The Shadow Secretary of State for Health and Social Care discusses what he sees as the priorities for the NHS as we head towards a general election.
good afternoon everyone and welcome back for the final two sessions of the day I’ll go and find my [Music] seat right I hope you enjoyed your lunch I hope you enjoyed the breakout sessions and uh the networking our next guest I think you all know is going to be the shadow Secretary of State for Health West streeting he’s joining us to discuss what he sees as the priority for the NHS we’ve been talking about the fact that the next general election is a year or so away at most um just to note that this session will be live streamed and we’ll be taking questions from the audience you can contribute online or you can contribute in the room um the slide with the Q&A function and you can use q&r QR code um just pick the right session to put your question in uh right without further Ado I welcome wor [Applause] reading thanks Samir and uh thanks to all of you for inviting me to be here to speak to you today um I hope everyone’s enjoyed the latest merry gound of the conservative clown show in Westminster this week um I gather this morning you heard from Victoria Atkins who is now the fifth Secretary of State for Health and Social care I’ve faced since being appointed as Shadow Health secretary less than two years ago um although to be fair two of them were called Steve Barkley um I understand she told you in her message that she is looking forward to working with you in the weeks and months ahead at least she’s realistic um in contrast to The Chopping and changing you have become used to from the government today I want to give you a clear idea of how a labor government will work with you over five years to get the NHS back on its feet um that’s right uh I gather K is not planning to make any changes so like it or lump it you are stuck with me I hope for um the foreseeable future um there are two great domestic crisis facing our country today the cost of living crisis and the crisis in R NHS the worst in its history and of course each crisis reinforces the other the state of the economy the public finances and the squeeze on people’s personal finances will make it harder to escape the crisis in the NHS the consequence of 13 years of low growth in our economy is that we have the highest tax burden on working people since the 1950s working people literally cannot afford it to go higher and the consequence of the economic joy ride that the conservatives took last year is that there is no slack in the public finances so there’s no route out of the crisis in the NHS that requires simply spending more money that’s the context in which we meet today and if my party privileged enough to win the next election and form the next government that is the reality we will inherit the status quo in the Health Service is intolerable to me to you and most of all to the patients we serve the crisis too urgent for us to Simply wait for the economy to pick up there isn’t time to wait not for the millions of people whose lives are put on hold while they wait for care not for those with conditions slowly worsening while they wait to see a GP a specialist or for a scan not for those who will need to call for an ambulance this winter so it really is reform or die not a slogan but a reality the NHS must change and in a year’s time it will fall to us in this room to change it I know the reform argument that Kia and I have been making hasn’t always been a crowd pleaser on BBC question time early this year a panelist told me that reform the word reform goes down like a cup of cold sick um well I’m afraid it’s worse than they thought we really do believe this stuff stu um and not only because of the scale of the crisis you all face today not only because of Weights rise public confidence in the Health Service Falls but because the challenges coming down the track of rising chronic disease are aging Society these challenges are bigger than even bigger than we face today they threaten to overwhelm and even bankrupt the NHS the Department of Health and Social care today accounts for 42% of total departmental spending ifs analysis of the NHS Workforce plan suggests that half of the public sector will be employed by the NHS by 2036 now I like Amanda Pritchard very much but we’re in danger of making her Louis the 14th l s the costs of continuing with the status quo simply pouring ever increasing amounts of money into a broken system will ultimately be borne by our schools our pensioners our police and in this dangerous World by our nation’s capacity to defend itself this is not acceptable to labor and I know it is not acceptable to you you see the consequences of poverty and a broken public realm walk through the doors of your hospitals and trusts every day you know that without a healthy economy without good Public Services we cannot build a healthy Society the NHS therefore has a duty to get better value for tax payers money the government’s announcement last week sums up their failure over the past 13 years at the same time as another shortterm pot of funding they watered down targets for operations and appointments this year not only if they wave the white flag on rishy sunak pledged to cut waiting lists they have once again left the public literally paying more and getting less and it’s not just the cost of their failure to resolve the strikes for the past 11 months either it’s A3 billion pound a year paid to recruitment agencies it’s the estimated 1.7 billion P cost of delayed discharges and the 13,000 beds enough to fill 26 hospitals taken up each day by patients who do not need to be there the costs of failure are racking up and while the taxpayer is picking up the bill the heaviest price is paid by patients the NHS has got to work better for patients and taxpayers it’s the only way we’re going to turn this crisis around by getting more out for what we put in so if labor wins the next election and we’re back in this room in a year’s time that’s what we will have to achieve from our relationship together and that’s