continue to go up for a while before it comes down.

But what the ex-minister wanted to use our interview for was to talk not about the immediate NHS pressures but the bigger picture.

He told me that he “doesn’t think the NHS will survive many more years” in its current form unless there is fundamental reform, and said we cannot pretend that the current system is providing good healthcare for people when “everyone is queueing for everything”, from a doctor’s appointment to an ambulance or hospital bed.

“Having worked up close now with the health service, I don’t think the model of the NHS that was set up some 70 years ago is sustainable for the future,” he said.

“You know that the world has changed and the NHS has not moved with that. Even before the pandemic, it was moving in that direction.

“And because of the change in demography, people are living longer, therefore needing more health care, and social care for that matter, new medicines. And everyone rightly wants to get access to new medicines and treatments and also the changing burden of disease.

“You know, we have a lot more obese people today, we have a lot more problems with addiction. So the NHS needs to change… we need an honest debate about the future of the NHS.”

‘Keeping the show on the road’

Mr Javid told me that this debate is being stymied by politics, as politicians with skin in the game are unable to talk about the challenges of the NHS without it being used as an attack by their opponents.

He pointed to the recent furore in Scotland, where reports of discussions around asking the wealthy to pay for treatment provoked a furious backlash and were shut down before they even began.

But he, alongside some others on the backbenchers such as David Davis, wants to use his newfound freedom to open the discussion about how to fund the NHS while maintaining the principle of it being universal and free at the point of use.

Because the question of fundamental reform is a big and urgent one. The NHS now accounts for just over 40% of government spending but is struggling to meet demand, despite record levels of funding.

In the autumn statement, the government announced £6bn of extra funding over the next two years, but nearly all of this will be eaten up by costs of inflation and growing demand, with £800m left for improvement of services, according to Nuffield Trust analysis shared with Sky News.

Matthew Taylor, chief executive of the NHS Confederation, said the new money allocated in November wouldn’t do much more than allow the NHS to “just about keep the show on the road”.

Mr Javid didn’t want to be drawn on what sort of funding model he would recommend, but said it was time to look at the German and French systems to see how fellow Europeans do it.

“They seem to be doing better than we are at the moment, so we have got to ask ourselves how they managed to do that,” he said.

“And they are mostly funded by the taxpayer, but they also have some different models.”

In Germany, there is a dual public-private system in which healthcare is funded by statutory contributions, with the additional option of taking out private health insurance to replace or top up state cover.

France, meanwhile, runs a statutory health insurance system, providing universal coverage for residents financed from four sources:

• Citizens pay obligatory health contributions levied on earned income, paid by employers, employees and the self-employed
• Contributions levied on unearned income
• Central government funding
• And users typically have to pay a small fraction of the cost of treatment they receive

Grasping the nettle on the NHS is, admits Mr Javid at the end of our interview, his unfinished business in politics.

“I would have in a way liked to have more time to look at reform and have that honest debate,” he told me.

But the political reality means that sort of debate is unlikely to happen this side of a general election.

Neither the Conservatives or Labour will want to risk doing anything that might be perceived in any way as creating a two-tier health service or threatening the principle of having an NHS that is free at the point of use.

For Labour, a party always trusted with the NHS, it is a boat Sir Keir Starmer will not want to rock, with Labour insiders telling me there is no way the leadership will open up any discussion about how the NHS funding model might change.

Instead, the shadow health secretary Wes Streeting will focus on how to better organise the NHS and shift attention towards preventive medicine and treatment.

As for Rishi Sunak, he hasn’t the bandwidth to be bold on fundamental reform as he struggles to keep his party even in the race for 2024.

‘Very bad period for country’

Even Mr Javid, perhaps more candid now he is out of cabinet, admitted the “odds are stacked against us” going into the 2024 and that the Liz Truss’s premiership “was a very bad period for our country”.

The former minister, who backed Ms Truss in the summer leadership campaign, said it was “obvious from the start, really, that she wasn’t going to be up for the job”.

