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The NHS winter crisis has been a struggle for patients and staff alike – but it has also prompted a long overdue and necessary debate about its sustainability and future.

There are those – like former health secretary Sajid Javid – who think the way forward for the free cradle-to-grave service is to start charging the patients who can afford it.

Shadow health secretary Wes Streeting’s reply to this proposal was: “Over my dead body.”

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Can the NHS survive?

Defenders of the NHS as a free for all service – including the former Labour prime minister Gordon Brown – warn this will create a two-tier system that will fail the most vulnerable.

However, all sides agree that the NHS is in need of reform and cannot be allowed to endure an endless cycle of summer and winter crises.

At its inception, the National Health Service was designed to serve a very different population. Today, thanks to advances in science and medicine, people live much longer.

But living longer does not necessarily mean people are healthier – and an ageing population, many with complex comorbidities, presents serious challenges.

Professor Kiran Patel, chief medical officer at University Hospitals Coventry & Warwickshire, has advised on future health planning at a regional and national level.

“We could always say that planning could have been better, but we’ve been planning for many, many decades,” Prof Patel says.

“We’ve known the population is getting older. We know that the public expect more, we know that technology and digital health care is up there [in term of priorities].”

COVID has left a long shadow over the NHS. We are still learning about the impact of the virus on our bodies.

We can see already its impact on patient waiting lists that now stand at over seven million.

But Prof Patel argues that the pandemic’s legacy is not all bad.

“The pandemic has forced us to actually adopt a lot of that [new technology] and to start thinking a bit more clearly in terms of planning, not just services, but also our workforce for the future as well,” he said.

The workforce issue is critical. There are over 165,000 vacancies currently in the NHS.

Ambulance workers, nurses and hospital staff are striking for better pay – and will continue their industrial action for weeks to come unless their demands are met.

They are burnt out, demoralised and feel undervalued.

Read more:
Pensioners and new mums relieved to get treatment as NHS struggles
Ambulance delays in December meant 6,000 suffered ‘severe harm’
Ambulance workers strike for third time in five weeks

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An NHS hospital under pressure

In November 2022, Health Secretary Steve Barclay outlined five priorities in the short term for the NHS.

They were employing more staff for NHS 111 and 999 services, focusing on urgent and emergency care, tackling delays in discharge from hospital, improving access to primary care, and investing in technology.

He was heavily criticised at the time by some health leaders for failing to mention the workforce crisis.

Labour’s Wes Streeting, speaking after the first wave of healthcare strikes, has had some strong words to say about the future of our health service.

He said the NHS was in an “existential crisis” – and pledged his party would train more staff, use the private sector to bring down waiting lists, and introduce fair pay and conditions for workers.

But he too has been under fire for outlining the Opposition’s proposals for GP reform – saying a Labour government would “tear up the contract” with GPs and could make family doctors salaried NHS employees.

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Charges for GP appointments?

Sajid Javid’s proposal would see patients charged £20 fees for GP appointments and £66 for emergency visits without a referral. The idea will be met with fierce opposition from frontline medics.

Dr Ed Hartley, the director for emergency medicine at University Hospitals Coventry & Warwickshire, would resist any moves to charge payments.

He says that would not solve the crisis. Instead, he wants to see reform and investment in key areas like social care and staff recruitment and retention.

“I want to see [extra funding] in social care, I want to see the right size of hospitals … we’ve lost thousands of hospital beds over the last decade, but we need to work out as a population what the right number is.

“I want to see system leadership. So, I want to see the NHS working with local authorities, with community health providers, all together to tackle problems, and I want to see long-term investment in the workforce.”

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How NHS crisis is affecting ambulances

Dr Hartley says extra funding will help to solve many of the health service’s problems, but only if it is directed towards long-term solutions.

He said: “Money in the right places fixes the NHS. Short-term projects – to put a holding pen for ambulances outside the A&E – don’t fix the NHS. Short-term projects to help buy some hotel rooms for care home patients or patients who need to leave hospital don’t fix the NHS.

“Long-term investment in the workforce, long-term investment in the right size of hospitals, and recognising the care sector as a rewarding career with progression, and presumably appropriate pay, will go a long way to helping the NHS.”

Kicking off a major ongoing project on the future of the National Health Service, an hour-long debate into the future of the NHS will take place this evening, live from University Hospital Coventry.

It begins at 7pm and will be hosted by Sky News presenter Anna Botting alongside a special panel.

If you are an NHS worker and would like to share your experiences with us anonymously, please email NHSstories@sky.uk.