what I want to talk to you about today so that’s where the Doom and Gloom ends because if I am back here in a year’s time as Secretary of State for Health and Social care it will be with a very clear task the targets Kier and I have committed to meeting within 5 years elective treatment within 18 weeks weights in A&E of no more than 4 hours ambulances that arrive on time GP appointments when you need one and NHS back on its feet there for you when you need it and over 10 years even greater ambition fewer lives lost to the biggest Killers cancer heart disease stroke and suicide the Gap in healthy life expectancy between regions halfed so everyone lives well for longer and NHS fit for the future I know how far off we are today I recognize that it feels almost impossible but it isn’t you have done this before and we can do it again this may come as a shock to some of you but I don’t have a messiah complex I know that the NHS will not be turned around by one person in the Department of Health when Kier says that our mission is to get the NHS back on its feet and fit for the future he’s not just talking about the shadow cabinet if we’re going to do this it will have to be the mission of Kier of me of everyone in this room and your 1.3 million colleagues outside of it a mission across government a mission in partnership with business and civil society and a mission that involves patients too if we’re going to deliver the care that patients deserve we will only be able to do it together so today I’m promising a deal my promise to you is this I will end the micromanaging no more getting on the phone to you about whatever issue pops into the Secretary of State’s head on any given day every day you spend rewriting the job titles for your equality diversity and inclusion officers is a day you’re not 100% focused on bringing down waiting times for patients I won’t waste your time or mine there is no time to waste instead we will give you long-term certainty with clear priorities over a five and 10e period as already set out in late Labor’s Mission by setting them now we have bound my hands and I hope liberated yours this must be our Focus every day over five years you will be given the freedom to innovate to try new things and to find the best ways of getting the service working better for patients in return we need much more transparency so we can see what’s working and what’s not where it’s working we will encourage you to go further faster where it’s not we will get the support in place to turn around your provider as quickly as possible a new culture based on honesty between grown-ups and a shared mission to get the NHS back on its feet and fit for the future I know that given the freedoms and the right incentives you will deliver and what gives me that confidence are the people working with and for the NHS today leading that way to the better future we want they you are showing that things can get better out of the chaos of the pandemic and the unbearable pressures facing the service today with their backs against the wall great NHS leaders are coming up with Brilliant Solutions like the Sussex muscular sceletal partnership who hired a local Leisure Center and invited their entire waste waiting list patients could speak with clinicians be directed to community support groups and Charities that present across wider health and well-being Services too and get immediate Rehabilitation treatment all in under two hours people were saved months of being passed from Pillar To Post Service to service 550 people attended over two days half of whom were then discharged from the waiting list patients who didn’t attend were seen five weeks sooner because the waiting list had been cut so significantly as a result and Labor’s plan to cut waiting list wasn’t dreamt up by me or my team it came from a number of trusts around the country they’ve set up specialist clinics on weekends shared waiting lists and staff across neighboring hospitals and dramatically reduced weights for patients we will put 1.1 billion pounds behind this idea paid for by abolishing the non-dom tax status so patients in every corner of the country benefit that will be my role in this new relationship not top down reorganizations and more structural changes from above taking the extraordinary things already happening in the Health Service and making them the ordinary bringing the best of the NHS to the rest of the NHS the center will always have a role in giving the NHS the tools it needs to do the job whether it’s training thousands more staff doubling the number of scanners bult buying the latest technology and getting it to you faster cutting red tape AP so GPS can provide continuity of care a fair pay agreement for care workers mental health support and toothbrushing in schools to prevent ill health in the first place labor will arm you with to the teeth to turn this around the reforms themselves will have to come from you we’re not just going to ask you to deliver but to lead on changing the system to provide Health Care in new different ways form Partnerships with each other the private and the voluntary sector and embrace new methods of treatment and prevention that means taking the lead on Shifting the focus of healthcare out of hospital and into the community ditching the old ways of working to bring the NHS into the digital age and reducing Demand with more of a focus on preventing ill health as opposed to Simply treating it again some of the best leaders have already blazed this Trail at this conference last year I spoke about leads and mid and midchester trusts which have shared their budgets with local authorities to boost social care and cut delayed discharges that collaboration keeps patients out of Hospital helps their recovery and frees up hospital beds for those who need them better for patients less expensive for the taxpayer but it shouldn’t take 400,000 delayed discharges a month and A&E waiting times going through the roof change can’t wait for the interests of the organization to align with those of patients we need a permanent revolution in the NHS so it is