FabStuff Podcast

In the latest Podcast, Greater Manchester Mayor Andy Burnham reveals that the government has agreed to appoint a new Health Commissioner who will be jointly accountable to the Mayor and to the government for health and social care services. The Mayor said that the Commissioner would have dual accountability, as the ICB chair for NHS purposes and as a health commissioner to the combined Greater Manchester authority. “I'm really excited about that.” he says.  “Finally it feels to me we're getting close here to (an integrated) model of commissioning, priority setting and direction setting. The rest of the Greater Manchester system now is highly integrated, our other public service work as one, but the health service has become an outlier. That's been worrying us greatly and we think this might solve it.” In a wide ranging discussion with Niall and Roy, Andy Burnham says we will never know whether he could have won the Gorton and Denton byelection, but insists he would never have asked to stand unless he thought he had a good chance, and he rejected the idea that if he had won, the Mayor role would have been at risk. Instead he suggests that if he had won the byelection that would have created a positive momentum for Labour in any Mayoral election.Among many insights in the podcast, Andy reflects  on how he began to move away from the New Labour health  agenda while serving as a minister in the Blair administration in the mid-2000s. As for the current government, he commends them for starting to get a grip on the challenges facing the NHS but laments the delay in tackling social care. “How much longer can we keep flinching from that challenge? It’s got to be faced. There will no marked improvement until they grasp the nettle of social care reform.” There is also a frank assessment of the state of current services, in which he points to the vast number of older people trapped in hospital beds, to their and everyone else’s detriment. Andy’s father has dementia and he talks about his frustration at a care system which seems determined to dial 999 at every opportunity and send his father into A and E, when that is the last place where he should be going. But he is optimistic that his model of integrated services focussed on prevention can in time release resources and create a much more responsive community based set of services.  He claims his ‘LiveWell’ revolution in Greater Manchester will mean doing prevention in a way that has never been tried before, diverting significant resources into voluntary and community organisations and letting them be first port of call. In time he believes it will create services that keep people healthy and create wellbeing, transform health and social care and  take pressure of the NHS and other public services.Send us Fan Mail

In their latest podcast, Niall and Roy have a fascinating exchange with Paul Farmer CBE, the leader of Age UK, Britain’s largest charity campaigning and providing services for older people.Have older people got it too easy?Little more than a generation ago, pensioners were seen as among the poorest and most vulnerable groups; today the vast majority have never had it so good. Yet Paul argues that is a dangerous narrative which ignores the two million or so older people who either experience poor health, financial insecurity or loneliness. And he rejects the idea that this is just about deprivation, suggesting we have not faced up to the enormous challenge of living in an ageing society.  When challenged on the cost of the triple lock for pensioners, Paul says he  welcomes the debate about the future of the state pension, including the possibility of means testing. But he warns that successive governments’ record on means testing has been extremely poor.  On social care another warning - because of chronic and persistent underfunding he suggests something terribly bad could easily happen and that solutions offered in the past will need to be revised given the parlous state of services today. Paul argues not only that social care needs significant extra funding but also a long-term view; the question is who is going to play for these reforms?  As for the NHS, he points to fact that in the last year more than fifty thousand patients in their 80s ended up hospital corridors, and that we need to start looking at the health service through the lens of older people. He is challenged on how much of Age UK’s income actually goes to local branches that provide direct services, as opposed to lobbying and other national activities. Paul responds by saying they have begun to give more to local branches and have plans to do more.  Listen to Niall and Roy’s reflections on this absorbing exchange with one of the most influential leaders advocating for older people in the UK.    Send us Fan Mail

Listen as  Niall and Roy delve into the world of nursing,  with the leader of the Royal College of Nursing (the  world's largest nursing union) Professor Nicola Ranger.In a frank exchange, Nicola reflects on the crisis of recruitment and retention, the fact that nurses spend too much of their time on pointless tasks, the unprecedented levels of low morale and the possibility of strike action. Nicola believes there is an urgent need to reform nurse education, including in her personal view,  a national exam for every nurse wanting to join the register. This is a clarion call for reform within and beyond the profession, and a warning of an existential threat to the NHS if the government does not invest and start to value nurses.  Send us Fan Mail