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SNP leadership race: John Swinney new party leader and is now set to become Scottish first minister

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SNP leadership race: John Swinney new party leader and is now set to become Scottish first minister

John Swinney has won the SNP leadership contest and is set to be named as Scotland’s new first minister, replacing Humza Yousaf.

Mr Swinney could become Scotland’s seventh first minister as early as Tuesday.

The SNP leadership nominations closed at 12pm on Monday, with the party confirming Mr Swinney was the sole nominee.

He is expected to give a speech later in the day.

Posting on X, he said: “I am deeply honoured to have been elected as leader of the SNP. I will give all that I have to serve my party and my country.”

The former deputy first minister, who served under close ally Nicola Sturgeon, emerged as a frontrunner following Mr Yousaf’s resignation last week.

Former finance secretary Kate Forbes had been tipped to join him, but later announced she would not stand and instead threw her support behind Mr Swinney.

More on Humza Yousaf

Mr Swinney has said he would want Ms Forbes to “play a significant part” in his government if elected as first minister.

EMBARGOED TO 0001 MONDAY MAY 6 File photo dated 02/05/24 of MSP John Swinney at the Scottish Parliament in Edinburgh, after he became the first candidate to declare his bid to become the new leader of the SNP and Scotland's next first minister. It seems beyond doubt that on Monday, exactly a quarter of a century after Scots first went to the polls to elect their MSPs, John Swinney will become the new SNP leader - and will therefore go on to be Scotland's seventh first minister. Issue date: Monda
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John Swinney. Pic: PA

Potential challenger Graeme McCormick also withdrew his bid at the 11th hour.

The veteran SNP activist claimed he had secured the 100 nominations from 20 branches needed to enter the contest but backed out of the campaign on Sunday evening after a “lengthy and fruitful conversation” with Mr Swinney.

The SNP has appeared keen to avoid an explosive leadership contest similar to the one that followed Ms Sturgeon’s resignation.

Last year’s race, involving Mr Yousaf, Ms Forbes and now Alba Party MSP Ash Regan, featured rows over religious beliefs, arguments about the recollection of past events, and widespread criticism of secrecy surrounding the vote.

It also led to the resignation of Ms Sturgeon’s husband Peter Murrell as SNP chief executive.

Scottish Tory leader Douglas Ross congratulated Mr Swinney on becoming SNP leader for a second time, but urged him to abandon his “relentless push for independence”.

Mr Ross added: “It’s difficult to see how he can be the fresh start Scotland needs when he’s the ultimate continuity candidate.”

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Patrick Harvie, Scottish Greens co-leader, said Scotland “needs a period of stable government”.

He added: “Mr Swinney knows that if he is to have our support then it must be on the basis of progressive policies that help us to tackle the climate crisis and build a fairer and more equal future.”

Mr Harvie said his party remains “utterly committed” to the policies delivered as a result of the Bute House Agreement and will “oppose any move away from them or steps to dilute them”.

He added: “We are committed to delivering on our vision of a fairer, greener and more equal Scotland, and are open to talks with John Swinney and his team about how we can work together to make that happen.”

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John Swinney speaking to Sky News

Read more:
Who is John Swinney?

What happens next?

Mr Swinney is now clear to take over as SNP leader, but will need to seek parliamentary approval to succeed Mr Yousaf as first minister.

The timing is decided by the parliamentary bureau, and could take place as early as Tuesday.

The parliament will have 28 days to nominate a replacement for Mr Yousaf once his resignation has been accepted by the King.

As the SNP is comfortably the largest party in Holyrood, the onus is on them to find a new leader who can work with other parties in a minority government.

The SNP’s tally of 63 MSPs leaves them just short of a majority in the 129-member parliament, meaning politicians from other parties would need to be persuaded to either vote for Mr Swinney, or at least abstain in the ballot, for the party to be successful.

The leaders from other political parties can also put themselves forward and MSPs can nominate a candidate, although it must be seconded by another member.

If that happens, any candidate that secures more than half of all votes will win the nomination.

If no one reaches that threshold, the candidate with the fewest votes will be eliminated – with the process repeated until the candidates are whittled down to two.

At that point, a candidate will only require a simple majority to win.

Whoever wins the vote is then formally appointed by the King.

An official swearing-in ceremony at the Court of Session in Edinburgh would then take place.

However, if no new first minister can be selected within the 28 days, the Scottish parliament would be forced to hold an extraordinary general election.

