New-found freedom allows former health secretary Sajid Javid to talk honestly about NHS big picture
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.
Read more: Ex-health secretary issues warning over NHS
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.”
Javid served as health secretary under Boris Johnson, while the new PM, Rishi Sunak, was chancellor
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
‘It is truly monstrous’: Inside the besieged Sudanese city where families are forced to eat animal feed to live
Al Fashir is being suffocated to death.
The paramilitary Rapid Support Forces (RSF) has held the capital of North Darfur hostage in a 14-month siege – blocking food or fuel from entering the locality and forcing starvation on its 900,000 inhabitants.
The entire city is currently a militarised zone as Sudan‘s army and the Darfur Joint Protection Force fend off the RSF from capturing the last state capital in the Darfur region not currently under their control.
Rare footage sent to Sky News from inside al Fashir town shows streets emptied of cars and people.
The city’s remaining residents are hiding from daytime shelling inside their homes, and volunteers move through town on donkey carts distributing the little food they can find.
Al Fashir is the capital of North Darfur
‘It is truly monstrous’
Journalist Muammer Ibrahim sent Sky News voice notes from there.
“The situation is monstrous,” he says. “It is truly monstrous.
“The markets are emptied of food and partially destroyed by shelling. Civilians were killed at the market, just a day ago. People have fled market areas but there is also shelling in residential areas. Every day, you hear of 10 or 12 civilians killed in attacks.”
His voice sounds shallow, weakened by the dire conditions, and gunshots can be heard in the background.
“The intense fighting has meant that people cannot safely search for anything to eat, but there is also nothing for their money to buy. The markets are depleted. Hundreds of thousands here are threatened by a full-blown famine,” he says.
“There has been a full blockade of any nutritional supplies arriving in al Fashir since the collapse of Zamzam camp. It closed any routes for produce or supplies to enter.”
The city’s remaining residents hide from daytime shelling
The RSF ransacked the famine-ridden Zamzam displacement camp 7.5 miles (12km) south of al Fashir town in April, after the military reclaimed Sudan’s capital Khartoum.
The United Nations believes that at least 100 people were killed in the attacks, including children and aid workers.
The majority of Zamzam’s half a million residents fled to other areas for safety. Hundreds of thousands of them are now squeezed into tents on the edges of al Fashir, completely cut off from humanitarian assistance.
The capture of the camp allowed the RSF to tighten their siege and block off the last remaining supply route. Aid convoys attempting to enter al Fashir have come under fire by the RSF since last year.
Aid convoys attempting to enter al Fashir have come under fire by the RSF since last year
“Already, between June and October 2024, we had several trucks stuck and prevented by the Rapid Support Forces from going to their destination which was al Fashir and Zamzam,” says Mathilde Simon, project coordinator at Medicins Sans Frontieres.
“They were prevented from doing so because they were taking food to those destinations.”
“There was another UN convoy that tried to reach al Fashir in the beginning of June. It could not, and five aid workers were killed.
“Since then, no convoy has been able to reach al Fashir. There have been ongoing negotiations to bring in food but they have not been successful until now.”
Mathilde Simon says malnutrition rates in al Fashir are ‘catastrophic’
Families are resorting to eating animal feed to survive.
Videos sent to Sky News by volunteers show extreme suffering and deprivation, with sickly children sitting on thin straw mats on the hard ground.
Community kitchens are their only source of survival, only able to offer small meals of sorghum porridge to hundreds of thousands of elderly men, women and children facing starvation.
The question now is whether famine has fully taken root in al Fashir after the collapse of Zamzam camp and intensified RSF siege.
‘Malnutrition rates are catastrophic’
“The lack of access has prevented us from carrying out further assessment that can help us have a better understanding of the situation, but already in December 2024 famine was confirmed by the IPC Famine Review Committee in five areas,” says Mathilde.
“It was already confirmed in August 2024 in Zamzam but had spread to other displacement camps including Abu Shouk and it was already projected in al Fashir.
“This was more than eight months ago and we know the situation has completely worsened and malnutrition rates are absolutely catastrophic.”
Fatma Yaqoub said her family have nothing to eat but animal feed
Treasurer of al Fashir’s Emergency Response Rooms, Mohamed al Doma, believes all signs point to a famine.
He had to walk for four hours to escape the city with his wife and two young children after living through a full year of the siege and offering support to residents as supplies and funding dwindled.
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“There is a famine of the first degree in al Fashir. All the basic necessities for life are not available,” he says.
“There is a lack of sustenance, a lack of nutrition and a lack of shelter. The fundamental conditions for human living are not living. There is nothing available in the markets – no food or work. There is no farming for subsistence. There is no aid entering al Fashir.”
“All of this points towards a full-blown famine.”
Hamas has said it is ready to cooperate with a request to deliver food to Israeli hostages in Gaza, if Israel agrees to permanently open a humanitarian corridor into the enclave.
The militant group’s statement comes amid international outcry over two videos it released of Israeli hostage Evyatar David, who it has held captive since 7 October 2023.
The now 24-year-old looks skeletal, with his shoulder blades protruding from his back.
The footage sparked huge criticism, with EU foreign policy chief Kaja Kallas labelling the videos “appalling” and saying they “expose the barbarity of Hamas”.
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Video released of Israeli hostage
Israeli Prime Minister Benjamin Netanyahu said on Sunday he had asked the Red Cross to give humanitarian assistance to the hostages.
Hamas’s military spokesperson Abu Obeidah said it is “ready to engage positively and respond to any request from the Red Cross to bring food and medicine to enemy captives” if certain conditions are met.