constantly improving for patients that greater freedom I describe can’t mean less accountability so that’s the deal clearer Direction but less interference from above with more transparency and accountability in return people today watch drivers delivering their takeaways on Virtual maps in real time they choose what film to watch and product to buy based on the reviews of thousands of their peers and they have a lifetime of information available to to them at the touch of a buttom if they want to know how long it will take to get the scan or operation they need or to see their GP they can easily find that out too so long as they have Private health care or they are prepared to troll through complicated data sets people want this information and it should be available to everyone not just the wealthy well-informed the NHS will always be the Public’s service there to serve the public patients interest must always be at its heart and the public should be able to judge if it is doing a good job by them if it isn’t it is right that patients should have the choice to go elsewhere so we can make sure so we will make sure that people can see how their local providers are performing and the progress being made towards our Targets this new age of transparency will Empower patients and put their experience at the center of the service with labor you won’t just be told how well your trust is doing you’ll also be told how well they should be doing with information about what the national standards are and what best practice looks like but we also need greater transparency so that we can spot what is working and who to learn from for those services at the top of the league tables we need to make sure they don’t hit a ceiling they should be incentivized to put the foot down on the accelerator and continue improving for those at the bottom of the table they need identifying so we can get them the support need did to get back on track we will partner them with turnaround teams of the best leaders to support them and monitor performance data more closely the number of patients waiting 52 weeks fell by a few percent nationally in the past year and that reduction was brought about by the improved work of less than a third of ics’s who have reduced the longest weights clearly do they do not need the same level of Performance Management or support as others we will need very different approaches for different organiz ations the number of delayed discharges are marginally down this year but in 16 integrated Care Systems they have worsened and in some twice as many patients are stuck in hospital when they don’t need to be there this may be caused by poor practice demographics or local social care capacity as Secretary of State I would expect that question to be quickly answered and a plan in place to turn around those worst performing services the conservatives have simply looked the other way and tolerated providers falling behind we will not we cannot if we are we’re to get the NHS back to where it needs to be delivering for patients in every part of the country accountability also means recognizing the seriousness of the work you do when you get it right lives are saved and transformed when you don’t the consequences can be tragic this was brought into horrifying Clarity most recently by the appalling events at the Countess of Chester Hospital the case for change has been made repeatedly in 2017 by Sir Robert Francis in 2019 by Tom K QC and in 2022 by General sagor messenger and Dame Linda polard it is long past Time for Action in September I wrote to Julian and to Matthew Taylor at the NHS Confederation asking you to begin Consulting your members and patient groups in government we will work with you to introduce a system of Regulation and crucially training to promote excellent leadership and to protect patients when things go wrong I’m clear this must include disbarring those found guilty of serious misconduct our aim in all of this is to Foster First Rate leadership across the service that’s why today I can announce that we will establish a college of clinical leadership good good clinical leadership is crucial to improve Services quality of care and transforming health care and it is time that is recognized that’s the deal the new relationship the change in culture that we are proposing the aim to get the NHS back on its feet and make it fit for the future how by getting more out for what we put in not asking NHS staff to work harder but helping them to work smarter the changes will be fundamental and deep it will take time and we will support you through the transition but we believe that the NHS can survive and thrive in the 21st century if we follow this approach reform was crucial to the last Labor government delivering the shortest waiting lists and highest patient satisfaction in history I don’t shy away from that record it’s what gives me confidence that we can turn the crisis in the NHS around you did it before and we can do it again yes times have changed the crisis is of course much worse today the state of the economy far poorer but we shouldn’t lose sight of the advantages we have today either there are opportunities available to us that were unimaginable back then the revolution in data medical technology and Life Sciences are game changers n Bean the great founder of the NHS said the service must always be changing improving and throughout its history the NHS has changed adapted pioneered from the first mass immunization program in 1958 to delivering the covid vaccine that led us out of lockdown and the pandemic from the first test tube baby in 1978 bringing hope to childless couples to the introduction of NHS Direct in 1998 making Healthcare advice available to all 24/7 today it falls to us our generation to harness the best Innovations technological advances and breakthroughs in life sciences and I’m convinced that if we combine the Ingenuity of our leading scientists the innovation of our NHS leaders and the care of our staff the NHS can once again be the Envy of the world if I’m back here in a year’s time we will together