The British Medical Association are never far away from the headlines but what is their real game? In their latest In the Loop podcast, Niall and Roy have an in depth discussion with Dr Tom Dolphin the BMA chair who leads one of the most powerful trade unions in the country, if not the most powerful.In a revealing exchange Tom reflects on the growing militancy of doctors and their willingness to strike, as well as the changes affecting General Practice which for some GPs is making their lives less satisfying and more transactional. But he insists the partnership model, in which GPs run their own businesses, can survive if it is properly supported, in spite of many younger doctors choosing to take on salaried roles.Tom  doubts the value of revalidation, the system that requires doctors to show they are competent and up to date and he blames the NHS for making doctors undergo pointless statutory training as part of that process. He is deeply concerned at so called ‘doctor substitution’, whereby tasks once performed by doctors are being carried out by professionals with new roles such as Physician Assistants, and he reveals talks are underway with the Royal College of Nursing about the expanding roles of Clinical Nurse Specialists.As the seemingly existential duel with the UK government goes on, this is a chance to hear the leader of Britain’s doctors as he reflects on the battles ahead for the BMA, but also to hear his take on the wider and fundamental challenges facing the medical profession. Tom insists the BMA and the UK government are aligned in their ambition for the NHS, but there is little sign in this exchange that the union will backdown. Indeed he issues a warning that if things don’t go their way, further strikes are possible from other doctors including consultants, the most senior doctors on the front line.Send us Fan Mail

Send us Fan Mail

To start their 2026 podcasts, Niall and Roy make a departure from their usual focus on the politics and management of the NHS, and explore the worrying state of our young people.  The awful reality is that youngsters in the UK appear to be unhappier than nearly all their European counterparts. Their first guest of the New Year is David Gregson an entrepreneur and philanthropist who has embarked on an ambitious and innovative programme called #BeeWell. Its aim is to improve the wellbeing of young people throughout the country, starting in Greater Manchester and a few other areas of England. Working with the Mayor, Andy Burnham together with schools, local authorities and the NHS, the architects of the #BeeWell approach already claim to be having a significant impact, affecting the lives of thousands of young people. But can this programme, which demands action and a mind-shift from statutory and voluntary services, really be the catalyst to change the prospects of the next generation? In a fascinating exchange, David Gregson points to weaker family relationships, restrictions on child freedom, and the fact that adults often no longer understand the world in which their youngsters live. He applauds moves by the UK government to raise the profile of youngsters’ wellbeing and its support for idea of conducting surveys in every school, but he wants them to go further and faster.Send us Fan Mail

Niall Dickson CBE and Roy Lilley with their latest guest Dr Charlotte Refsum In their latest In The Loop podcast Niall and Roy lock horns with Dr Charlotte Refsum Director of Health Policy at the Tony Blair Institute. In a frank discussion Charlotte a former GP,  reveals how the former Prime Minister is still closely involved in policy development and she lays out the stark choices facing the NHS if it is to survive in the face of the enormous challenges it currently faces. Charlotte is a former GP who has specialised in health policy. She worked for the consultancy firm KMPG and has been involved in supporting change in 25 countries.  She contributed to the government’s NHS plan and has worked with Sir Patrick Vallance and Sir John Bell on technology and how the arrival of the AI era will transform health and care.In the podcast Charlotte defends the Institute’s links with big tech companies and non- democratic governments and insists she and her colleagues have editorial independence and have never felt under any pressure to write anything or hold a view because of those relationships or funding. What follows is a frank assessment of the current government’s strategy but hard questions about what will be needed to implement the changes needed and whether the absolute priority, which concentrates so much of its resources on older people with long term conditions, is justified. Charlotte suggests the current budget may be all we can afford, and in her view the NHS needs to find ways of living within its means. That will involve thinking like an insurer, assessing future risks and taking prevention much more seriously. And there is also  talk of copayments for some new treatments for those who can afford it and the need for the NHS to start decommissioning some services if it is to embrace the technological revolution that is underway.  And she suggests we need a revolution in primary care. As for the professions, she suggests the impact on doctors and others is uncertain but will be profound.  One of the changes she identifies is how new technology will continue to undermine the asymmetry of information that underpins the professions and how it will become easier and cheaper for people to seek advice from elsewhere. But she adds, that does not mean a dystopian future where we send out someone with an NVQ and an iPad to get and manage complex cases! Send us Fan Mail

