In a scathIng report publIshed In the last few seconds, the surgeon tasked by the pm to assess the state of The Nhs says Its In a crItIcal condItIon. Can SIr KeIr StarmerfIx It . And as the government thIs week pledges to Double Down on KnIfe CrIme, the fathers of these two teenagers, both fatally stabbed, say the law must go much further. Hello and welcome to newsnIght, lIve each weeknIght wIth IntervIews and InsIght. WIth us thIs evenIng, Lord Bethell who was a Health MInIster under the last conservatIve government. MarvIn rees, who was Labour Mayor of brIstol for eIght years and Gp And DIrector of research at Health ThInk tank the nuffIeld trust, Dr Becks FIsher and nIck, too. We are goIng to talk about thIs 160 page report. Its just been publIshed by Consultant Surgeon and former labour Health MInIster now Independent Peer Lord DarzI who was asked by the PrIme MInIster to InvestIgate the state of The Nhs In england and the state of the NatIons Health much of It we all know already cos we all use The Nhs waItIng tIme targets are beIng mIssed, we struggle to see a gp, A E Is In an awful state says Lord DarzI. But Some of what he says Isnt quIte So obvIous. NIck, tell us more about what he says . Here It Is, a pretty hefty tome. ThIs Is a very stark assessment. He talks about how The Nhs Is In a crItIcal condItIon but he does say the vItal sIgns remaIn strong. There are all the examples you talked about and then Lord DarzI talks about and then Lord DarzI talks about how there are four heavy Interrelated factors that have contrIbuted to what he descrIbes as the dIre state of The Nhs. FIrstly, AusterIty And FundIng and capItal starvatIon. Secondly, the Impact of covId and the aftermath. ThIrdly, a lack of patIent boys and Staff Engagement and fInally, management structures. Two of those factors he lays out the door of the last government, austerIty and those management changes, well, hes thInkIng about Andrew Lansley, the fIrst Health Secretary In the coalItIon, hIs massIve reforms whIch Lord DarzI descrIbes as a calamIty wIthout precedent. And on covId, he has thIs fascInatIng, extraordInary fact that The Nhs delayed, cancelled or postponed more RoutIne Care than any comparable Health System but he does say that the state of The Nhs Is notjust about does say that the state of The Nhs Is not just about what happens does say that the state of The Nhs Is notjust about what happens In The Nhs he talks about how health In our country Is deterIoratIng, talks about the Impact of poor housIng and low Income. gs about the Impact of poor housIng and low Income. ssI about the Impact of poor housIng and low Income. , about the Impact of poor housIng and low Income low Income. As I saId, quIte a bIt of thIs we low Income. As I saId, quIte a bIt of thIs we know low Income. As I saId, quIte a bIt of thIs we know already. Low Income. As I saId, quIte a bIt of thIs we know already. But low Income. As I saId, quIte a bIt| of thIs we know already. But what low Income. As I saId, quIte a bIt. Of thIs we know already. But what Is thIs report for, where Is It leadIng to . KeIr starmer Is doIng a bIg Speech Tomorrow . ThIs to . KeIr starmer Is doIng a bIg Speech Tomorrow . To . KeIr starmer Is doIng a bIg Speech Tomorrow . ThIs report Is desIuned Speech Tomorrow . ThIs report Is desIgned to Speech Tomorrow . ThIs report Is desIgned to lay Speech Tomorrow . ThIs report Is desIgned to lay the Speech Tomorrow . ThIs report Is desIgned to lay the ground Speech Tomorrow . ThIs report Is desIgned to lay the ground for. Speech tomorrow . ThIs report Is I desIgned to lay the ground for KeIr Starmer s ten Year Plan for The Nhs. In that Speech Tomorrow, the PrIme MInIster Is goIng to say thIs, It Is reform or dIe and then the PrIme MInIster wIll pledge what he Is goIng to descrIbe as the bIggest reImagInIng of our nhs sInce Its bIrth. He wIll say thIs wIll Involve three bIg shIfts. FIrstly, move from what he descrIbed as analog to dIgItal nhs. Secondly, move more care from hospItals to communItIes and thIrdly, talkIng about the need to be more bold about movIng from sIckness to preventIon. That to reform or dIe message means the emphasIs wIll be on reforms, not IncreasIng taxes. 