Mr Javid told me that her decisions to side-line independent fiscal watchdog the Office of Budget Responsibility was “completely wrong”, as was the fighting with the Bank Of England and Ms Truss’s decision to fire the head of the Treasury as soon as she became prime minister.

“That was before the mini-budget and I think it got worse and worse at that point,” he added. “So I think it is something that was a very bad period for the country.”

A bad period, a bumpy 2023 ahead and a “tough battle” in the 2024 election, this former leading politician has decided it’s time to pursue a career outside politics once more.

He certainly won’t be the last big name Conservative to do so as the party eyes the opposition benches.

World

Why hastily declared ceasefires tend to be fragile

Published

6 hours ago

June 24, 2025

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Why hastily declared ceasefires tend to be fragile

Ceasefires that are suddenly declared tend to be pretty fragile.

Stable ceasefires usually require a lot of preparation so that everyone on both sides knows what is supposed to happen, and – more importantly – when.

And they normally agree on how it will be monitored so one side cannot seize a quick advantage by breaking it suddenly.

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Without such preparations, and sometimes even with them, ceasefires will tend to be breached – perhaps by accident, perhaps because one side does not exercise full control over its own forces, perhaps as a result of false alarms, or even because a third party – a guerrilla group or a militia, say – choose that moment to launch an attack of their own.

The important question is whether a ceasefire breach is just random and unfortunate, or else deliberate and systemic – where someone is actively trying to break it.

Either way, ceasefires have to be politically reinforced all the time if they are to hold.

All sides may need to rededicate themselves to it at regular intervals, mainly because, as genuine enemies, they won’t trust each other and will remain naturally suspicious at every twitch and utterance from the other side.

This is where an external power like the United States plays a critical part.

If enemies like Israel and Iran naturally distrust each other and need little incentive to “hit back” in some way at every provocation, it will take US pressure to make them abide by a ceasefire that may be breaking down.

Appeals to good nature are hardly relevant in this respect. An external arbiter has to make the continuance of a ceasefire a matter of hard national interest to both sides.

And that often requires as much bullying as persuasion. It may be true that “blessed are the peacemakers”.

World

Five key takeaways from Volodymyr Zelenskyy’s interview with Sky News

Published

6 hours ago

June 24, 2025

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Five key takeaways from Volodymyr Zelenskyy's interview with Sky News

Volodymyr Zelenskyy has given a wide-ranging interview to Sky News in which he was asked about the prospect of Russia attacking NATO, whether he would cede land as part of a peace deal and how to force Vladimir Putin to the negotiating table.

The Ukrainian president spoke to chief presenter Mark Austin.

Here are the five key takeaways from their discussion.

NATO ‘at risk of attack’

Mr Zelenskyy said plans for NATO members to increase defence spending to 5% of GDP by 2035 are “very slow” and warned Russia could attack a NATO country within five years to test the alliance.

“We believe that, starting from 2030, Putin can have significantly greater capabilities,” he said. “Today, Ukraine is holding him up, he has no time to drill the army.”

But while Mr Zelenskyy conceded his ambition to join NATO “isn’t possible now”, he asserted long term “NATO needs Ukrainians”.

US support ‘may be reduced’

Asked about his views on the Israel-Iran conflict, and the impact of a wider Middle East war on Ukraine, Mr Zelenskyy accepted the “political focus is changing”.

“This means that aid from partners, above all from the United States, may be reduced,” he said.

“He [Putin] will increase strikes against us to use this opportunity, to use the fact that America’s focus is changing over to the Middle East.”

On the subject of Mr Putin’s close relationship with Iran, which has supplied Russia with attack drones, Mr Zelenskyy said: “The Russians will feel the advantage on the battlefield and it will be difficult for us.”

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Trump and Putin ‘will never be friends’

Mr Zelenskyy was sceptical about Mr Putin’s relationship with Donald Trump.

“I truly don’t know what relationship Trump has with Putin… but I am confident that President Trump understands that Ukrainians are allies to America, and the real existential enemy of America is Russia.

