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Maths, mops, restroom and cleaning supplies. First aid and safety products to help your employees stay safe. They even test and inspect fire extinguishers and emergency lights. Sintas helps keep your business running smoothly. See what Sintas can do for you. Visit Sintas.com and get ready for the workday. Welcome to the rest's politics with me, Alistair Campbell. And with me, Rory Schitt. And we're standing, not actually that bizarrely as we're about to explain on the top of the O2. So if you hear strange noise, helicopter's plane, so it's right next to London City Airport, I'm trying to deal with the legacies of my vertigo. But the reason why we're here, Alistair, is because when we do our rest is politics tour, the final culminating venue is this one, the O2, weird that we're going to be there. Pretty weird. But we are also going to be joined by the presenters of our sister podcast in the United States, Anthony Scaramucci and Katie Kay. And not only are they coming here to the O2, they will be joining us in Glasgow, in Cardiff and in Manchester. So that's all very exciting. That's why we're here at the dome. Very exciting. And I think I can confidently say probably the largest live audience ever for a podcast in the UK. I'd just also, yeah. Anyway, tell us a little bit about the O2 and the history of this because it's very associated, isn't it, with Labour, with Tony Blair, with Alistair Campbell, with Peter Madison. What's your memory of it? Well, the whole, it's a very interesting example of the dome, of how sometimes outgoing governments can work pretty well with incoming governments. In fact, over there, we can see the whole kind of Olympic thing. And that's another example where one government goes out, another government comes in. The dome was very much the brainchild of Michael Hessel Tyne under John Major. And what was this idea? The idea was that a sort of very kind of wasted piece of land should become this amazing celebration of the new millennium. And am I right in saying that a lot of this is about the Crystal Palace and exceptions in the 1950s. The idea is there's going to be this regeneration comes through some amazing building, huge project, millions of people will turn up. Because you remember where I live in South Kent, the Natural History Museum, the science museum, always built from the money, from the tickets of people coming to see that exhibition at the Crystal Palace. Well, it was about saying at the turn of the century, a new millennium showing a confident picture of Britain about our history and also about our future. Michael Hessel Tyne, I think, realised that the writing was on the wall, that they were not going to win the 1970 election, and that for all the money that they were going out to sort of, to build this thing, they needed the commitment of the Labour Party at the same time. So, one of the most memorable meetings, Michael Hessel Tyne coming in this century, look, if you guys don't sign this office, it's not going to happen. We were in opposition. And it almost was like saying, you know, this is a bit like being government. So then it happened. And of course, it was a very difficult decision. Most of the cabinet didn't want to do it. Correctly with retrospect. Well, I don't know when you stand here now, Roy. I mean, we talked about John Major, the National Lottery of the success of the Paralympics. Legacy takes many, many forms. Yeah. It takes a strange route. This, just look around now. This is pretty amazing, isn't it, to be honest? I'm not saying it was just like this. This is lovely, but this cost literally hundreds of millions of pounds, because there's got a catastrophic financial investment. And if we look at it at the time, if it's a rather kind of sad, because New Labour came in, they did have us, you had a vision of New Britain. Yeah. We got excited, cool Britannia, all that kind of stuff. I wish we were. And when Tony Blair turned up, we were all very excited. But then when it came to this, you didn't deliver anything like Danny Boyle at the Olympics, which is presumably what you were hoping to deliver. Well, Danny Boyle at the Olympics, of course, was 12 years later. And listen, if you were to say to me, which was the better event, the only ceremony of London 2012, or the night of the Belledium celebrations here, I'm giving it to Danny Boyle by a very large margin. And what went wrong? Why weren't you able to do a Danny Boyle-style event? Well, because he was all set on this building, because it was a project with a very, very clear deadline, midnight, turn of the century. And it was very, very hard to put together something that everybody was going to go, wow, this is amazing, like they did with Danny Boyle. And also the politics of it were very difficult. There wasn't that much enthusiasm. It took a lot of drive from the top, Tony Blair, Peter Mandelson, as you say, was involved. Charlie Faulkner was involved. At my right, Peter Mandelson was in charge. Then he had to resign. And then Charlie Faulkner was put in charge as a successor. Charlie was in charge on the night. And Charlie, I regret to say, Charlie, who I love dearly, but it's one of the few times I've ever really, really lost my temper, was on the night when we were getting, I was the media guy getting inundated with text messages from journalists and not just kind of, you know, lobby guys, but editors, owners who were stuck at Stratford Railway Station. And they couldn't get here because of the sort of chaos of the transport arrangements. And I remember this sort of, Charlie always says that my ears went absolutely purple as I was raging at this. So then we, of course, midnight comes along. Yeah. And the Queen's here. And I think. The Queen's here. I can, Prince Philip was here, Prince Isan was here. There were lots of royals here. Tony and Cherie standing alongside the Queen. And I was watching it on TV like most of the rest of the country. Well, I was sitting a couple of rows behind the Queen, frankly feeling a bit sick. My phone, literally a mid-life, still go with people. I can't get it. What the fuck is going to be? You were feeling sick because this was meant to be a really great media moment and the transport had all got screwed up. So you knew all the journalists were going to be pissed off from the negative way of that, because they'd all been stuck at the train station. And also back to the Danny Boyle point. I mean, look, Mick Huttonhall's a great singer and the cause are a great band, but it sort of, it didn't feel that it had that kind of absolutely mega historic moment. I'll never forget William Hague, who was then pleased with the Conservative Party. I think he was sitting in the row behind me. I was with Fiona and our kids. And at one point, as I'm looking around at these empty seats where the bjure it to be, and I'm looking around at the Queen looking to be absolutely frank, quite grumpy about the whole thing of what the hell is going on. And I looked around and saw it was William Hague, and he said, "It's going very well, I must say." And then the whole thing about, you know, holding hands in all Lang Zion and Shari loves belting out a song. So she's belting it out. Todie's looking a little bit sort of, you know, nervous. But what we knew and what we said, we then all got on a boat and went back down the river, back down to Westminster. And on the boat, I can remember saying to Tony, wasn't great, was it? No, they're not going to like this, are they? And from that moment, the media basically tried to kill the whole thing. I came to see it. I remember wombling around in this building. And I thought this is going to be... It was okay. It was kind of okay. It was kind of okay. I mean, for people who didn't see it at the time, there was, I think there was who we are and what we do. And there was a sort of special black-out of film. But it was pretty lame. I mean, who we are and what we do, it's pretty empty. I've got to be right. I bought a ticket. I appeared at stuff. I thought I was going