0ne EmphasIs wIll be on reforms, not IncreasIng taxes. One fInal thIng, an Independent report commIssIoned by the government, I dont see any mentIon of the fact Lord DarzI was a labour Health MInIster In Gordon Browns government. He labour Health MInIster In Gordon Browns government. Labour Health MInIster In Gordon Browns government. He was Indeed. Lord bethell, browns government. He was Indeed. Lord bethell, health browns government. He was Indeed. Lord bethell, Health MInIster browns government. He was Indeed. Lord bethell, Health MInIster under I Lord Bethell, Health MInIster under the last conservatIve government. Welcome. Your government left The Nhs In a crItIcal condItIon accordIng to Lord DarzI, do you accept that . Accept that . The report Is IncredIbly accept that . The report Is IncredIbly powerful accept that . The report Is IncredIbly powerful and I accept that . The report Is IncredIbly powerful and spells out IncredIbly powerful and spells out In clear IncredIbly powerful and spells out In clear terms and I wouldnt argue wIth a In clear terms and I wouldnt argue wIth a word In clear terms and I wouldnt argue wIth a word of the evIdence he has put forward. He alSo very thoughtfully puts together Some of the reaSons for that and that does Include the reaSons for that and that does Include the massIve demographIc changes Include the massIve demographIc changes we have got, the underlyIng poor health of the natIon, as nIck referred poor health of the natIon, as nIck referred to, poor health of the natIon, as nIck referred to, and Some of the workforce referred to, and Some of the Workforce Problem Is we, lIke every other Workforce Problem Is we, lIke every other country In the world, are sufferIng other country In the world, are sufferIng from. Other country In the world, are sufferIng from. You dIdnt mentIon austerI , sufferIng from. You dIdnt mentIon austerIty. I sufferIng from. You dIdnt mentIon austerIty, IwIll SufferIng from. You dIdnt mentIon austerIty, I wIll come sufferIng from. You dIdnt mentIon austerIty, I wIll come back sufferIng from. You dIdnt mentIon austerIty, I wIll come back to sufferIng from. You dIdnt mentIon austerIty, I wIll come back to that, whIch was a CoalItIon PolIcy because he says although he has worked In The Nhs for 30 years, he Is shocked by Some of the thIngs he has found. 0ne by Some of the thIngs he has found. One example, let me gIve to you, the uk has apprecIably hIgher Cancer MortalIty rates than other countrIes. No Progress WhatSoever was made In dIagnosIng cancer at stage one and stage two, whIch everyone knows are the early stages, In other words more lIkely to survIve, between 2013 21. He In other words more lIkely to survIve, between 201321. He Is rIuht. SurvIve, between 201321. He Is rIght that survIve, between 201321. He Is rIght that Is survIve, between 201321. He Is rIght. That Is unbelIevable. RIght. That Is unbelIevable. CatchIna rIght. That Is unbelIevable. CatchIng dIsease rIght. That Is unbelIevable. CatchIng dIsease early rIght. That Is unbelIevable. CatchIng dIsease early and | rIght. That Is unbelIevable. CatchIng dIsease early and treatIng earlIer catchIng dIsease early and treatIng earlIer SomethIng The Nhs Is partIcularly bad at. We have the attItude partIcularly bad at. We have the attItude that we waIt for people to stagger attItude that we waIt for people to stagger Into A E, beIng blood and wIth lamps and then we Intervene when wIth lamps and then we Intervene when Its wIth lamps and then we Intervene when Its clear what the condItIon Is. When Its clear what the condItIon Is that when Its clear what the condItIon Is that Is when Its clear what the condItIon Is. That Is not approprIate In the zIst Is. That Is not approprIate In the 215t century and It speaks of a very old fashIoned model that we need to fIx. Old fashIoned model that we need to fIx what old fashIoned model that we need to fIx. What KeIr Starmer Is due to announce fIx. What KeIr Starmer Is due to announce tomorrow Is the kInd of ambItIon announce tomorrow Is the kInd of ambItIon that Is needed to fIx that. I do ambItIon that Is needed to fIx that. I do hope ambItIon that Is needed to fIx that. I do hope that he has hIs eyes fIrmly I do hope that he has hIs eyes fIrmly fIxed on the bIg ambItIon for that fIrmly fIxed on the bIg ambItIon for that do fIrmly fIxed on the bIg ambItIon for that.. fIrmly fIxed on the bIg ambItIon for that. fIrmly fIxed on the bIg ambItIon for that. I.. that. Do you wIsh the last conservatIve that. Do you wIsh the last conservatIve government | that. Do you wIsh the last conservatIve government over the last 1a years had that kInd of ambItIon . In last14 years had that kInd of ambItIon . Last 14 years had that kInd of ambItIon ... ambItIon . In Some ways. LIsten, there was. AmbItIon . In Some ways. LIsten, there was, after ambItIon . In Some ways. LIsten, there was, after the ambItIon . In Some ways. LIsten, there was, after the lansley there was, after the lansley reforms, there was, after the lansley reforms, there was a feelIng that we couldnt reforms, there was a feelIng that we couldnt trouble the system agaIn. Do you couldnt trouble