These are that Israel must permanently open a humanitarian corridor and halt airstrikes during the distribution of aid, he said.
Gaza’s health ministry said on Sunday that six more people had died of starvation or malnutrition in the enclave in the past 24 hours.
This raises the number of those who have died from what multiple international agencies warn may be an unfolding famine to 175 since the war began, the ministry said. This includes 93 children, it added.
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Baby Zainab starved to death in Gaza
No aid entered Gaza between 2 March and 19 May due an Israeli blockade and deliveries of supplies including food, medicine and fuel have been limited since then.
Israeli authorities have previously said there is “no famine caused by Israel” – and that its military is “working to facilitate and ease the distribution of humanitarian aid in the Gaza Strip”.
Meanwhile, Palestinian health authorities also said at least 80 people in Gaza were killed by Israeli gunfire and airstrikes on Sunday.
These included people trying to reach aid distribution, Palestinian medics said.
The Israel Defence Forces (IDF) has repeatedly said it “categorically rejects the claims of intentional harm to civilians” and has previously blamed Hamas militants for fomenting chaos and endangering civilians.
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Hamas killed around 1,200 people, mostly civilians, in its attack on 7 October 2023 and abducted 251 others. Of those, they still hold around 50, with 20 believed to be alive, after most of the others were released in ceasefires or other deals.
Israel’s retaliatory offensive has killed more than 60,000 Palestinians, according to Gaza’s Hamas-run health ministry, which does not differentiate between militants and civilians in its count.
We’ve seen this many times before.
Highly anticipated talks and meetings with America, Israel’s closest ally and the one country with the power to pressure Israeli Prime Minister Benjamin Netanyahu to change course, then nothing changes.
We need to give Steve Witkoff time to report his assessments back to the White House before we can give a complete verdict on this visit but what we’ve seen and heard so far has offered little hope.
The pressure on Donald Trump to stop the humanitarian catastrophe in Gaza is mounting after a small but vocal contingent of his base expressed outrage.
Even one of his biggest supporters in Congress, Marjorie Taylor Green, has referred to it as a genocide.
It was little coincidence Mr Witkoff was dispatched to the region for the first time in three months to speak to people on both sides and “learn the truth” to quote US ambassador to Israel, Mike Huckabee, who accompanied him to an aid site in Gaza.
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Gaza nurse: ‘We’re rationing care’
The pair spent five hours in Gaza speaking to people at a Gaza Humanitarian Foundation centre and it’s understood saw nothing of the large crowd of Palestinians gathering a mile away waiting for food.
Their sanitised tour of Gaza did not include a visit to a hospital where medics are receiving casualties by the dozen from deadly incidents at aid sites, and where they’re treating children for malnutrition and hunger.
A critical trauma nurse at Nasser hospital told us a 13-year-old boy was among the people shot while Mr Witkoff was in the enclave.
An American paediatrician at the same hospital who had publicly extended an invitation to meet with Mr Witkoff heard nothing from the US delegation.
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‘Come here, right now’: Gaza doctor’s message to US envoy
Dr Tom Adamkiewicz described people “being shot like rabbits” and “a new level of barbarity that I don’t think the world has seen”.
The US delegation was defensive of the controversial GHF aid distribution that was launched by America and Israel in May, hailing its delivery of a million meals a day.
But if their new system of feeding Gaza is truly working, why are we seeing images of starved children and hearing deaths every day of people in search of food?
The backdrop of this trip is very different to the last time Mr Witkoff was here.
In May, life was a struggle for Palestinians in Gaza, people were dying in Israeli bombings but, for the most part, people weren’t dying due to a lack of food or getting killed trying to reach aid.
Mr Netanyahu’s easing of humanitarian conditions a week ago, allowing foreign aid to drop from the sky, was an indirect admission of failure by the GHF.
Yet, for now, the US is standing by this highly criticised way of delivering aid.
A UN source tells me more aid is getting through than it was a week ago – around 30 lorries are due to enter today compared to around five that were getting in each day before.
Still nowhere near enough and it’s a complex process of clearances and coordination with the IDF through areas of conflict.
Lorries are regularly refused entry without explanation.
Then there was Mr Witkoff’s meeting with hostage families a day later where we began to get a sense of America’s new plan for Gaza.
The US issued no public statement but family members shared conversations they’d had with Mr Trump’s envoy: bring all the hostages home in one deal, disarm Hamas and end the war. Easier to propose than to put into practice.
Within hours of those comments being reported in the Israeli media, Hamas released a video of hostage Evyatar David looking emaciated in an underground tunnel in Gaza.
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Video released of Israeli hostage
Now 24 years old, he was kidnapped from the Nova festival on 7 October and is one of 20 hostages understood to be still alive. The release of the video was timed for maximum impact.
Hamas also poured water on any hopes of a deal in a statement, refusing to disarm unless an independent Palestinian state is established.
Hamas has perhaps become more emboldened in this demand after key Israeli allies, including the UK, announced plans for formal recognition in the last week.
It’s hard to see a way forward. The current Israeli government has, in effect, abandoned the idea of a two-state solution.
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The Trump administration’s recent boycott of international conferences on the matter suggests America is taking a similar line, breaking with its long-standing position.
Arab nations could now be key in what happens next.
In an unprecedented move, Saudi Arabia, Qatar and Egypt joined a resolution calling for Hamas to disarm and surrender control of Gaza following a UN conference earlier this week.
This is hugely significant – highly influential powers in its own backyard have not applied this sort of pressure before.
For all the US delegation’s good intentions, it’s still political deadlock. Israeli hostages and Palestinians in Gaza left to starve and suffer the consequences.
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