to see some really cool technology. Like, I'd respond to me that maybe a vision of the future, robots or something. Which I guess was the great exhibition in the 19th century, Victorian Great Exhibition, was all the wonders, the world, technology, devices, products. Well, I've got to be honest, I came several times during the building. And let's be honest, the building is pretty amazing. You said pretty amazing. I mean, I'm not sure about the building, really. I love the building. What is it? It's like 12 towers, because there are 12 moments in the end. 12 and 52 meters high, because there are 52 weeks. I've got 52 meters high and it's on Greenwich Mean Time. Fantastic. Yeah. No, listen, I've got to be honest. I went to it several times. And I can't remember that much. But Rory, I always had at the back of my mind that one day, this is going to be transformed into an amazing entertainment venue. In which podcasters... In which podcasters... And eventually, there's going to be this new medium called The Podcast. And people are going to come together from different sides of the political offence. And maybe I'll be one of them and you'll be the other one and we'll do a podcast live at the O2. So it was all worth it in it? Yeah, I can't say I planned it in that way, but I kind of had a hunt. No, I think it's all worked out as a hunt. Just to finish on this before we move on to the rest of the podcast, I do think these things are really interesting, these mega projects. So, you'll remember that Tony Blair was on the record quite a lot saying this is going to be very exciting. Peter Manleston saying this was really going to symbolise New Britain. And I felt that a bit bizarrely with HS2, which has turned into this monumental catastrophe. Tens of billions of pounds worth catastrophe. But for Cameron and Osborne, it was the politician looking for the big symbolic legacy project, something that people can stare at. I mean, you know, people obsessed with the Hoover Dam or FDR building. Do you think there is a bit of a risk in modern politics that people get a little fixated on kind of big buildings, big projects, and they put too much into it and that that's often a route to failure? I would argue, for example, that looking out over there at London 2012, I think London 2012 was one of those big moments for the country and there was a legacy. I mean, it wasn't perfect, but I think it really, really took the country forward. I think what's just happened in Paris is the same. And if you look at, so just to go back to Paris, I remember being at a European summit chaired by President Miterral when they used L'Adé France, this new, amazing sort of beautifully art, beautifully designed, very French, kind of modern terrible. Hardly ugly, yeah. I like it. I'm sure that your friend Charles thought you was a car bunker, but I loved it. But I think that's a really interesting example where he was obsessed, Miterral was obsessed with his gone Pojé. And that was one of his gone Pojé. And there it is, decades later, that's where the swimming is in the Olympic Games. So I think these things can be a very, very big driver of a country is feeling about itself. But this wasn't, was it? This is not a big driver of the country is feeling about itself. It is now, but accidentally. I think accidentally, it is now, the O2 is now one of the most famous musical performance venues in the world. You know, if Beyonce or Taylor Swift are doing a kind of world tour, this is one of the places they're likely to come. So it has become a part of our cultural heritage. I'm not saying that was planned, that would be very disingenuous, even Peter Mandel said I don't think would go that far. If you look at the area generally, but I think this area is transformed because of the joint big projects of this and the Olympics. So I guess you are disagreeing agreeably with me because my general instincts, when politicians start talking about grand mega legacy projects, I get a bit worried. I tend to think governments more about sweating the small details. And HS2 definitely became for me, a kind of vision of that. But to finish on this, one of the great bits news that we're announcing here is that we've opened up the top flight of O2, new tickets becoming available. So joining the over 10,000 people that are going to be here, we're now opened up first stream of tickets. So people are to be encouraged to come along because they are going to be able to see us here at the O2. So it's October the 15th. To get tickets, you go to therestyspolarities.com and we'll be joined by Cattie Kay and Anthony Scaramucci, who will also be joining us in Cardiff, Glasgow and Manchester and Taylor Swift, Beyonce and Oasis will be joining us at Brighton and Birmingham. We can't guarantee that. We can't guarantee that, but it's a rumour. It's a rumour. It's a rumour. It's possible, isn't it? Anything's possible. It's definitely not that. Yeah. And if Kamala is around as well and needs a new sort of venue before the election, that would be great as well. And if not, I can get that old dude from the beach boys that I saw in Cape Cod. So that's it. I'd actually quite like to do the whole podcast up here, but the security guy is over there looking at us. Now he's saying it's all fine. We could do the NHS up here. They don't like the sound quality. They keep stopping us for the planes flying up. They think it's all about ticket sales up here. They don't want to talk about serious policy. Anyway, that's the reason why we've been banging on about the dome is because we're going to be here, but we're now going to go down. We've climbed up 300 steps. We're now going to go down and then we will do the rest of the podcast in better sound quality. Talk about some pretty serious issues internationally and domestically restructuring the NHS and big global events. So Rory, we're now back on earth. We're back on ground level and we're going to talk about the NHS. We're going to talk about Ukraine and we're going to talk about social media in Australia. So let's kick off with the National Health Service. So Lord Darsey, who was a minister under Gordon Brown and is a distinguished doctor, produced a rapid turnaround review for Kia Sama and for the new health sexually worse treating on the NHS and a surprise surprise, I think anyone listening will be surprised to discover that he concludes the NHS is in real trouble and the statistics are pretty shocking. There are currently 7.8 million procedures currently waiting and people would have seen in the newspapers stories about 12 hour waits at emergency rooms, you know, ambulances piled up trying to get people in. So he's come forward with a series of recommendations. One of the big ones is around capital investment. So one of the biggest ways in which the NHS has already been struggling is in terms of buildings and equipment. So he reckons we need to spend about 37 billion pounds, 37,000 million pounds on capital infrastructure buildings, including a 13 billion pound backlog of repairs to buildings. And then he's very interested in the shift away from hospitals towards communities, which was treating spoke about when we interviewed him on the show. In fact, people want more on some of the politics around health, maybe worth listening to, worth treating him for you by us on leading. But anyway, what was your, what was your view on it? Well, essentially, you've gone to some of the recommendations. I was somewhat overwhelmed by the analysis before that. And I think this, this, if you go, if you go through the whole report, essentially, he says, the NHS is in real trouble. We've got to be honest with the public with just how bad it is. We're a very unhealthy nation. The last government broke promise upon promise on waiting times, GP weights have got longer mental health is in a terrible state, A&E is awful, cancer cares lagging behind everything else, quality of care is terrible, low productivity, low capital spending, as you say, terrible morale of staff, terrible patient engagement. And then his conclusion, the NHS is in