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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‘Current NHS model is not sustainable’
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.
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“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.
Emergency responders are searching for bodies inside stranded cars and buildings following deadly flash floods in Spain that have killed at least 158 people.
Scenes of destruction have been left in the wake of the powerful floodwaters which hit the east of the country late on Tuesday and early Wednesday, marking Spain‘s worst natural disaster this century.
Cars have been piled high on top of each other, homes and businesses have been swept away, trees have been uprooted, and roads and bridges have been left unrecognisable.
At least 92 people have died in the worst-hit region of Valencia, while deaths were also reported in Castilla La Mancha and southern Andalusia.
An unknown number of people remain missing.
“Unfortunately, there are dead people inside some vehicles,” Spain’s transport minister Oscar Puente said.
In the Valencian district of La Torre, nine dead bodies were discovered inside a garage – with a local police officer among the victims.
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Man pulled from deadly floods
Luis Sanchez, a welder, said he saved several people from floodwaters rushing through the V-31 motorway south of Valencia city.
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“I saw bodies floating past. I called out but nothing,” Mr Sanchez said.
“The firefighters took the elderly first, when they could get in. I am from nearby so I tried to help and rescue people. People were crying all over, they were trapped.”
Satellite images from NASA show how severe flooding has impacted Valencia and its surrounding towns.
The images, captured on 30 October, show large areas to the south of the city covered in floodwater.
The Turia river, which runs through the city, can be seen at a much higher level.
The Pobles del Sud, a large lake nearby, overflowed. Much of the area surrounding the lake was covered in floodwater.
The worst of the destruction was concentrated in Paiporta, a municipality next to Valencia city, where 62 people have been reported dead.
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Spanish town ‘worst-hit’ by floods
Mayor Maribel Albalat told national broadcaster RTVE: “We found a lot of elderly people in the town centre. There were also a lot of people who came to get their cars out of their garages… it was a real trap.”
What has caused the devastation?
The flooding events in Spain have been hard to witness. But the rainfall there could never have been anything but devastating.
Chiva, located just to the west of Valencia, received 491mm of rain in an eight-hour window.
Some 100-200mm fell in surrounding areas with the accumulation of running water producing apocalyptic scenes.
In addition there have been over 20,000 lightning strikes.
Whilst the rainfall totals are astounding in themselves, this part of the world is simply not accustomed to huge quantities of water falling from the sky.
In an average year, Spain would expect somewhere between 50 and 100 mm of rain throughout the entire month of October but Valencia and Andalusia would expect far less – just 60–70mm.
So how did this happen? It’s attributable to a DANA, a “depresion aislada en niveles altos” or a “cut-off low”.
This is a low pressure system which becomes slow moving or stationary, blocked by high pressure elsewhere, which can only keep shedding its rain over the same area for long periods of time.
These systems are not that unusual. They occur when cool air from the north is drawn across the Mediterranean in late summer and autumn when the waters are war. The temperature differential enhances storms and rainfall totals.
But whilst not uncommon, this one was certainly extreme.
And it hasn’t gone yet. This same system has continued to bring further heavy rain and thunderstorms today, but it has now moved a little further north and east, heading toward the French border and currently remaining to the west of Barcelona.
The rain and thunderstorms are likely to continue for a few days yet with the Tarragona and Castellon regions still under an amber warning while a yellow warning remains in force for both eastern and western Spain.
Spanish Prime Minister Pedro Sanchez said on Thursday morning that Valencia had been declared a disaster zone and that the priority was to find victims and missing people.
He also urged those affected to stay at home as more torrential rain was forecast.
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“The most important thing is that I know Spanish people are aware that this phenomenon has not finished,” he said.
Sky News’ Europe correspondent Adam Parsons, reporting from Valencia, said the devastation suffered in the region is “enormous”.
“What we’re witnessing now are the locals here who are waking up and seeing what’s happened to their town and what has happened is something almost apocalyptic,” he said.
A nearby shop was left “absolutely wrecked” and looked like a “bomb has gone off in there”, he added.