begin that Journey thank you very [Applause] much so much just some that need um I’m going to ask one question and then I’m going to start taking the terrific questions that are coming in from the audience um you talked about a five to 10 year commitment people will be wondering though what are you thinking and prioritizing in your first year maybe even in your first 100 days sure to an extent you can you can see that with the um oh thanks very much to an extent you can you get sense of that from um some of the commitments we made at the labor Party Conference uh back in back here in Liverpool actually uh in what feels like years ago now but it’s actually only weeks ago um we’ve got to deal with the elective backlog we’ve got to get the waiting list down that’s crucial for patients who are waiting in agony um I I think actually it’s essential for staff morale too I think it’s it’s vital that um in the in the immediate future that staff begin to feel like they’re working in an improving NHS not a failing NHS I think that’s a essential to retention alongside other things things um it’s also really important for the economy as well the the the we’re not going to get the economic growth we need if people are languishing sick on waiting lists and and that’s why we’ve made some very specific practical commitments um two million more appointments a year to cut an HS waiting list 700,000 extra NHS Dentistry appointments uh a year um so that those things we can sort of crack on with um pretty pretty much immediately um but the the The Wider change will take time and that’s why we’re committed you to to a degree of service recovery in the first term of a labor government but also being honest with ourselves with you and crucially with the public that if we’re serious about building an NHS fit for the future that’s that’s going to be a decade in the making it took it took a decade to break the NHS to the point that it is today and it’s going to take time to turn it around and I don’t you certainly wouldn’t believe me I don’t think the public would believe me if I said there were quick fixes or a labor magic wand and just con continuity of secretaries of State um will turn things around um and in building that plan we’re looking this side of the election um very deeply and seriously and practically so we go into access talks with the department but out of the other side of the election um with a credible set of plans but I feel very strongly especially reflecting back on how the last Labor government approached its 10-year plan that it’s got to be firstly a plan for Health and Social care and secondly if we’re to bring to life that cultural change that I described it’s got to be a genuine partnership so what I don’t want to do is race straight out of an election and within the first 100 days impose a 10-year plan on the system I think it’s important that I come out the traps with a credible plan for you to get your teeth into to scrutinize to challenge to inform to iterate reiterate and and and come out with something at the end of that process um that’s much stronger as a result that you have genuine buy into and I don’t just mean leaders in this room I I mean people working at every level of the system um because going back to um and I’ll finish on this point so get more questions in going back to something I said in the in the speech about that episode of question time and reform going down like a bucket of cold sick I’ve actually been pleasantly surprised and taken back by the extent to which people working at every level of the um NHS and social care system are desperate to see things change and improve and when I’ve talked for example about improving back office systems and it to improve the staff interface with systems their patients experience and their satisfaction at work um I thought the reaction would be oh no not another government IT project um actually people already seeing that working in a number of places and they want a piece of that action so I think there is an appetite for change um where the anxiety comes in is people want it to be changed they believe in um change that they’re bought into and change that they can shape um at every level of the NHS so that’s that’s the commitment I make in terms of the culture and the approach we will take in building a 10-year plan for Health and Social care you just pointed out obviously that it’s Health and Social care you also mentioned in your speech a fair pay agreement for care workers several questions have come in about whether you’re going to commit to more funding for social care it’s been this issue that’s been left over the last 13 years so we started off with Workforce because I think like the NHS if you don’t have a plan for the workforce you don’t have a plan for the system U you know glad we we finally got the government to a point where they’re beginning that process of of the expansion that we need in the NHS Workforce but in Social care unless we deal with Fair pay we’re going to still struggle on Recruitment and Retention and more than that um I think people who work in Social care are Care Professionals the idea um that they are unskilled workers is an insult to the work that they do and the value that families place in those wonderful people and we can’t keep on exploiting their Goodwill so um we will F it’ll be first of a series of fair pay agreements across sectors actually we’ll start with with social care but in building the long-term plan um for for social care I’ll have more to say about that um in the not too distant future because again we’ve got to get the approach right on how we build that plan because of course it involves local authorities and their funding pictures involves local authorities it involves um large and diverse private sector it involves the interface with with the NHS and frankly um there isn’t a shortage of good ideas there’s just been a shortage of good Politics on social care for more than a decade and you know whether it was David Cameron um back in the news um torpedo in Gordon Brown and Andy Burnham’s plan um and white paper