critical condition, but its vital signs are strong. I felt this was a really absolutely brutal analysis. And I worry it goes back to what we talked about in relation to Grenfell, whether the scale of policy solutions are going to match the challenge, because it is utterly damning when you read what's happened. And I have to say, Rory, when you see people like Victoria Atkins, the shadow of health secretary, come out and say, as she did, well, rather labor go on about what we did 14 years ago, 10 years ago, it's what they're going to do now that matters. That is true. That is true. It is what labor does now that matters. However, this is about as devastating analysis of the last government's management of the NHS is anybody could have written. And he's not couched in those terms. But even, you know, the Lansley reforms, we'll forget about the Lansley reforms. He says they were a total catastrophe, which has left the NHS workforce kind of, you know, still dealing with the fallout. The other thing to say is, I can remember the last time Aradazi wrote a report on the health service, it was the Labour government in 2008. And it was called high quality care for all. And it advised that we go from diagnose and treat to predict and prevent. And as you say, we're streetings through sort of three prong mantra now is to go from hospital to communities, as you said, analog to digital and to go from cure to prevention, all very, very, very, very, very sensible. What this report made me worry about was whether it actually is going to be able to be done in any sort of reasonable timeframe without loads of money. Yeah. And even with loads of money, how would you do it? Because, of course, that view from where streetings is exactly what Rishi Sunak, the outgoing conservative Prime Minister, was pitching all the way through those debates whenever an asked about his NHS policy, it was all about analog to digital, hospital, community, and prevention. The logic of it is obvious, right? And where streetings in the leading interview has some pretty good stats on the fact that the UK spends much more on hospitals and much less on primary care, public health and prevention than its equivalents in Europe. And he gives a good example. I mean, obviously, if you detect someone with stage one cancer, it's cheaper to deal with and the prognosis is much better. If you don't detect them to there at stage three, it's hospitalization, hugely expensive and difficult prognosis. So the logic of the whole thing is pretty clear. One challenge, though, is that that logic was pretty clear to the conservative government as well and was part of their stated policy. And it's what Jeremy Hunt was banging on about when he took over from Andrew Lansey. And as I said, Rishi Sunak was talking about a great deal. As for the investment in capital, of course, that was supposed to be Boris Johnson, Dominic Cummings, you remember, 40 new hospitals and all this kind of stuff was all about them recognizing that there was a massive backlog of investment. And even on the money side, the story around the NHS spend, and this is boring for listeners in a way, because we keep pointing this out. But the point is not that the Conservatives cut the NHS spend. NHS spend went up on average about 1% above inflation every year from 2010. The problem is that health in Britain gets much more expensive than inflation, naturally, because we're getting older all the time and drugs are getting more expensive. A lot of the money, well, substantial parts of that budget did go on these reorganizations, which, as I say, is absolutely scathing. You're pulling the capital spending worry. So in 2009, just before Labour left office, when NHS satisfaction ratings were at their highest, and when waiting times were at their lowest, capital spending was 0.54% of GDP. This is from Herodarsi's report. By 2013, it was 0.26. So that is austerity, I'm afraid. That is austerity. And he says, and it rose during the pandemic for obvious reasons. He said, if we'd matched the EU average, we would have spent $27 billion more on capital investment. If we'd matched the Nordics, it would be $35 billion. If we'd matched what he calls other English language countries, mainly Australia, which comes out really well from this report, it would be $46 billion. And the average overall, as you say, $37 billion, which he said would have eliminated all backrock maintenance and funded Johnson's mythical 40 new hospitals. So that is a massive, massive, massive gap. And you keep saying on the podcast, you said again last week. And Kia Starmer said, last said in his response to this report, there will be no new money without reform. Well, that's fine. But actually, reform can, particularly in the early days of reform, provide additional needs for resources. And it's very, very hard for me to work out how they're going to do this. I'm not a tall surprise. I think it was a sensible thing for Kia Starmer to talk about, you know, we're going to need 10 years to turn this around, because this looks like it's going to become a very, very, very difficult, long-term project. We keep coming back to this question of austerity and Tory cuts and stuff. So taking you as a kind of random person who sometimes says that economics is not your strong point, what's your guess of how much you think Gordon Brown increased health spending between, or Gordon Brown, Tony Blair, 18, 2000, 2010, and that 10 years? How much is it actually? Yeah, percentage transfer in the old terms, yeah. Well, you've obviously got the answer right in front of you. So I'm not going to guess because then I could look stupid. And it's something I want to know. In the olden days, I would have known that off the top of my head. So the answer is it's absolutely massive. Health spending, the annual budget on health, more than doubled between 2000 and 2010, went from 48 billion a year to 110 billion pounds a year. And I guess that's the sort of big elephant in the room. I supported it. I mean, I think Gordon Brown did the right thing. I think you did the right thing, you guys. But I think we have to be brutally clear with people what you did, which is you more than doubled the amount spent. It's a huge increase. And what then happened is not that the Conservatives came in and cut. It's the Conservatives came in and reduced. Yeah, they reduced the rates. They only increased by 1% a year over inflation instead of going up massively. They did increase the workforce. But the other thing that comes through Aradaz's report is that productivity didn't increase. If anything, the opposite happened. Yeah. So let's just step away for a second. So first big problem that you've put your finger on is money. If you really wanted to achieve the sort of improvements that you guys achieved, you're looking at something like doubling the amount that you spent on the NHS when the NHS is already consuming about four out of every 10 pounds in current expenditure. So problem number one. Problem number two is that the politics of this. So I just wanted to sort of bring it back to you and Tony Blair and me as an MP and a minister about really talking about the problem of reform. So we have the idea, which we all agree about, and then it's actually doing it. So the truth is that reform in the NHS, I mean, almost broke Margaret Thatcher in 1990. She sacked Ken Clark reversal of forms 2003, which I'd love to talk to you a bit about. You almost lost your majority in trying to bring in foundation hospitals. Lansley and David Cameron, Lansley was sacked and the whole Lansley reforms, again, critically threatened the coalition with the Lib Dems. And why does that happen? Well, partly because one of the biggest problems that's very, very central of all of this is hospitals. And in order to do what Lord Dazzi is talking about, what West Street is talking about, you've got to move money from hospitals to the front line. And basically that means cutting hospitals. I mean, there's no other way of putting it. If you're shifting the proportion of money you're spending on