Niall Dickson CBE and Roy Lilley with their latest guest Rob Webster CBE For this next edition of In The Loop podcast Niall and Roy come together with Rob Webster one of the most prominent NHS managers and a huge advocate of integration. Rob heads up the West Yorkshire and Harrogate Health and Care Partnership an integrated care system.  And like every other system in the country he is grappling with a huge financial challenge, a big reorganisation, redundancies and staff threatening industrial action. So how is he managing as he faces a 45% reduction is his workforce and key staff in an angry mood? Rob reveals this is the most frustrating period in his 36 year career with enormous pressure on everyone and he admits it is causing harm to his staff.  But he insists it will not distract from the work. While he acknowledges the difficult financial position, he says the transition is incredibly difficult, supports the aims of the reorganisation and believes that close working relationships between health, local authorities and the third sector can and will deliver meaningful change.  He says the NHS must put its people first and argues that staff have quite rightly become dissatisfied and that the job of NHS leaders is to do something about this. He notes how painful it has been to see the attrition of standards over the past fifteen years but suggests this can be a period where the NHS has to recover and transform services.Niall and Roy remain concerned about what can be achieved given all the headwinds but here again is a leader who says they can make progress.This podcast was recorded before the government announced the go-ahead for widespread redundancies in ICBs and NHSE.  Speaking at a Providers conference on 12th November the Secretary of State said; ‘...Funding arrangements [for voluntary redundancies] have been agreed with HM Treasury and will be from within the existing funding settlement. We will not be cutting any investment to the NHS frontline. Further detail will come forward in the coming weeks.’It is widely anticipated that NHS organisations will be permitted to overspend budgets in the current year and the amounts reclaimed over subsequent years through efficiency savings. Send us Fan Mail

In their latest podcast Niall and Roy engage with Sarah Woolnough the Chief Executive of The King’s Fund, one of the country’s leading health think tanks. In a frank discussion, Sarah defends the role of think tanks and laments the government’s failure to embrace public health and prevention in its first year in office. She is highly critical too of the decision to kick the social care can down the road and says the Fund is now exploring radically different ways it could be funded, including social insurance.She is no fan either of the current reorganisation, arguing that she would have done it differently and quoting NHS leaders warning that it is already a major distraction. And she calls on the government to be honest about what it can and cannot be achieve within current funding constraints.Sarah reveals one of the most powerful moments she has had since joining the Fund: listening to leaders revealing the moral injury they have felt for not being totally transparent about their financial position for fear of being placed under greater performance scrutiny. And while she wishes pharmaceutical bosses better understood NHS funding challenges she understands their ‘immense frustration and anger’ because they feel the government has led them up the garden path.Send us Fan Mail

EXCLUSIVESir Jim Mackey, Chief Executive  NHS England in conversation with Niall Dickson & Roy Lilley... in a frank interview Sir Jim talks about the difficulties he is facing and the fact taking on what he thought would be the job and how it's actually worked out, are two very different things!In this wide ranging conversation he accepts the pending redundancies are a cause for great concern and says that he does not anticipate any compulsory redundancies although the time scales are still uncertain.Managing the complexity of reorganisation, the pressures to deliver waiting lists and the Ten Year Plan are all on his 'to-do-list'.Listen to how he prioritises and how he sees the future.Send us Fan Mail