the system agaIn. Do you what Lord DarzI calls the health and SocIal care. I do you what Lord DarzI calls the health and SocIal care. Do you what Lord DarzI calls the health and SocIal care. I read It. It was a health and SocIal care. I read It. It was a CalamIty Health and SocIal care. I read It. It was a calamIty wIthout It was a calamIty wIthout InternatIonal presIdent. It proved dIsastrous for stock do you agree . The danger of scapegoatIng Andrew Lansley the danger of scapegoatIng Andrew Lansley for Today Nhs problems. It Is lansley for Today Nhs problems. It Is not lansley for Today Nhs problems. It Is not really about scapegoatIng Andrew Lansley. He was the Health Secretary, the PrIme MInIster was davId cameron, the chancellor george osborne, they were all In It 0sborne, they were all In It together and the party voted for It. Those reforms were a mIstake. They were largely unwound and they were regretful were largely unwound and they were regretful but the Idea that Today Nhs Is regretful but the Idea that Today Nhs Is problematIc sImply because of a Reform Nhs Is problematIc sImply because of a Reform Agenda that went wrong 12 years a Reform Agenda that went wrong 12 years agom a Reform Agenda that went wrong 12 years ago. It a Reform Agenda that went wrong 12 years ago years ago. It Is not ust because of that. Years ago. It Is notjust because of that. AdmInIstratIve of that. AdmInIstratIve dIsplacement. Of that. AdmInIstratIve dIsplacement. I of that. AdmInIstratIve dIsplacement. I would | of that. AdmInIstratIve dIsplacement. I would lIke us to of that. AdmInIstratIve dIsplacement. I would lIke us to be focused dIsplacement. I would lIke us to be focused on dIsplacement. I would lIke us to be focused on the other thIng, the capItal focused on the other thIng, the capItal spend. Why couldnt we persuade capItal spend. Why couldnt we persuade the treasury to spend the 39 bIllIon . Persuade the treasury to spend the 39 bIllIon . You persuade the treasury to spend the 39 bIllIon . persuade the treasury to spend the 39 bIllIon . Wes 39 bIllIon . You tell me. Wes streetIng 39 bIllIon . You tell me. Wes streetIng would 39 bIllIon . You tell me. Wes streetIng would have 39 bIllIon . You tell me. Wes streetIng would have to 39 bIllIon . You tell me. Wes I streetIng would have to answer 39 bIllIon . You tell me. Wes streetIng would have to answer that. We dIdnt streetIng would have to answer that. We dIdnt manage to do It and he Is now facIng we dIdnt manage to do It and he Is now facIng the challenge. The answer Is health now facIng the challenge. The answer Is Health And Growth were not put together Is Health And Growth were not put together In the same thought. We never together In the same thought. We never managed to persuade the treasury never managed to persuade the treasury that an Investment In Health Treasury that an Investment In health would yIeld an economIc DIvIdend Health would yIeld an economIc dIvIdend. In fact, the treasury took the vIew dIvIdend. In fact, the treasury took the vIew that spendIng money on health the vIew that spendIng money on health was basIcally money down the DraIn And Health was basIcally money down the DraIn And Allthat health was basIcally money down the draIn and all that would happen as It would draIn and all that would happen as It would lead to older people lIvIng longer and costIng us more. We need a massIve longer and costIng us more. We need a massIve rethInk on that mentalIty and If a massIve rethInk on that mentalIty and If that a massIve rethInk on that mentalIty and If that Is not fIxed, we wIll have and If that Is not fIxed, we wIll have the and If that Is not fIxed, we wIll have the same problem In ten years tIme have the same problem In ten years tIme. So have the same problem In ten years tIme,. , have the same problem In ten years tIme. ,. tIme. So austerIty, Lord DarzI oInts tIme. So austerIty, Lord DarzI poInts out. TIme. So austerIty, Lord DarzI poInts out, was tIme. So austerIty, Lord DarzI poInts out, was one tIme. So austerIty, Lord DarzI poInts out, was one of tIme. So austerIty, Lord DarzI poInts out, was one of the I tIme. So austerIty, Lord DarzI. PoInts out, was one of the four major reaSons why The Nhs Is In the state It Is In England And CapItal start date starvatIon. SpendIng growIng at around 1 In real Terms Buster In 2018, more realIstIc promIse was made of 3. 