hospitals towards the front line, you're cutting hospital budgets. And every single time you cut a hospital, you have MPs up in arms. And I saw this just to be honest about this. I saw this in Cambridge, right? So the Cumberland infirmary in Carlisle, even in 2010, even at the end of the Labour government, was in real trouble. Terrible results on breast cancer screening, superbug problems. So there was an attempt by the government to try to deal with this. And the boards and the experts came together. And they said, we've got too many hospitals in Canberra. We got the West Cumberland infirmary. And we've got Carlisle. And there's a really good teaching hospital in Newcastle. And all the evidence suggests we would get much better results if we merged the two hospitals in Cambria. And we moved more and more services to Newcastle, where they have much better research and results. Consequently, total cross-party, lived-em conservative Labour up in arms. And of course, none of us want to see the big picture. I was fighting about the closing of every single community hospital in my constituency. Elections were lost by elections were lost over the issue of the A&E in the West Cumberland infirmary. And nobody wanted to buy into the idea that actually patient outcomes would be better if we closed these hospitals. So I'm just going to stop there and get you to talk a little bit about the politics of this. Well, the politics are very, very, very difficult. And what this report, I think, I think the purpose of this report is actually to try to establish in the public mind a bit like they did on the economy with the black hole. We've been banging on about the NHS being in a really, really, really bad state for years, ever since the Tories have been in. It's actually a lot worse than you think. And here's the evidence and here's the report. And then, where Streeting has the job and Kia Starmer has the job of bringing forward the reforms that he's talking about and bringing forward a 10-year plan. Now, if they are right that this is going to take 10 years, which I think and I think they probably are. That means they're going to have to win another general election, at least one more general election. And to win that general election, they are going to have to, and people are going to get sick to death of hearing labor ministers blame the last lot and the mess you left behind and you ruined the NHS, and we're fixing it. But they're going to have to cement that in the public mind, just as David Cameron, George Osborne did with the mess we inherited back in 2010. Otherwise, they will find it incredibly difficult to do difficult things. They're going to find it difficult anyway. And as you say, every time, we're seeing a version of this right now in relation to the universal, taking away the universal winter fuel allowance. Which is tiny compared to the NHS, right? Exactly. And yet, look at the right-wing newspapers, which normally would be arguing that universal benefits aren't a good thing and the thing should be means tested to save the state money. Every single contender in the Tory leadership election is coming out and saying this is a terrible thing to do. Every single MP who voted with the government on it is getting thousands of emails of organised campaigns, just as you used to when you voted on the government whip on unpopular things. So MPs are getting a very early sign on the issue of what will happen if you imagine, as you say, if you're the successor, a Labour MP in a Labour constituency with a hospital that the health secretary comes along and says, actually, we're going to reorganise, we're going to have fewer hospitals, we're going to put more of our resources into the community, we're going to build up mental health teams outside hospitals, and you know full well, there'll be a massive campaign because of the hospital. Now, my point to West Street in Keir Starmer, you have to face it down. Also, you're an MP who's won what wasn't a Labour seat before. So you feel that you fought to take this marginal seat, you've sweated every vote, some of these seats are on tiny tiny margins, and you've got either a Libdam or Tory opponent producing pamphlets quoting you saying you supported the NHS and now the ANE is closing in your local hospital or the hospital itself is closing on the breast cancer services are closing. Yeah, listen, it's not easy, but funnily I've just been reading Tony Blair's book on leadership, which is it's a very kind of Tony kind of read, but he's very interesting on this business of doing difficult unpopular things and he makes few recommendations. One of them is do it early in the first term because by the end of the first term, you've got to be able to show that it's progress being made. Which is the Ken Clark point, right? Absolutely, absolutely. But the other thing he says is that leadership is not about saying the things that people want to say and doing the things that you know that people want to do. Leadership is actually about confronting people with choices that perhaps they won't want to make, but your job as the leader is to persuade them of the long term need. Now that is very, very difficult in the modern age. And another example, the other thing about Tony's book is obsessed with technology and you know rightly in that it's so important to a lot of the changes that we talk about. But in Aradaz's report, he makes the point that actually the technological advances, if anything, have actually increased the workload of clinicians because the technology is not being used to best advantage. And I still don't think that we fully understand what we mean when we say technology can transform the way that we interact with the state. And Tony's argument is that we've got it, you know, he wants a sort of complete reimagining of the public's interaction with services like the National Health Service. On that again, it's true. I mean, I really believe that AI and technology could have incredible productivity benefits. But the fight that you would have is that to get productivity benefits literally just means you're basically replacing a human with a computer. And every time you do that, somebody's losing their job. And therefore, you have all the unions out against you. And their first argument will be safety. You know, the computer's not as safe or reliable as a human doing that job. And they will have incredible public support because people will be suspicious about the introduction to technology. So again, is the Labour government going to show the courage and the determination to face down the nurses, the doctors, the unions in order to bring these productivity benefits they could do? My other question, how can you do it early in your term unless you've got it up your sleeve? I mean, I got the impression that you had before you came in in '97 already had pretty clear thoughts about Independence, the Bank of England, sure start so that you were able to get going quite quickly. Real reform of the NHS would require some secret plan, which these guys have developed over the last two, three years, which is really going to be a piece of legislation, the law that they're going to drive through the House of Commons. But when does it exist? I mean, do you think this thing exists or they're writing it now? I mean, I don't know is the answer to that. I think the three pillars are the ones that we've talked about that we're treating as taught in terms of kind of where they want to take the NHS in terms of the areas for reform. Again, to go back to the report, when you read his analysis of the landscape reforms, I didn't know this. They established over 300 new National Health Services organizations. And he makes the point, how can they possibly all be high performing when you're creating 300 new organizations within an existing already complex structure? So I think there'll be resistance to some extent by the government in wanting to make it all about organizational and institutional change. But if you're talking about transforming from the analysis that this report