in 2010 um labor torpedoing Theresa May’s plan in 2017 the tour is torpedoing their own plan um with Boris Johnson after 2019 you can just see how the Party politics has really held back the the focus and on the long-term future of social care and so I it’s my responsibility to fix the politics so that we can get the plan and I have more to say about that in the not too distant future all right what’s your position on the new hospital program um well um I’m I’m really looking forward to um uh engaging with the new secretary of state as no doubt she will go in and as I would be doing um on day one after a general election and saying so the new hospital plan how’s it going um what’s the time scale and how’s the funding uh looking and I hope that she will be able to provide the same assurances that Steve Barkley um gave us all that this plan absolutely Stacks up um and will be delivered um within budget um but you know I think there there are real concerns about the way in which the plan has been set out the the the way in which it’s held up to scrutiny so far so we’re looking really carefully at um at not just the new hospitals but thinking more broadly about the big capital investment challenge across the Health and Social care estate I want to make sure that those new hospital Pro projects um are delivered you look at some of those buildings and an absolute State I mean take what for General I mean we we proposed um that re Bild when we were lasting government and the Tes scrapped the plan when they came in and then we end literally ended up with a sink Cole outside Watford General I mean what a what a um epitome of conservative government a sinkhole outside the hospital okay um so we know that there’s an urgent pressing need to do that and I I would prefer this not to be a battle line between labor and the conservatives because when when the system and when government sets out a big Capital program it’s really important it’s stuck to um we I’m afraid we’ve seen that with HS too and I don’t want to see the same happen to um long-term investment plans for um the NHS estate what’s your view on the current plan to reduce routine elective activity and other NHS programs to fund urgent and emergency services for the winter ahead and I know that you’re not in power but you must have a view um I I I think it’s well I as I said in my speech really it’s it for the public it feels like paying more and getting less and robbing Peter to pay pay Paul and the reason why we end up back in this depressing annual cycle and it really is an annual cycle now um in fact it’s a year it’s become a year round we used to have annual winter crisis under the Tes now we have a Perma crisis but it is really depressing when you know winter isn’t a surprise happens every year um roughly the same time every year and we know the challenges that it brings but government is so slow to do proper planning ahead and to put in place the certainty and stability in terms of funding and support to allow people to plan adequately so we end up in the worst of all worlds where money is unlocked far too late thrown at the system to give the impression something’s happening the system do their best to use the resources they given as best they can but ultimately it doesn’t make the the impact it would have had if the if the planning had you know had been a lot earlier um a lot more predictable and and delivered in partnership with the system so and it’s kind of why reference in the speech this kind of the constant merry-go round of short-term funding pots it’s wasteful in every sense a waste of money a waste of time and a waste of potential and um you know the truth is Victoria Atkins is arriving as the new secretary of state at roughly the same time that if there’s a general election this time next year I could arrive in the department as a new secretary of state should we win the election and at this stage there isn’t that much you can really do ahead of winter it’s kind of already already landing on us so um I’m pretty Furious to be honest about the waste of money that we see and also the consequences for patients as a result and that’s one of many reasons why rishy sunak won’t hit his commitment to cut waiting list um a question about um the reward packages or pensions really how will you make sure that the reward package for NH staff is fit for purpose and help support capacity so as an example um the pension scheme this ask a questioner says is a fantastic benefit but underappreciated for those earning the least it’s unaffordable during the cost of living crisis for those where the most senior pensions tax um means that um there’s a risk of people um taking retirement because there’s loss of capacity because they feel there’s no alternative reward available um and there is fear that labor government would reintroduce the lifetime allowance causing many more immediate retirements well I think the last fear is UN unfounded and and bluntly we wouldn’t have got to where we got to with the government had we not bang this drum in Parliament um and I I been very clear about why it was that we made that case because we we we recognized that we were losing people from the NHS far earlier than they would have otherwise chosen because their accountant says that there was no point in them working for the NHS any longer because of the of the tax Arrangements um but you know my my kind of only caveat to that is um as a result that was a fairly generous tax cut for um some fairly wealthy people so we’re not going to undo that and we’re not going to put doctors in a position where they’re forced to retire early because it’s not in our national interest but as a result of taking that decision we don’t we don’t expect to be beaten up along the way uh a simple thank you will do okay um you’ve mentioned providing support for challenged providers and you talked about a college of clinical leadership what will support look like especially if you’ve got these lead tables where you know it’ll be obvious if people are are failing and we know the experience of League tables in the past under