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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.

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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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Changes needed to fix ‘broken system’, as illegal migration ‘creating division across our country’, says home secretary

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Changes needed to fix 'broken system', as illegal migration 'creating division across our country', says home secretary

Home Secretary Shabana Mahmood has denied that her plans to clamp down on illegal immigration are “racist” – instead describing them as a “moral mission”.

Shabana Mahmood said illegal immigration was causing “huge divides” in the UK, and added: “I do believe we need to act if we are to retain public consent for having an asylum system at all.”

Politics latest: Mahmood dismisses ‘tittle-tattle’ over leadership rumours

Speaking on Sunday Morning with Trevor Phillips, Ms Mahmood said the government would set out changes to the asylum system in a bid to reduce the “pull factor” for those arriving in the UK via small boat.

The home secretary has been looking to Denmark for inspiration, where there are tighter rules on family reunions and restrictions on how long refugees can stay.

Measures that are expected to be announced on Monday include changing the rules so that people who are granted asylum in the UK will only be allowed to stay temporarily, and will have their refugee status subject to regular review.

The statutory legal duty to provide asylum seeker support, including housing and weekly allowances, is expected to be revoked.

More on Migrant Crisis

Ms Mahmood said such changes were needed to fix the “broken” asylum system.

‘Moral mission’

But asked how she would respond to those who believe the government has been “panicked into a racist immigration policy”, Ms Mahmood said: “I reject that entirely.”

“I am the child of immigrants,” she said. “My parents came to this country legally, in the late 60s and early 70s. This is a moral mission for me.”

Ms Mahmood said she had observed how illegal migration had been “creating division across our country”.

“I can see that it is polarising communities across the country. I can see that it is dividing people and making them estranged from one another. I don’t want to stand back and watch that happen in my country.”

What measures is the home secretary set to announce?

  • Refugee status will become temporary and subject to regular review – with people facing removal as soon as their home countries are deemed safe
  • New safe and legal routes to be introduced for those genuinely fleeing war and persecution
  • Changes to the legal framework that will require judges to prioritise public safety over migrants’ rights to a family life – amid fears that Article 8 of the European Convention on Human Rights has been used to frustrate removals
  • Using facial age estimation technology, a form of AI ,to rapidly assess a person’s age in a bid to deter people who pretend to be children in an attempt to claim asylum
  • Capped work and study routes for refugees will also be created  

Under current UK rules, people who are granted refugee status have it for five years and can then apply for indefinite leave to remain and get on a route to citizenship.

The government has already announced it will change the rules around indefinite leave to remain with a new set of requirements, including how much someone contributes to the UK and higher English language requirements.

The move to impose tighter restrictions have been interpreted as a way for Labour to counter the threat posed by Nigel Farage and Reform UK, which has laid out plans to deport people who already have ILR – which gives people the right to settle, work and study in the UK and even claim benefits, even if they do not then apply to be British citizens.

Ms Mahmood said that highlighting issues in the system did not amount to making “right-wing talking points or fake news” and that the government had a “genuine problem to fix”.

Although Ms Mahmood is seeking to emulate aspects of the Danish asylum system, she is not copying it in full.

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Inside Europe’s people-smuggling industry

In Denmark, asylum seekers’ access to public housing is restricted in certain areas where there are more than 30% of ethnic minorities, low levels of education and low incomes.

The home secretary said she was not going to “dictate where people live based on percentages”.

Asked if this was one of the measures the UK government may adopt, the home secretary said: “That’s not the sort of country that we are.”

Alongside bringing in measures to mimic Denmark, Ms Mahmood said she would also announce plans to reform the European Convention on Human Rights (ECHR) – aspects of which she said had been used to “frustrate the removal” of those with no right to be in the UK.

Read more:
Migrants shopping for life jackets: Inside the route to the Channel
Here’s how the Danish migration model works

Chris Philp, the shadow home secretary, said Labour’s plans to reduce immigration were merely a “series of gimmicks” while Zia Yusuf, Reform’s head of policy, claimed Ms Mahmood would be blocked from bringing in her plans by her own MPs.

Meanwhile, the SNP have branded the government’s reforms to asylum policy “outrageous”, and have accused Labour of “dancing to Nigel Farage’s tune on immigration”.