presents, which is really, really damning, to something where he says, and Keir Starmer says, and West Street, he says, "The fundamental principles of the National Health Service are not up for grabs, so the funding model is going to stay the same." And then I think you're kind of hemming yourself in. I'm presuming you said this is sort of short order review. I imagine they'll now be a longest order review. I wonder whether they will at some point try to broaden this out to bring other parties into the debate and discussion about it. I mean, it's astonishing they haven't. I mean, it would seem to me that the obvious thing to do with the NHS is to get a cross-party 10, 15, 20-year plan together, which everybody signs up to. That's why I keep shamelessly trying to say, I'd love to serve on a cross-party commission on this and bring in the end of this. You've downgraded your role. You wanted to chair it earlier. No, you just want to be on it. Exactly. No, I just want to be on it. But no, because I think there's nothing more important, and there's nothing which more obviously needs a much longer-term plan. And that's the only hope, presumably, of getting really difficult reforms through. As we conclude, just to bring it to life again for people, I guess one of the interesting things about the NHS, unlike prisons, which most people don't visit, is we all go to the GP and we've all got relatives in hospital, so that we see the best and the worst of it much more frequently. And it touches our lives. There are more than 1 million people employed in the NHS, 360 million GP appointments a year. I mean, so if you think about my personal experience, delivered my son at home, fantastic experience with 999 because they told me how to help get the baby out. Obviously, with Shoshana doing most of the work. Slightly disappointing experience with the ambulance, given the ambulance didn't turn up for about an hour and a half after the baby was born in Central London. Then fantastic experience with the midwife, who then turned up and weighed the baby at home and said we didn't have to go to hospital. So I'm going to do a little snapshot, but I mean, every single one of us are living these lives where we turn up, we see some things we think are terrific, and so many things that are obviously ludicrous and wasteful. And then finally, when you look at the statistics, one of the reasons they keep reforming doesn't matter where it's Ken Clark or Alan Melbourne with labor or Andrew Lansey. One of the things they're always worrying about is how different different hospitals are in performance. I mean, you can see some hospitals will spend on average 2,000 pounds on a procedure that another hospital is spending 1,000 pounds on a procedure to do. Some hospitals are managing to get twice as many procedures done in a day compared to another hospital. And they can be hospital to London hospitals with very similar cash from populations. So a loss of this stuff comes out. What do you do about it? What do you do? I mean, you know, I felt this in a small way in prisons. If you turn up the places filthy on the windows where you turn up in a hospital, they're missing appointments, the emergency rooms, stuff, the ambulances are queuing outside, too many patients today. How do you sort that out? And of course, you can't do it from the center, right? You need really good management systems, but you train the management systems. And then of course, Lord Darcy says, we've created 300 new management systems. Yeah. Yeah. I noticed that when Kia Starman and West Street, when the review was published, and they did a hospital visit with cameras in tow, and I recognized it was University College Hospital. And it was in one of the most modern high tech, amazing equipment, fantastic new blocks. And yet the story was about how terrible everything was. It is all sort of falling into bits. Anybody watching that clip and work here, some was talking with a thought, my God, if every hospital was like that would be kind of okay. We all know, as you say, we all have our experience, some good, some bad. I was in hospital a few months ago, and actually things went a bit wrong, but it wasn't their fault. And they were absolutely brilliant about either dealt with it. Other experiences, my GP is pretty good. So we've all got those stories, but equally, what comes through this report and what comes through all the polling is that sat patient satisfaction is going down and down and down and down. And one of the big things he talks about, you talk about too much focus on hospitals, too much resource on hospitals, even worse than that, because of the lack of provision of social care and the failure of the last lot, or failure of either the last governments to really to fix it, the capacity that is wasted on people who are literally staying in there for weeks, sometimes for months without good medical need, because they have nowhere to go. And as a result, ambulance delays, he says the main cause of ambulance delays, which you suffered as well, is probably the ambulance that should have been coming to you when your when your son was being born, was stuck in a queue outside the hospital waiting to try to find some space to take somebody who who needed a bed. And my final point, Roy, before we go to a break, you know, I've got an interest in in mental health and his analysis on mental health was just devastating to read. 41% drop in learning disability nurses. Overall, mental health now 20% of the disease burden, but 10% of the resource that goes into health service, a reduction in mental health nursing between 2011 and 2016, out of area placements rising again, including for children and young people. We've had a wasted decade where the talk has been good. I've said on this podcast many times, I think David Cameron Theresa May really meant it when they said they wanted to reform mental health and improve mental health services. But you read this report and I'm afraid they got worse on their watch. So anyway, this is going to be forget sort of rounds over Keir Starmer's wives clothing and even things like winter fuel allowance. I mean, eventually that will either get tapered and sorted or it'll get, you know, just sort of go into the body politic. But this, the national health service, the future of the national health service, this is fundamental to the future of our politics for the next, for the next several general elections. And this report on whether they can fix the problems the outlines is right up there and top three top government challenges for Keir Starmer right now. Very good. Well, Alison, let's take a quick break. This episode is brought to you by the London Review of Books. And London Review of Books is actually probably the magazine that I admire most in the whole world. So fourth nightly magazine, I'm slightly biased here because I've also written for the London Review of Books, but I don't write for many more. And I still continue to read them because I admire them. Even without your oil, they've got some amazing writers such as David Runciman, James Butler, Andrew O'Hagan and Mary Beard, not just brilliant writers, but deeply, deeply knowledgeable about the things they write about. That's right. Andrew O'Hagan was there at the Republican National Convention, wrote a great piece on that. Famous, he actually wrote a great piece on Grumpfland in the past. But they cover a huge range of subjects. I particularly enjoy reading James Meek, who's just written a great piece on the housing crisis. No other magazine is as widely recognised as the London Review of Books for the Quality and Breath of its Writing. And listeners to the rest of his politics will get a free L.R.B. tote bag when they subscribe. Go to lrb.me/tote to get six issues for just six pounds and a free L.R.B. tote bag, plus lrb.me/tote to subscribe. Want a website with unmatched power speed and control? 