“They may be short-term partners, but they will never be friends.”

On his relationship with Mr Trump, Mr Zelenskyy was asked about whether he felt bullied by the US president during their spat in the Oval Office.

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“I believe I conducted myself honestly. I really wanted America to be a strong partner… and to be honest, I was counting on that,” he said.

In a sign of potential frustration, the Ukrainian president added: “Indeed, there were things that don’t bring us closer to ending the war. There were some media… standing around us… talking about some small things like my suit. It’s not the main thing.”

Putin and peace talks

Mr Zelenskyy was clear he supported both a ceasefire and peace talks, adding that he would enter negotiations to understand “if real compromises are possible and if there is a real way to end the war”.

But he avoided directly saying whether he would be willing to surrender four annexed regions of Ukraine, as part of any peace deal.

“I don’t believe that he [Putin] is interested in these four regions. He wants to occupy Ukraine. Putin wants more,” he said.

“Putin is counting on a slow occupation of Ukraine, the reduction in European support and America standing back from this war completely… plus the removal of sanctions.

“But I think the strategy should be as follows: Pressure on Putin with political sanctions, with long-range weapons… to force him to the negotiating table.”

Russia ‘using UK tech for missiles’

On Monday, Mr Zelenskyy met Sir Keir Starmer and agreed to share battlefield technology, boosting Ukraine’s drone production, which Mr Zelenskyy described as a “strong step forward”.

But he also spoke about the failure to limit Russia’s access to crucial technology being used in military hardware.

He said “components for missiles and drones” from countries “including the UK” were being used by Russian companies who were not subject to sanctions.

“It is vitally important for us, and we’re handing these lists [of Russian companies] over to our partners and asking them to apply sanctions. Otherwise, the Russians will have missiles,” he added.

World

At least 25 people killed after Israeli forces open fire near aid trucks in Gaza, witnesses say

Published

6 hours ago

June 24, 2025

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At least 25 people killed after Israeli forces open fire near aid trucks in Gaza, witnesses say

At least 25 people have been killed after Israeli forces opened fire towards people waiting for aid trucks in Gaza, according to witnesses and hospitals.

The Awda hospital in the Nuseirat refugee camp, which received the victims, said the Palestinians were waiting for the trucks on a road south of Wadi Gaza.

Witnesses told the Associated Press (AP) news agency Israeli forces opened fire as people were advancing to be close to the approaching trucks.

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The Awda hospital said another 146 Palestinians were wounded. Among them were 62 in a critical condition, who were transferred to other hospitals in central Gaza, it added.

In the central town of Deir al-Balah, the Al Aqsa Martyrs hospital said it received the bodies of six people who were killed in the same incident.

“It was a massacre,” one witness, Ahmed Halawa, said.

He said tanks and drones fired at people, “even as we were fleeing – many people were either martyred or wounded”.

Another witness, Hossam Abu Shahada, said drones were flying over the area, watching the crowds. Then there was gunfire from tanks and drones, leaving a “chaotic and bloody” scene as people attempted to escape.

He said he saw at least three people lying on the ground motionless and many others wounded as he fled.

The Israeli military did not immediately comment on the reports.

Philippe Lazzarini, the head of the UN’s Palestinian refugee agency, described the aid delivery mechanism in Gaza as “an abomination that humiliates and degrades desperate people”.

He added: “It is a death trap, costing more lives than it saves.”

A spokesperson for the UN’s Human Rights Office said: “The weaponisation of food for civilians, in addition to restricting or preventing their access to life-sustaining services, constitutes a war crime and, under certain circumstances, may constitute elements of other crimes under international law.”

Around 56,000 Palestinians have been killed during the Israel-Hamas war in Gaza, according to the territory’s Hamas-run health ministry. The ministry says more than half of the dead were women and children, but does not distinguish between civilians and militants in its count.

The war began after Hamas attacked Israel on 7 October 2023, when militants stormed across the border and killed around 1,200 people, mostly civilians, and took another 251 hostages. Most of the hostages have been released in ceasefire agreements.