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West Ham agree deal to replace David Moyes at end of season

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West Ham agree deal to replace David Moyes at end of season

West Ham have agreed a deal in principle with Julen Lopetegui to take over from David Moyes as manager at the end of the season, Sky Sports News understands.

Lopetegui, 57, has been out of work since leaving Wolves three days before the start of the season but has stayed in England in hopes of landing another job in the Premier League.

The Spaniard, who has also managed Porto, Spain, Real Madrid and Sevilla during an illustrious coaching career, looks set to take charge at the London Stadium at the end of the season after Moyes’ expected departure.

File photo dated 29-07-2023 of Julen Lopetegui. Wolves parted company with head coach Julen Lopetegui. Issue date: Thursday November 14, 2023.
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Julen Lopetegui. File pic: PA

West Ham are ninth in the league after Sunday’s 5-0 defeat at Chelsea.

Moyes, 61, who is out of contract in the summer, has faced increased questions about his future as his team has won only one of its previous nine league games.

He said he felt “really sorry” for West Ham fans after watching his side fall to a heavy loss at Stamford Bridge.

He said: “The fans have been great but I feel bad for them.

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“I don’t normally have teams who get beaten like this but we are lacking some ingredients – mental toughness and leadership to get better results, or at least not get hammered.

West Ham United manager David Moyes during the Premier League match at Stamford Bridge, London. Picture date: Sunday May 5, 2024.
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West Ham United manager David Moyes during the Premier League defeat at Chelsea. Pic PA

“The fans played their part and I can only say I’m really sorry for how it played out.”

The Scot, whose second spell as Hammers boss began in 2019, led the club to its best Premier League points total of 65 in 2021, finishing in sixth place.

The following year they finished seventh and reached the semi-finals of the Europa League.

They went one better last year, winning the Europa Conference League final, the club’s first European trophy since 1965.

In November, Lopetegui told Sky Sports News he had unfinished business in the Premier League.

He said: “It’s why I’ve said no to different countries and different situations because I would like to stay here in England. I feel like our team here is just starting and we want to achieve our dreams.

“The way the country lives football here is special – it’s the best league in the world, the most competitive league in the world, the best environment for the players, coaches and fans too.”

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Rishi Sunak admits Tories may not win general election and claims UK heading for hung parliament

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Rishi Sunak admits Tories may not win general election and claims UK heading for hung parliament

Rishi Sunak has admitted the Tories may not win the general election after grim defeats in the local polls.

The prime minister suggested the UK was on course for a hung parliament and claimed voters would not want to see Labour leader Sir Keir Starmer “propped up in Downing Street” by the SNP or smaller parties.

In an interview with The Times, Mr Sunak pointed to Sky News analysis of the local election results by election expert Professor Michael Thrasher which suggested Labour would be the largest party in a hung parliament.

Politics live: PM told to ‘wake up and smell the coffee’ after elections

“These results suggest we are heading for a hung parliament with Labour as the largest party,” Mr Sunak told the paper.

“Keir Starmer propped up in Downing Street by the SNP, Liberal Democrats and the Greens would be a disaster for Britain.

“The country doesn’t need more political horse-trading, but action. We are the only party that has a plan to deliver on the priorities of the people.”

Meanwhile, Tory rebels have warned the prime minister to change his political course after the weekend’s local election results.

Read more:
The local election winners and losers
Charts tell story of Conservative collapse

Analysis: Labour’s future success is less clear-cut

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PM on ‘disappointing’ election results

Sunak urged to take party towards right

Former home secretary Suella Braverman urged him to mould the party towards the right in order to win back voters.

But she told the BBC a change of leadership was not a “feasible prospect,” adding: “There is no superman or superwoman out there who can do it.”

Ms Braverman urged the prime minister to adopt several measures to win back voters, including further tax cuts and a cap on legal migration.

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Rishi Sunak ‘up for the fight’ in general election

Tories ‘up for the fight,’ minister insists

But Transport Secretary Mark Harper insisted Mr Sunak and the Tories are “up for the fight” of a general election despite their terrible results in the local contests.

Talking to Sky News’ Sunday Morning With Trevor Phillips, the minister said: “I think the key thing that people need to do now is get behind the prime minister, focus on the things the government is focused on delivering – the British people’s priorities around the economy, dealing with migration – and get out there and take that fight to the country ahead of the general election.”

Labour won 1,158 seats in the 107 councils in England that held elections on 2 May, an increase of more than 232.

The Liberal Democrats won 552 seats, up nearly 100, while the Tories came in third place on 515 seats, down nearly 400.

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