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Shop Lion's.com's prime-time kickoff event save up to 50% off select styles, plus doorbusters. Rules and restrictions may apply. Welcome back to the rest of his politics with me, Alastair Campbell. And with me, Rory Stewart. Now, Rory, last week, Kia Starman went off to Washington, sat down with Joe Biden. And the big issue in terms of the coverage of that was about Ukraine. And this issue of weather Ukraine and Zelensky can use these storm shadow missiles, which can go much deeper into Russian territory up to now the missiles that the allies have been giving to Zelensky. They can use them. They use them for defense within their own territory. So giving them storm shadows already, they can use them to hit Russian territory, but only Russian territory, which has been occupied since the invasion. So they can hit crime here. They can hit done yet. It's because of hands that back to you. So big issue, these storm shadow missiles, which cost a million dollars every time you fire one off. And Zelensky wants to be able to use them to go further. They have a range of 250 kilometers. They can penetrate bunkers. They can penetrate ammunition stores. And you can see why he's pretty desperate to get his hands on them. And I think we were expecting a decision from the meeting with Joe Biden, but we didn't get one. Yeah. So storm shadow missiles are a cruise missile. It's quite a big thing. I mean, it's got a three meter wingspan. You strap it to the bottom of a bomber, release it, and it actually climbs up to altitude and then comes in. And since the French and the British started supplying them spring of last year, they've killed a Russian general. They've killed the commander of the Black Sea, fleet with them and strikes on Sevastopol. They've hit a submarine. They've hit a major Russian ship. So they've been quite effective. But at the moment, as you say, they can only be used for hitting territory, which is considered to be Ukrainian territory occupied by Russia rather than Russia itself. And what Kiyastama seems to now want to do is allow them to use these missiles to fire into Russia itself. That could be very useful, because it could allow them, obviously, more straightforwardly, to drive back Russian assets further back. So as you say, this thing would drive them back another 150 miles. It can also potentially hit Russian infrastructure. One of the big changes in the war is that the Russians are increasingly hitting electricity infrastructure in Ukraine. And maybe if you started hitting Russian infrastructure, it would provide a deterrence or some reason for Russia to back off of it. And again, it's one of these things which on its own isn't going to change anything. It's just part of the sort of general picture. The sort of bigger, broader pictures still are big debates about strategy. Should they have gone into course? Should the Ukrainians have invaded Russian territory? Is that a smart move because it gives them a bargaining chip? Or is it overextending them so they're going to weaken their front lines and the Russians may be able to advance in other areas? Is Russia going to continue to largely ignore what they're doing there and concentrate on breaking through the existing front lines, in which case the Ukrainians can dig in or Russia going to go north and try to deal with that? And what happens next year? Because a lot of this story around us supplying missiles is also about the US and the $60 billion that they voted this year, and the funny ways in which the Pentagon accounts for it, because of course it's not cash. What's happening is that the Pentagon says, "Oh, well, we're providing you with $60 billion worth of equipment." But of course, the Pentagon has every reason to overvalue its equipment. So a lot of kind of dodgy, armored personnel carriers that they use in Afghanistan, they don't have much use of, they put a big price tag on and ship them off to Ukraine. And a lot of the things Ukrainians want, they're still not getting that many off. And it's very difficult to get into the depths of Pentagon to work out why when the US military have 60-page trip missile batteries, they're only prepared to give one to Ukraine. Just a few things on the kind of political or the geopolitical arena on this. I think one of the reasons why Zelensky is really trying to get this thing over the line is because of these reports that Iran has been supplying more ballistic missiles to Russia and getting as part of the deal, getting support for their nuclear program, which presses a lot of buttons in Washington. And then the other thing that I think is worth talking about, there was a very interesting Jake Sullivan, whose Biden's main foreign policy advisor. He did a video link speech to policy makers and military people in Ukraine last week. And he was saying that it wasn't an unwillingness that was stopping them from doing this. It was difficult, complicated logistics. He said it's not a matter of political will, but given what Ukraine is up against, we've got to do more or we've got to do better. Now, reading between the lines, that sounded to me much more cautious than the message that Anthony Blinken, when he went with David Lamme to meet Zelensky recently, sounded a lot more cautious. The other interesting thing that came out of that was the head of Ukraine's intelligence said that at the moment of all of Russia's allies, the one that was the most damaging in terms of assistance was North Korea, because of the large, the massive quantities of ammunition that they were providing. So if you throw in Iran with their ballistic missiles and North Korea in that context, you can see why Biden might be a little bit cautious. The reason why the way, by the way, why the American go ahead is necessary, isn't just because they're the leaders of the Alliance, it's just that for these missiles to work, they require a certain amount of American technological and technical support. In order to operate, we had a good interview coming up with Anne Applebaum on leading in which she frames this debate. The big debate, obviously, is between people who think Biden's been correct to follow this relatively cautious policy. So listeners will remember over the last two and a half years again and again, America will say it won't supply a certain kind of weapon system, and then a few months later, it supplies it. So if you're on Biden's side, you say this is smart, they've been cautious, they don't want to provoke too much response from Russia, and that they're slowly boiling the frog and they can gradually increase the support without Putin yet. If you're on the other side, which is the Anne Applebaum side or Ben Wallace, who's been talking about it's quite a lot, that view is no, no, no, we've been far too wimpy, we should have provided much more support, and everything we provide is a dollar short and a day late, and one of the reasons that Ukraine never manages to do its counter-offensive is that we're always producing the stuff lamely, limply at the wrong time, and that we should challenge Russia more. And obviously, at the heart of this debate, is a question of trying to guess when Putin says you've crossed the red line, if Europe directly gets involved in supporting missile strikes on Russian territory, I'm going to lose the plot. How seriously do we take that? So we don't know. We don't know. Actually, I mean, the book, the honest ones, we don't know. We don't know what's inside his head. We also are struggling to work out how he's going to respond. He's presumably not going to fire ballistic missiles into Europe, but he could well support Iran or North Korea to cause trouble in other places. There might be intelligent stuff coming in that Putin might be expelling more of our people. He might threaten cyber attacks. So there's an incredible game of Bluff. It's in Putin's interest to suggest that if we support strikes into Russia, some amazing hell will be unleashed by Russia, which will push us into a third world war. And, of course, it's in Ukraine's interest to argue that that's all Bluff and Putin's not going to do anything, hasn't done anything in the past. But I think the honest truth is nobody really