The party’s concerns were echoed by the Greens, whose deputy leader Mothin Ali said the furore over the number of people arriving in the UK on small boats was a “very manufactured problem”.

He told Sky News: “To me, it feels like a very manufactured problem. It’s a problem that’s been created to create outrage.”

Max Wilkinson, the Liberal Democrats’ home affairs spokesperson, told Sky News it was “right” that the government was aiming to tackle illegal migration, but said some of the language used had been a “bit uncomfortable”.

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Labour MPs fear wipe out at next local election – as chancellor’s career is ‘toast’

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Labour MPs fear wipe out at next local election - as chancellor's career is 'toast'

Many Labour MPs have been left shellshocked after the chaotic political self-sabotage of the past week.

Bafflement, anger, disappointment, and sheer frustration are all on relatively open display at the circular firing squad which seems to have surrounded the prime minister.

The botched effort to flush out backroom plotters and force Wes Streeting to declare his loyalty ahead of the budget has instead led even previously loyal Starmerites to predict the PM could be forced out of office before the local elections in May.

“We have so many councillors coming up for election across the country,” one says, “and at the moment it looks like they’re going to be wiped out. That’s our base – we just can’t afford to lose them. I like Keir [Starmer] but there’s only a limited window left to turn things around. There’s a real question of urgency.”

Another criticised a “boys club” at No 10 who they claimed have “undermined” the prime minister and “forgotten they’re meant to be serving the British people.”

There’s clearly widespread muttering about what to do next – and even a degree of enviousness at the lack of a regicidal 1922 committee mechanism, as enjoyed by the Tories.

“Leadership speculation is destabilising,” one said. “But there’s really no obvious strategy. Andy Burnham isn’t even an MP. You’d need a stalking horse candidate and we don’t have one. There’s no 1922. It’s very messy.”

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Starmer’s faithfuls are ‘losing faith’

Others are gunning for the chancellor after months of careful pitch-rolling for manifesto-breaching tax rises in the budget were ripped up overnight.

“Her career is toast,” one told me. “Rachel has just lost all credibility. She screwed up on the manifesto. She screwed up on the last two fiscal events, costing the party huge amounts of support and leaving the economy stagnating.

“Having now walked everyone up the mountain of tax rises and made us vote to support them on the opposition day debate two days ago, she’s now worried her job is at risk and has bottled it.

“Talk to any major business or investor and they are holding off investing in the UK until it is clear what the UK’s tax policy is going to be, putting us in a situation where the chancellor is going to have to go through this all over again in six months – which just means no real economic growth for another six months.”

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Why is the economy flatlining?

Read more:
Starmer and Reeves ditch plans to raise income tax
Former chancellor Osborne is shock contender to head HSBC

After less than 18 months in office, the government is stuck in a political morass largely of its own making.

Treasury sources have belatedly argued that the chancellor’s pre-budget change of heart on income tax is down to better-than-expected economic forecasts from the Office for Budget Responsibility.

That should be a cause of celebration. The question is whether she and the PM are now too damaged to make that case to the country – and rescue their benighted prospects.

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Man charged with murder of 17-year-old girl

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Man charged with murder of 17-year-old girl

A teenager has been charged with murder and attempted murder following the death of a 17-year-old girl, police have said.

Armed police were called to Cefn Fforest in Blackwood, Wales, at around 7.15am on Thursday after being told two people were seriously injured.

Lainie Williams was pronounced dead at the scene, while a second, a 38-year-old woman, who also sustained injuries, has been discharged from hospital.

Gwent Police said 18-year-old Cameron Cheng, a British national from Newbridge, Caerphilly, has also been charged with possession of a bladed article in a public place.

He is remanded to appear before Newport Magistrates’ Court on 17 November.

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Ex-chancellor is shock contender to head HSBC

Assistant Chief Constable Vicki Townsend said: “We understand that there has been a great deal of interest in this investigation.

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“It is vital that people consider how their language, especially comments made online, could affect our ability to bring anyone found to have committed a criminal offence to justice.

“Even though we’ve reached this significant development in the investigation, our enquiries continue so it is likely that residents will continue to see officers in the area.

“So if anyone has any information, please speak to our officers or contact us in the usual way.”

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