Dr Allison Gardner MP interview

Torrin Wilkins: Hello, and welcome to the Centre Think Tank interview series in conversation. My name is Torrin Wilkins, the Director of Centre Think Tank. Today we will be discussing social care, artificial intelligence, NHS funding and Prevention within Health. With me today to explore these issues further, I am delighted to be joined by Allison Gardner. Allison has a wide range of experience, including being the Member of Parliament for Stoke-on-Trent since 2024.

She has also served as a scientific advisor for the National Institute for Health and Care Excellence, or NICE, on artificial intelligence and as a lecturer at Keele University, where she taught data science. She has firsthand experience of the issues we will be unpacking today with her work on artificial intelligence and how it can apply to healthcare. Thank you so much for being with me today, Allison.

Allison Gardner: My pleasure.

Torrin Wilkins: For my first question, the government has announced an independent commission to reform our social care system alongside some more immediate investment. The issues at the moment include high prices and a lack of availability. How do we reform social care to make the system accessible to anyone who needs it? And why is this particular review needed when we have so much work previously on the topic?

Allison Gardner: I will take the second part of your question first, which is why we need this review. Now, in the previous government, and I know I do not want to hark back because people get fed up about it, but we do have to deal with the realities of what we are dealing with in the existing situation. In the previous government, we had 10 ministers looking at social care since 2010.

You get this disjointed system, lots of innovation, lots of reviews, but it all just starts to fall apart. It is a very unstable system. The Casey Review is taking both a short-term and long-term view, which is a positive step. Next year, they want to look at what actions need to be taken to fix some of the fundamental problems that cannot wait.

Then, taking the longer-term action of 2028, they will have a set of actions and recommendations coming out at that point to see how we can reform it. The key part of this is to bring in stability and create a cross-party consensus. So no matter who the Minister for Social Care is or which government is in power, we start building that coherent National Care Service (which we have discussed in our manifesto), so that it lasts beyond a single government. I spoke to an excellent chief executive of one of my local trusts who has since retired, and I said, ‘What do I need to do to help you run your hospital efficiently and help the NHS?’. She said, ‘Fix social care. You cannot fix the NHS without fixing social care’. This is the aim that we are pursuing. 

The other problem that we have had is that social care is delivered by the local government. And we know that all of our local councils have had to cut to the bone, just trying to float above bankruptcy. Some of them have already gone bankrupt. That is just an unmanageable situation. Particularly with my own (Stoke-on-Trent). I have several councils in my constituency that are using Stoke-on-Trent as an example. The adult social care budget and the children in care budgets are really high, and we need to be able to deliver that and prevent bankruptcy from happening. We need to invest in local government. The government is putting £1.3 billion into local authorities and ring-fencing about £600 million to support social care delivery.

It sounds like a lot, but across the country, this is still not a large amount, and the situation remains urgent. We do need this review because we do not want reform that is done for good news bites, headlines and stuff that is not meaningful. This is the deeper, cutting-edge type of reform that will last.

Torrin Wilkins: Another question around the future of social care. And as you say, at the moment, there is this real struggle even to deliver the basic provisions of social care. And of course, one that has been floated is the idea of making it free at the point of use, just like many other national health services. Would that be affordable? And is it something the government should consider? What time frame do you think that is on? 

Allison Gardner: There is a good question that I joked earlier about: do not get me making any funding commitments and spending commitments off the hook! We would have to wait for the outcome of the review for that question. A lot of social care is free at the point of use, but it is a very complex system, and there is a wide range of needs from a wide range of people. Anything on a large scale like that would be quite challenging. I think we do need to depend on the outcome of the review to see what suggestions and funding models exist. I suspect it might be a mixed funding model who delivers a key question. We are looking to do things, and we might touch on them later on, like the Neighbourhood Care Service, as well as the National Care Service and how that would all work. At this moment, I would not say definitively, we should be able to provide support for people who need it, when they need it, and ensure it is the right type of support. Whatever funding model we adopt must be affordable both for the services delivering care and for the people receiving it.

Torrin Wilkins: Thinking about the review itself, is there anything that you are hoping that it comes out with that is new compared to older reviews? I always find this a really interesting one, because there have been several reviews now that have taken place on this issue. Is there anything that you think the newer review could shed light on that has not been covered before?

Allison Gardner: I cannot give specific examples, but I think it is always really important that we do not reinvent the wheel, we need to see what works or what has worked in the past, and think, let us not reinvent that, let us not even rename it, because we want to badge it as ours. If that works, let us build on that and then find what has not worked and why it has not worked, and then we either scrap it or we learn from it. I do not want to wipe everything fresh and start again. We have to have that view. A classic example would be the impact that Sure Start Centres had. Now, this seems to be focused on very young children, but the long-term impact on people’s life opportunities, both in terms of what they can do with their lives and within their health and their education, is massive. I would hope that because they are taking this little bit of time to develop it, we do take that longer-term strategy of what we can fix now.

We might not see the benefits of that until 15 to 20 years, when people are adults, but we know that those issues can be fixed. That is what I would like to do. And the other thing I would really, really like is that this is not something that is developed in an office in London. That this is done by, and in collaboration with, the people who matter. Which are the people, the people who need those services, making sure they do not have reforms done to them, or we do not impose what we think is good for them? Instead, they tell us what they think would help them and what would be good for them, and what would be good for their communities, and we listen to that. Maybe there has to be some flexibility in there for local delivery.