knows. It was interesting that when this debate was going on ahead of Kiyastama going off to Washington, Putin called in one of the state media people, just one microphone, and he did a clip to camera, essentially with the sort of understated, but clear threat that if you do this, then that's you at war with Russia, and terrible consequences will follow. And everybody goes off thinking he's talking about nuclear weapons. And he's kind of done that several times. So does that mean that the last time he was bluffing, and that the time after that, when we sent him the tanks and all the other stuff, he was bluffing? And does it mean that there's no limit to when the bluff runs out? And none of us know. I mean, Medvedev, his kind of sort of predecessor, former president who's now still quite a big part of the Russian machine, he came up with a very unpleasant turn of phrase. He said that if we did this, Kiyast would be reduced to a giant melted spot. They would melt it. Now, again, I think the word melt is designed to sort of say, you know, get us thinking about nukes. But the truth is, if, you know, I think people enjoy the interview with Applebaum and she feels very strongly about this, I think you and I do, even though we're aware of the sort, you know, the risks to put our cuts on the table, we tend to believe we should have provided more support to Ukraine earlier and take more risk on this. And if Russia does win or is allowed to define this as a win, then that is a terrible thing for European security and frankly the security of the world, because it won't be the last thing that he goes at. And of course, the other thing in the mix here is which Zelensky is worried about Zelensky, I'm sure will have followed the debate between Trump and Harris the same as most people did. And Donald Trump would not bring himself to say that it is a good thing for the world if Ukraine wins this war. Instead, he's back to his sort of boastful bracket stuff about, I'll get this fixed even before I become president. In other words, he'll do a deal which involves Putin keeping the land that he's got, keeping the ground that he's taken. So that's the other big thing that's into the mix here that Zelensky is worried about, which probably makes him even more agitated that Joe Biden is so cautious. They're all going to be Biden, Starmer Zelensky, lots of the others going to be the United Nations General Assembly. I think that's the point at which this decision gets made. There's also been some interesting stuff out of Germany. I mean, Schultz came in with a big fanfare. He was going to increase military expenditure to 2%, set aside $100 billion to do that. But that $100 billion is going to run out. And it would take a 60% rise in the defense budget to meet that 2%. I mean, some of the stats are extraordinary to get their how it levels up to where they were in 2003 for would take 100 years. And what Germany is actually doing is putting more money into social welfare, putting more money into child benefit. You get 3,000 euros per child up to the age of 25. And that is costing more than the entire core budget of the German defense ministry. The other factor in the German context is that one of the things that we've got this another state election at the weekend in Brandenburg where the AFD looked like they might win. And the rise of the far right, the populist far right and the populist far left, both of them essentially constantly echoing Putin's main talking points, that is also making life more difficult on Ukraine for Schultz. I'm going to make a prediction, Rory. You brought up Germany. I'm going to make a prediction that the German SPD will do a Biden-Harris. A Biden-Harris? Good. They'll get rid of Schultz. They'll get rid of Schultz. You've heard it here first. Well, you probably haven't heard it here first if you're German. You've heard it here first if you're you. Very good. It's very interesting. We do just briefly to close off. Our current leading guest, by the way, is Nate Silver. So that's where we talk about all things American election. But we interviewed a while back, Peter Malenowski, who's the premier of South Australia, who is trying to ban social media access for children under 14. And interestingly, he has employed this former High Court Chief Justice Robert French to draw up draft legislation. And it's a fascinating thing. He's literally drawn up the legislation and his report explains how he has come to that conclusion. It's a really interesting read. It's a policy development. I think you were light, Rory. But the big news is that Anthony Albanese, the prime minister of Australia, the federal state of Australia, the Commonwealth of Australia, he has decided to roll it out for the whole country. So that is a great example of one leader in one state, comes up with an idea, fights for it, wins that fight politically, and now the whole country. And if that happens and if Australia do that, I suspect that the other countries will do the same. And very interesting, too, because one of the reasons he managed to do it is he also got the opposition to sign up for it before he got his own party leader to sign up for it. Let's just quickly just rom through the arguments on this. There are three positions, obviously, on this. There's the position of the social media companies and your friend Nick Clegg, which is they want his little legislation constraints of this sort as possible. And we need to be honest about that, because I am getting a bit in the neck from people saying we're being a bit too gentle to Helen Schmitt and to Nick Clegg when we interview them. They're very good at being emollient and sweet on interviews. But when you see their lawyers in court, it's quite clear that these social media companies basically want no restrictions or control at all on what they're doing and rely on very, very extreme arguments. So there's that for you. Second view is the Manonorska's view, which is social media for children is dangerous and it should be banned. And the third view is what's been developing more in the UK and Europe, which is sort of typically sort of somewhere in the middle, which is, can you control the content? So they would say it's like saying instead of children can't get in a car, they must wear a seatbelt or it's not, they can't get to a pool, but there should be a fence around a pool would be the Australian example. And I guess the debate just to lay it out very quickly for listeners is on the harm side, the harm side is the content social media can be absolutely horrible. The contact that you get through social media, right, who you can get in touch with getting in touch with creepy people on social media, conduct on social media, which is kind of children being bullied or shown horrible explicit naked images. And finally, all the contract stuff, commercial data harvesting on children, that's sort of downside. The upside, if you're making the argument social media, is that it's a place where a lot of children feel there's opportunity to socialize, to make friends, to relax, to get away from the stress at school, to experiment with things that their parents don't necessarily want them experimenting with, and also gain information from learning. So the people who are going the middle ground say, we've got to get that. And then there's a final view, I think, which I'm sympathetic to, I'd love to hear you on, which is that maybe we might end up with the compromise, but maybe Peter Manonorska is right to start with a really aggressive ban, because that might be the only way to get these companies to start concentrating and meet us in the middle. He talks in terms of this being a ban. Albanese, interestingly, prefers to talk about it being minimum age access. It's about, you know, it would take away freedoms. But the other row going on with social media in Australia, the Australian government has got these new laws coming in unrelated to this, although in the same area, basically saying that they're going to levy substantial fines on social media companies if they don't