In their latest venture In the Loop, Niall and Roy turn to mental health and conduct the first interview with Claire Murdoch,  NHS England’s outgoing mental health director since she dramatically resigned earlier this month after nearly ten years on the job.   In the podcast, Claire says she quit because she felt she no longer had political support and reveals her dismay at the failure of the new government to maintain the share of NHS spend on mental health. In a strong defence of what has been achieved on her watch, including more than doubling the number of professional staff working in child and adolescent services, much improved access for young people, despite a huge increase in demand, and great progress on a nationwide roll out of mental health support in schools. Looking forward, she says the share of NHS spend has been phenomenally helpful and must be protected and that as far as she is concerned it was ‘job begun not job done’. But this discussion also reflects the reality of mental health care in England today with services desperately struggling to meet the explosion in demand and with patients of all ages unable to access the support and treatment they need.Send us Fan Mail

The latest podcast from Niall and Roy sees a somewhat different take on the current state of the NHS from Dame Jennifer Dixon, the longstanding and respected Chief Executive of the Health Foundation. Jennifer, who once practised in paediatrics before moving into public health, accuses the government of being disrespectful and menacing in its approach as it seeks to reform the service and argues that the system needs to use its principal asset which is human capital.  She also questions whether it will be possible to deliver all that is being promised, arguing that while technology will help it is possible to be unrealistic about what it will achieve.Dame Jennifer also questions whether the current approach to prevention will work suggesting that there is a limit to how much the NHS can do given its funding constraints and she warns that if autonomous Integrated Care Boards could go upstream and spend funds in that way it could be at the expense of basic services. She says that while we are not there yet, if improvements don’t come fast enough, we may get into a situation where we need to look at getting much more money into the system from some other routes.On her own profession, she says she understands why young doctors are angry but reveals how she saw at one hospital how disrespectful they were to their chief medical officer, switching off their online cameras and putting barbed comments in the chat box. Jennifer calls for much more practical support for resident doctors but predicts that technology will mean more tasks will be protocolised and that as a result in the future there may be a need for fewer physicians, with those who are there working at the top of their licences. The next five years she says will be the most critical in the NHS’s existence.Send us Fan Mail

In their latest podcast Niall and Roy have a fascinating exchange with Professor Lord  Darzi, the eminent surgeon and former government minister whose independent investigation earlier this year laid bare an NHS that is failing at so many levels and which has lost public confidence. In the podcast, Ara Darzi reveals how shocked he was to find that staffing was not the issue, but that instead there had been a serious crash in productivity. Nor was funding the issue. He says money has been wasted over the last fifteen years. Instead, he argues that the answers lie in empowering local leaders and grabbing the huge opportunities for innovation from the digital revolution. He predicts that AI will transform clinical practice and slash the current administrative burden. But none of this will work unless the NHS receives capital investment, and he adds that the neglected area of social care must be tackled. Send us Fan Mail

In this episode of their Podcast In the Loop Niall and Roy step on to new ground in a fascinating discussion with Professor Tas Qureshi. a General and Gastro-intestinal Surgeon at Poole Hospital in Dorset. But Tas has another role – he has made a number of trips to Gaza as a volunteer, giving up his free time to support his fellow surgeons there as they deal with the most horrifying of trauma injuries, as well as helping to train staff in the treatment of cancer.  This is a personal story, not a political statement but by telling it Tas hopes to highlight the plight of all those who are suffering, including so many children. In doing so he gives us a mental picture of what it is like to operate, medically and in every other way, in a war zone. You will have seen many terrible pictures of the suffering in Gaza, but this account, with words only, is in some ways more illuminating, more powerful. He reveals the impossible choices he and his colleagues face of which child to treat and which ones must be left to die, sometimes in agony, the so called safe houses which are not safe from bombs and bullets, and the resilience of humans in the face of impossible odds. Many UK doctors do incredibly valuable pro bonowork, but Tas is one of a smaller band who are also prepared to risk their lives to relieve suffering. And like Tas, they are not keen to promote themselves, but are keen to tell the story of what they have witnessed. Send us Fan Mail