4 and that was broken. SpendIng Increased by just under 3 a year. Just under 3 a year. Daytoday sendIn just under 3 a year. Daytoday spendIng on The Nhs has just under 3 a year. Daytoday spendIng on The Nhs has never I just under 3 a year. Daytoday I spendIng on The Nhs has never been hIgher~ spendIng on The Nhs has never been hIgher~ we spendIng on The Nhs has never been hIgher. We are currently spendIng, eu average, we are abSolutely spendIng more than we have ever done spendIng more than we have ever done. There Is a CapItal DefIcIt that done. There Is a CapItal DefIcIt that the done. There Is a CapItal DefIcIt that the problem wIth The Nhs In the report that the problem wIth The Nhs In the report from Lord DarzI poInts out, Its more report from Lord DarzI poInts out, Its more than what happened ten years Its more than what happened ten years ago. Its more than what happened ten years ago, Its that we havent adjusted years ago, Its that we havent adjusted to the amazIng IndustrIal revolutIon goIng on In health to catch revolutIon goIng on In health To Catch DIsease earlIer and treatIng eartIer~ To Catch DIsease earlIer and treatIng earlIer. To make up the Workforce DefIcIt earlIer. To make up the Workforce DefIcIt that earlIer. To make up the Workforce DefIcIt that we have and every other Country DefIcIt that we have and every other country has defIcIt that we have and every other country has. To get CommunIty Treatment Country has. To get CommunIty Treatment workIng and fIred up and to delIver treatment workIng and fIred up and to delIver productIvIty returns. These to delIver productIvIty returns. These are to delIver productIvIty returns. These are massIve challenges. They are massIve these are massIve challenges. They are massIve challenges these are massIve challenges. Tue are massIve challenges but these are massIve challenges. Tte are massIve challenges but you these are massIve challenges. Tt21 are massIve challenges but you had 14 years. I feel lIke you are speakIng as though you havent been In power for speakIng as though you havent been In powerfor loads speakIng as though you havent been In power for loads of tIme. SpeakIng as though you havent been In powerfor loads of tIme. Tt Is In power for loads of tIme. It Is not that, In power for loads of tIme. It Is not that, I In power for loads of tIme. It Is not that, I feel In power for loads of tIme. It Is not that, I feel very In power for loads of tIme. It Is not that, I feel very frustrated that we not that, I feel very frustrated that we were not able to wrestle wIth these problems as effectIvely as we wIth these problems as effectIvely as we should have done. Gk. WIth these problems as effectIvely as we should have done. 0k. Thats for sure, as we should have done. 0k. Thats for sure. You as we should have done. 0k. Thats for sure, you are as we should have done. 0k. Thats for sure, you are a as we should have done. 0k. Thats for sure, you are a gp as we should have done. 0k. Thats for sure, you are a gp In for sure, you are a gp In 0xfordshIre and alSo from the nuffIeld trust, whIch has contrIbuted to Some extent of thIs report. Does It rIng true wIth your ExperIence And ExperIence of your patIents . ExperIence and experIence of your atIents . ~ ,. ~ patIents . AbSolutely, I thInk It does. I thInk patIents . AbSolutely, I thInk It does. I thInk all patIents . AbSolutely, I thInk It does. I thInk all of patIents . AbSolutely, I thInk It does. I thInk all of us patIents . AbSolutely, I thInk It does. I thInk all of us who I patIents . AbSolutely, I thInk It does. I thInk all of us who use | patIents . AbSolutely, I thInk It I does. I thInk all of us who use The Nhs, who work In It and study It know full well It has been really strugglIng for a long tIme now. I thInk those problems have been In plaIn sIght. I thInk what the report of Lord DarzI does Is put It all together In a way that Is quIte arrestIng. I thInk the challenge now Is alSo recognIsIng that thIs Is a partIal dIagnosIs. I thInk government has been very keen to say we are goIng to set out all of the problems wIth The Nhs but then outsIde the terms of thIs revIew where publIc health and SocIal care. Two vItal servIces In the remIt of local authorItIes. Budgets have been massIvely cut, huge polIcy problems have not been attended to over the past decade and the SocIal care a lot longer. Those servIces are affectIng The Nhs. nd Lot longer. Those servIces are affectIng The Nhs. Lot longer. Those servIces are affectIng The Nhs. And as we all know and these affectIng The Nhs. And as we all know and these are affectIng The Nhs. And as we all know and these are lord affectIng The Nhs. And as we all know and these are Lord DarzIs| know and these are Lord DarzIs words, 13 of Nhs Beds are occupIed by people waItIng for SocIal care support. MarvIn rees, sIr KeIr Starmer wIll say Tomorrow Reform or dIe, essentIally because that Is that what patIents want to hear, what staff want to hear, more refor