Three days of mourning has been declared in Spain, beginning on Thursday.
Spain’s Mediterranean coast is used to autumn storms that can cause flooding, but this was the most powerful flash flood event in recent memory, and scientists have linked its strength to climate change.
“When the alert came the water was already two metres high,” Carolina shouts from her balcony. “There were no police, firefighters or the mayor. No one came to rescue us.”
The distress is echoed street after street.
Carmen puts her head in her hands and weeps.
“They have lost everything,” she says, pointing at her neighbours’ houses.
Every home is in ruins and their owners are heartbroken.
Dolores shows us inside her house. She says the flood was up to the ceiling but because no help came, they have had to hammer holes in the walls to clear the water.
“I feel awful. I’m terrified and very afraid. My husband is sick – we need more help,” she says.
The level of destruction is immense.
On the street, we meet Noel with his children. The youngest toddler barefoot in the mud.
Yesterday, Noel and his wife had nothing to eat. He feels helpless.
“Right now, there are people who are trapped. The mud is up to their waists, so they can’t open their doors,” he says.
“I live on a high floor so I didn’t have problems with the flooding in my home, but I don’t have water, light, or food.”
There’s a growing feeling of desperation in this suburb.
At one point, someone shouts “food!” and people rush to grab what they can from a nearby shop.
It’s not clear if they have been let in by the owner or are looting.
The devastation is so great and at a time when people are at their most in need, they feel frustrated and alone.
In a nearby shelter we meet people from Algemesi who have been made homeless by the flood.
Carol says she has never felt so hopeless.
“There was a tree trunk that came into the front of my house. There are no walls, no ceiling. I don’t have anything. There’s nothing left,” she explains, beginning to cry.
For many, the initial trauma of this natural disaster has been compounded in the aftermath by a feeling of loss and loneliness.
Thousands of North Korean soldiers are now positioned near Ukraine’s border and likely to enter combat in the coming days, the US says.
Russian troops have been training them in artillery, drones and “basic infantry operations, including trench clearing”, said US secretary of state Antony Blinken.
He said it strongly indicated they would be used on the front line and would therefore become legitimate targets for Ukraine.
Some 10,000 North Korean troops are in Russia, including up to 8,000 in the Kursk border region, Mr Blinken said.
The troops are wearing Russian uniforms and carrying Russian gear, according to US defence secretary Lloyd Austin.
“We’ve not yet seen these troops deploy into combat against Ukrainian forces, but we would expect that to happen in the coming days,” Mr Blinken said on Thursday.
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America’s top diplomat said the recruitment of troops from North Korea to Russia’s “meat grinder” was a “clear sign of weakness”.
Mr Blinken made the assessment after he and Mr Austin met their South Korean counterparts in Washington DC.
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Foreign minister Cho Tae-yul called for the immediate withdrawal of North Korean soldiers from Russia and condemned it “in the strongest possible terms”.
They also all agreed China should do more to rein in North Korea, Mr Blinken said, adding that he’d had a “robust conversation” with Beijing this week.
Mr Austin also announced that – with the US election just days away – America would soon be announcing new security assistance for Ukraine.
The deployment of troops to Russia is down to the close relationship between President Putin and North Korea’s Kim Jong Un.
A mutual defence pact was agreed during their summit, meaning the countries will help each other if they are attacked.
The US says North Korea has also given munitions to Russia as it continues its grinding effort to take more territory in Ukraine’s east.
The White House published images earlier this month which it said showed 1,000 containers of equipment being sent to Russia by rail.
There are concerns about what military aid Russia will now provide in exchange.
North Korea test-fired an an intercontinental ballistic missile for the first time in almost a year on Thursday and there is speculation Russia may have provided technological help.
In a statement, the US, Japan and South Korea condemned the launch as a “flagrant violation” of UN resolutions.
“We strongly urge (North Korea) to immediately cease its series of provocative and destabilising actions that threaten peace and security on the Korean Peninsula and beyond,” they said.