In their latest podcast Niall and Roy invite Dr Penny Dash, the new chair of NHS England, to join them.Within weeks of her appointment the secretary of state announced that NHS England was for the chop and that he would subject the NHS to a major reorganisation. But Penny is unphased and says the current system is riddled with complexity and duplication and could not have survived, although she admits with the Department running everything we could well be back to the old challenges of too much political involvement. She also makes clear there is much to do to make the Integrated Care Boards effective commissioners.  Making the NHS more efficient is a clear priority – workforce numbers have gone up, but activity has not, and now she says we have more operating theatre staff than any other country in the world. So, with only limited extra funding, how will the new NHS leadership achieve the promised transformation – according to Penny, better allocation of resources, better operational management, increased productivity, and a real embrace of technology which she describes as ‘a bit of a magic wand’. Listen now!Send us Fan Mail

In this latest podcast Niall and Roy talk to Dr Bill Kirkup CBE, who has headed some of the major enquiries into failing NHS services, including paediatric cardiac surgery in Oxford. Liverpool Community Services, and the high-profile investigations into maternity services at Morecambe Bay and East Kent Hospitals.In a frank discussion, Bill reveals that he does not believe enquiries have made things better or stopped the pattern of failure. He says that since his investigation into Morecambe Bay the problems in maternity have appeared at an accelerating rate. And he is adamant that while these enquiries can help to expose what has gone wrong in a particular Trust and provide vindication for families,  they are not equipped to bring about improvements. Bill argues that the failings identified in these Trusts are systemic and national, not particular and local. They are symptoms of wider cultural problems.He is also scathing about the value of the operational recommendations that have come out of some enquiries. He points out that there are now literally hundreds of maternity recommendations which has led to a situation in which Trusts have to employ people with clipboards just going round ticking off which ones they have done.Since the recording of this podcast the Secretary of State Wes Streeting has announced a national investigation into maternity services. However, Bill  Kirkup joins for an extended discussion with his reaction to yet another maternity reviewSend us Fan Mail

In their latest podcast Niall Dickson and Roy Lilley are joined by former health secretary, foreign secretary, and chancellor,  Sir Jeremy Hunt. In a fascinating insight, reflecting on his years in power, Sir Jeremy reveals how terrified he was to find himself responsible for the NHS knowing nothing much beyond his own constituency issues.Over time he says he learned how to work the system to secure more resources for the NHS from the Treasury.  He says being Foreign Secretary was great fun and you were not blamed for anything, while being health secretary was a privilege, but you were blamed for everything. He feels that having NHS England as an arm’s length body worked during his time, and that Wes Streeting needs to be careful what he wishes for in ordering its abolition.Sir Jeremy admits cuts to social care went too far in 2010 and says he wanted to do more but was moved on before he could follow up his 2019 NHS cash injection. He remains passionate about patient safety and calls for no fault medical negligence, the abolition of all NHS targets and a single budget at local level for older people receiving NHS and social care services. Send us Fan Mail

In this podcast on social care reform with Niall Dickson and Roy Lilley,  Sir Andrew Dilnot, the former Director of the Institute for Fiscal Studies pulls no punches when it comes to the missed opportunities of successive governments. As the author of the definitive 2014 report on social care reform, he shows his frustration and dismay at this government’s failure to tackle a crisis that is now leaving millions of vulnerable older people without the support they need, and at the same time crippling the NHS.  And Sir Andrew reveals how, if only Boris Johnson had remained Prime Minister for a little longer, serious reform could have been achieved. He points out that the extra demand for social care is a fantastic achievement created by longer lives but argues that there is a need for a  change in public attitudes and for government to grow up and get on with it. If they don’t, he predicts they will not deal with the challenges facing the NHS.Send us Fan Mail

Send us Fan Mail

What happens when a leading banker groomed in the disciplines and attitudes of the private sector finds himself in charge of the NHS in England? Surely he will be highly sceptical at least, suspicious and critical at best? But no - the story of Richard Meddings the outgoing NHS England Chair is of a Damascene conversion. In this podcast with Niall Dickson and Roy Lilley, Richard reveals himself as an arch defender of the NHS at every level including the achievements of the about to be abolished NHS England.Send us Fan Mail