comply with the Australian government rules on combating scams and disinformation. And on that basis, Elon Musk, whose Twitter account is becoming more embarrassing by the day, he basically says, Australia, you know, he talked about Kia Starmer being extreme and obvious and all this stuff. He called the Australian government fascists, because they wanted to do this to find companies that allow disinformation and do nothing about it. So I can't imagine Musk is going to be very happy about this, the social media stuff and the kids. And if you remember Roy, you remember Roy Peter Manonorska said that the social media companies just thus far refused really to engage with him on this. And they've now got a bill, they're going to get a bill through Parliament. It's become such a sort of symbolic issue of free speech. I mean, I did a long conversation, I'm in the States now, a long conversation with an American tech investor. For an hour and a half, he just kept saying Europe and Australia are trying to create authoritarian states. And he tried to suggest that any kind of attempts to limit free speech on social media is an attack on fundamental human rights and liberties. So I then had dinner with my best friend who's British and was complaining about this and expecting him to sympathize with me. And he also slightly took this view and said he's very suspicious and, you know, that humans are more grown up and were able to cope with this stuff much better than people think and a lot of it's a joke and the government's every acting and free speech is being censored and that then leads into, obviously, people who are worried about what's happening in universities and free speech being censored there. So I was trying to say, and I guess you and I agree on this, that it's very dangerous in politics to turn a detailed individualist like, you know, what exactly is in the legislation on the digital act and Britain into a huge kind of philosophical discussion about freedom and tyranny and Hitler and autocracy. We just got to keep bringing it back to the details. What are we actually proposing and what will it really mean? Yeah, that's why I wonder, I mean, I can't imagine a huge proportion of our listeners would necessarily get through the whole thing. But I think we should put in the newsletter, the full report written by this guy French, because it's a very, very interesting example of somebody given the job of analyzing report, all the meetings that he had, he just has very short notes of all the points that were made. And then he ends the process by drafting the legislation. So it's a really interesting example of, and you know, legislation gets amended and there'll be arguments about it and so forth. But what he's done is to give, is take you through the process of actually, and it's how a government might do it, how you might bring this into being. Because of course, what the social media companies will say, rightly, is that it will be very difficult to work out exactly how to do this. One of the things Albanese is taught is it might have to be done through facial recognition. Well, that again, brings into question all sorts of other issues that we've talked about and other episodes of the podcast. So anyway, I'm with Peter Miles-Gus. I think that there is a real problem. I think when we were talking about the National Health Service and the rise in mental illness epidemic amongst young people, I don't blame social media in quotes, but I think it is a big factor. I think the fact that a girl said to me in a school recently, with social media, if you are being bullied, there is now no escape, there is no sanctuary, there is no way you can go to hide away from it. And I think that's stuff that we've got to listen to. And you may be right, maybe a piece of my analysis is right out there and we'll end up somewhere in the middle, but I hope we don't end up so far in the middle that it just becomes a bit of a much. Well, this maybe is a good way of looping together all the different things that we're talking about, which is the difference between the kind of analyst and the politician and what seems to be the perfect technocratic policy and what you actually have to do to get stuff done. And that'll be true with the NHS. I mean, some great work of people want to get into the details of this by an amazing health journalist called Andy Crowther. This was a great book by Isabel Hardman on the history of the NHS, but I also slightly feel when I hear Andy making 100 detailed points, the big question is how do you do it in our political sphere, not what's the ideal solution? And the same's true here, if you talk about social media, Sonia Livingston, if people are interested, LSE academics, given a great info on ABC, Australian news, where she lays out the arguments on either the side. But I'm still with you. I think actually these companies are not being reasonable. You can't have a reasonable debate with them. There isn't a halfway house where they're going to voluntarily come along and agree to lose unrestricted access to their biggest growing market share. So I think this is a situation where you have to pull the handbrake pretty aggressively in order to get anything done. And just look at the way Elon Musk is behaving at the moment. Trump has this guy trying to shoot at him from a golf course. And Elon Musk does what he calls a funny tweet about, well, nobody's trying to kill Biden or Harris with then a sort of face of a smiling thingy. The idea of that guy engaging with something like this. So I think Peter Malalowski is right, they're not going to engage. We'll just bring forward a bill and now Benaz is taking it up. Now, Rory, you mentioned a few books there. And I've only mentioned Tony's. I want to mention another book which relates to our previous suggestion about Ukraine. Lindsey Hillsom, who we both admire, channel for international affairs editor, she's written a really good book called I brought the war with me stories and poems from the front line. It's a very interesting memoir because it it's sort of got these very short chapters about the many, many, many, many, many dangerous places she's been to. But then she has a poem between every chapter that relates to the chapter before. And it's a really, really nice book. And I just want to reach this one very short poem by a German called Gunter Koonert, translated from the German by Michael Hamburger. When the man was dragged from out under the debris of his shelled house, he shook himself and said, never again, at least not right away. Very powerful. So we began with talking about our UK tour and people come join us. People grumbled that for Australian listeners, they're not getting an Australia tour. This is a shameless opportunity for Rory to talk about this. They hadn't already had one. I was there a few weeks ago. I was there a few weeks ago there. Well, there we are. But you're not about to go back again. I am. So that's a great opportunity for people to hear and engage. And I'm really looking forward to it, particularly after all our stuff with Peter Manonorska. So just in case people in Australia would be interested in coming on to hear me, 21st of October, I'll be in Melbourne, 29th October, Sydney, 2nd November, Brisbane, 3rd November, Canberra, 4th November, Perth. And thank you to all our Australian listeners. I mean, I think you'd probably agree that one of the most interesting and engaged listeners we have around the world are from Australia. I got an email from a friend of mine in Australia telling me that Boris Johnson is going to be there in in December. And if you want to go and get a signed copy of his book, you can just have to pay $10,000 for a table at one of his events. And there you go. And you'll be pleased to know Rory, this guy, I won't drop a minute by naming him. He said, "On the same day, I got an invite to go and hear Rory Stewart speak. I shall go and hear Stewart not Johnson." Very good. It's not least much cheaper. All right, well, thank you very much. Awesome. I'll see you. See you. Bye-bye.
