We sat down with the Health Secretary Wes Streeting and started the interview by putting it to him that we won’t find out what the NHS reforms will really look like until next year’s Spending Review.

Wes Streeting: Well, of course lots hangs on the budget and the spending review and we’re not going to make promises we can’t keep or the country can’t afford like the last lot did.

Cathy Newman: But you know what reform is, do you, in your department here?

Wes Streeting: Hanging on each of those shifts, we’ve already given some clues about what that might look like. For example, the shift from hospital to community. In the first month or two in office, we’ve already employed another thousand more GPs, left unemployed by the last government. They’re going to be on the frontline by the end of the year. That’s brilliant for patients. It deals with the access issue and the unemployment issue.

Cathy Newman: Let’s talk about some of the actual sort of nitty gritty of this, because you’ve said insistently that there’s no money without reform, but don’t you need money to kick start reform?

Wes Streeting: It’s investment plus reform that delivers results. And the lesson of the previous government is that if you just pour more money in, as they did from 2019 to 2024, way more staff working in our hospitals, but less productive because we put the wrong people in the wrong place with outdated technology and you’re rotting a state.

Cathy Newman: So there will be investment?

Wes Streeting: Around the spending review, my priority and the chancellor’s priority is that kind of technological investment to deliver the big productivity gains that patients will experience through ease of access and staff will experience because they’re not working with creaking, outdated IT.

Cathy Newman: And the chancellor’s behind that, putting extra investment in. What kind of scale are we talking here?

Wes Streeting: She is behind that. I recognise, the whole government recognises the challenge she has, both plugging the £22 billion black hole we inherited this year and the weak foundations of the economy we’ll still be grappling with over the coming years.

Cathy Newman: So when Sir Keir Starmer says I’m not pouring more money in, it’s not actually quite right is it, because you are intending to pour money in but it will be strictly pegged to reform is what you’re trying to say.

Wes Streeting: Well, I’d say two things. Firstly, as Keir said, no investment without reform. We’ve got to see improvements to the way that the NHS spends the money and the outcomes we’re able to achieve. And the second cautionary note, Lord Darzi’s right. We’ve seen a massive underfunding over the last decade. We can’t correct that in one year or even in one spending review over the next few years. So don’t expect to look at the Darzi Report and see Rachael fund the entire backlog of under-investment in one go.

Cathy Newman: So it’ll be a gradual process of investment but a pressing concern, winter is looming. You’re expecting presumably to have to once again put your hand in your pocket for a winter crisis in the NHS.

Wes Streeting: No, I’ve been very clear with the NHS. We’re not going through this annual round of cash injections for winter. What we are going to do is recognise that this is going to be a difficult winter to put patient safety, dignity and comfort first and foremost, and to, through the spending review and through the reform agenda, get back to where we were when we were last in government, where we didn’t have these annual winter crises and where they didn’t get worse and worse every single year.

Cathy Newman: But you know that you’re going to be asked for more money this winter. You’re really going to say no?

Wes Streeting: I think people have got the message that there is a £22 billion black hole in the public finances during this year. And this is why…

Cathy Newman: Is that a no then. Just to be clear.

Wes Streeting: Of course it is.

Cathy Newman: You all say how shocked you are at what you found in the NHS. You know, Keir Starmer said that, you’ve said that, Lord Darzi says it today. Should people be scared about getting sick today?

Wes Streeting: Well, I can only speak from my own experience, really. Which is that if I think about people that I’m close to, I can think of examples myself included, where in my case, my kidney cancer was diagnosed early. I was referred to treatment quickly. And as a result, I’m talking to you today cancer free and likely to, I hope live a long, healthy and happy life. There are other people in my family who the NHS didn’t reach in time and whose outcomes have been far worse. And that is the tragedy, that the NHS is not always there for us when we need it. And you look at the damning statistics in Lord Darzi’s report, the numbers don’t lie.

Cathy Newman: So we should all be a bit scared really about getting sick?

Wes Streeting: I don’t want people to feel afraid to pick up the phone and dial 999 if they need an ambulance. I don’t want people to not see a GP or book an appointment if they feel like they’re going to be a burden on the system. If people need to access health care, they should come forward and do so in the normal way. What I am honest with people about, though, and what I will not shy away from is the fact that the NHS is not always there for us when we need it, that it is not currently good enough, that it is broken and that we need to fix it.

Cathy Newman: What impact assessment have you done about the risk to pensioners lives to their health from means testing the winter fuel allowance?

Wes Streeting: The Chancellor will do the usual impact assessment around the budget and the spending review for all of her fiscal measures. That’s the normal way of doing things.

Cathy Newman: So it hasn’t been done yet?

Wes Streeting: No the confidence I have is that, and I know this is tough for people and I know that this has not been popular with people. I’d say to pensioners who are thinking at the moment, well, why us and what about everyone else? That decision raised £1.5 billion. The black hole is 22. There are harder choices still to face. The chancellor and the whole government with her are facing up to those choices. And I know the medicine doesn’t always taste great, but it’s a lot better than not taking it.