previous labor government was controversial about the impact they had yeah I’m I’m I’m I’m glad the question was put in that way I I sort of did wonder um you know whether people would pick it outside uh on league tables I know they’re really really popular um I hope that the way I’ve sort of set this out this afternoon gives you a real sense of what it is we’re trying to achieve and and and why and and how we’re trying to achieve it because I I think there’s a a pretty uh blunt approach to Performance Management especially where um you’ve got providers that are trailing um either the national average or seriously training trailing the top performers and sometimes um you know with big p and small P politics um organiz ational politics there can be a temptation to say well this trust is failing sack sack the leaders must be the chief exec we’re going to get a new chief executive we’re going to get a new Chief Operating Officer in and that’s going to solve the problem uh and then they come in and you know there’s some marginal improvements and then um a few years down the line CQC comes back and performance isn’t very good and so say right we’re going to sack this chief executive and this Chief Operating Officer and get someone I don’t don’t think that’s serious um unless it’s demonstrable that the problem genu genuinely is individual personnel and I think we should have um low tolerance for for poor um personal performance um I add a question in there which is someone said you have previously had a very dim view of NHS managers in the spirit of honest and growing up dialogue is that still your view we saying no no I’ve never had a particularly dim view of NHS managers I think I did I did have a pop at the expansion of the number of six figure salaries paid in the NHS one box day which had the um very early on in my job which had the um consequence of ruining everyone’s boxing day including mine as the social Med it turns out every NHS manager in the country was on Twitter that boxing day and they were in my mentions um look I’ve gone out of my I’ve gone out of my way especially with the sort of um announcement about the the College of clinical leadership to recognize the importance of good leadership and management and crucially and come back to this point of the that I was making about just going around and sacking manag all the time um you’ve got to support people to become good managers and good leaders someone might be an outstanding clinician doesn’t automatically make them a good manager or a good leader um it is a skill in itself and we owe it to um leaders in this system and potential leaders in this system to nurture them to train them and support them and that’s why I say where you’ve got poor poor performance at the bottom of a of a league table the right approach is to is to to is to go in and and look at the factors that are driving poor performance and to put in place the right package of support to help them turn that around because um one of the things I’ve been struck by and I think one of the cultural changes I’ve seen in the NHS in recent years borne out of this crisis is um you know you walk into a hospital as I did down in the southwest uh the other summer and um ABS it was on Steve Barkley’s hit list the first time he was Secretary of State it was one of the troubled trust he was ringing and berating to brief the media and feel good about himself and um I went into the hospital the chief exec took me around gave me a very honest account of the challenges and most of the answers to the poor performance of that hospital lay in primary care and social care so just coming in or picking up the phone and shouting at a chief exe demanding they do better um isn’t changing anyone’s lives isn’t changing patient experience it’s just moralizing um what you actually need to do is go in and look at the contextual factors for poor performance and say okay what do we need to change in this context what support do you need from the center or from system Partners to improve performance to the benefit of patients and that’s what I want to bring and I think having that transparent data available enables us to have those conversations and the benefit for patients also is you know and I see this happen all the time in the sort of world I now live and work in compared to the world I grew up in um the wealthy wel connected are really good at working out who the good providers are in fact they’re very good sometimes at working out who the best individual Consultants are and making sure they get access to those people and to those providers uh and I want every patient to have access to that information and data transparently so they can also make informed choices not just the wealthy well connected the the other side of that is people also want to know that their local hospital will be the best place to go and that they don’t need to it’s not about having access to information always it’s about just knowing you can trust your local services to provide the best standards and that was one of the issues that came up of the previously of a government that’s absolutely true giving people information that they don’t have to go and research and then apply for you know apply to that hospital apply to that school well and but to be honest people are doing that already it’s just that only some people are doing that already and and of course we would want we would want it to be the case that every local practice every local hospital every local provider is providing an outstanding level of care or has um the shortest possible waiting list but I’m starting with the world as it is not as I would wish it to be um and I want to make sure that we have transparent information not data sets that are buried away only for the wealthy well connected to access um we’re streeting thank you so much I think you can understand why I just wanted to get through all the questions being submitted online sadly we’re out of time for this session but um I’m sure we’ll be speaking to you again in one way or another uh thank you again thanks for having me thank you