Torrin Wilkins: Technology, and specifically artificial intelligence, has been spoken about a lot recently, and it is often proposed as a solution to many of the serious issues the NHS faces. Is this as much of a game-changer as is often described, or will this need to take place alongside some more wide-scale reform?

Allison Gardner: It has to be alongside some wide-scale reforms. The key thing is that technology is not a ‘cure-all’ for basic systemic problems. Sometimes technology is not the answer; sometimes it is lower-tech or non-tech solutions that actually will do a lot more in delivery and ensure there is future resilience and improvements within the service. I will separate the two questions out: there does need to be reform in how we structure things. I worked within the NHS, and I was an NHS campaigner when I was a councillor, and I struggled to work out what was where — Integrated Care Boards (ICBs), Integrated Care Systems (ICSs), Primary Care Networks (PCNs), NHS England, NHS Digital, NHS Transformation, etc. I was like “stop!” It was just crazy. I could go on, but I will not. One big reform, very brave, would be scrapping NHS England. That is very radical and very well-reasoned. But often it is how you enact that over two years and how you shift in-house to the Department of Health and Social Care, the functions that need to remain central, and then move out into our local areas, so that we get that frontline delivery that we want and that people want.

I will say that that does not necessarily mean we have fewer managers; it is more important where those managers are located. We do need NHS managers to deliver these services, and I hate that rhetoric about not having NHS managers; we just need them in the local delivery of services. That is one aspect, and I welcome those sorts of reforms. With regards to technology, there are areas where we can have significant improvements. For example, we are very low on scanners, and the ones we do have are aging. I welcome the £3.1 billion being allocated to scanners and the capital budget we have to improve early diagnosis. But this has to be within everything, and this is my specialism. When integrating technology into the delivery of health services, you have to have the correct governance processes because technology is very positive. But you have to deploy and manage it correctly so you get the resilience and you do not get the harms when it goes wrong. That would be my one caveat.

Torrin Wilkins: And in terms of NHS England, of course, big news that it is being abolished. Are there any cautionary tales about what the government should and should not do with those extra powers and responsibilities? I know you talked about managers and integrating them into the community rather than where they are, so how would you like to see that transformation?

Allison Gardner: That is a tough one. That is a really interesting one. I think a clear separation of what is required of central services. One of the big bug bears is procurement into the NHS. The decisions made as to what can be a local decision, what can be a procurement that is across the NHS, what can be implemented throughout. What you do get (this is my personal opinion so I am not speaking for the government) when you have the local delivery is you have all these technology systems. They are not necessarily interoperable with another region’s systems and if you are hopping between specialist centres, that interoperability and that sending of your information and your notes is quite challenging. Then you get this complexity in the system. The role of the government has some say in that. 

A classic example is that local NHS institutions are very risk-averse. In your Data Protection Impact Assessment (DPIA), try to get a new technology in. In one, for the same technology, it can take a week for that approval to go through; in another, it can take longer than a year. This hampers innovation within the NHS. The central government could help by implementing frameworks so that all parts of the NHS adhere to try to streamline, so we do not get that variability. And the same with the statutory requirements. I would like to see that to make sure that things are governed correctly post deployment, which is not about getting that innovation into the NHS, but making sure it is well governed. I can see some central use there, but locally, I would also like people to have the flexibility to deliver the service they know they need for their local areas.

Some rigidity from the central government on key things that are NHS and social care throughout, but some flexibility as well to deliver what local people know they need.

Torrin Wilkins: Now the NHS is often seen as a national institution, and it is, of course, free at the point of use. But there are also conversations around the funding model for the health service, particularly from the Reform UK Party at the moment. Do we need to change the funding model for the NHS, or is this more about how much money the NHS has and where it is spent?

Allison Gardner: Thank you for mentioning this. Yes, there are people, and it is not just Reform UK but also the Conservative Party, including Jeremy Hunt, a former Health and Social Care Secretary, who have looked at privatising the NHS. I do worry sometimes that this ‘free at the point of care’ principle can be used as a cover-up, but what really matters is that care feels free to the people receiving it. So, no, it absolutely 100% should not be going down the Reform or Conservative model, and we have seen the deliberately managed decline of the NHS to then start instituting that change in the funding model. It needs to stay as it was; it can work, it just needs to have that proper belief in it. Reform is needed so that it works properly, and that the focus on things like preventative health will be managed, because we need to get the nation well. I think we fight tooth and nail to protect our NHS, it is ours, it should be publicly owned, and be accountable to us. It is a people’s NHS, and I do not approve of any changes to the funding model other than to improve what it already is.

Torrin Wilkins: For my final question, the discussions around treatment are incredibly important, but so is preventing illness, and I think governments have known for a long time that this is incredibly useful, and it saves quite a lot of money when we detect illnesses early, it is good for patients and for public finances. How can we do this more effectively now?

Allison Gardner: It is the longer-term view. I think it might have been Wes Streeting who said this, but we should think of it less as a national health service and as a national wellness service in many ways. An example would be dental care and getting children to brush their teeth. Now we know that there is a real issue with children’s dental care, and actually, one of the top reasons for children being taken into hospital is because of tooth decay and issues with their teeth.

That is one issue, but that type of health does not just fit with the mouth. Oral hygiene and oral dental health actually impact your entire body. Where if you have various types of gum disease, loads of triggers can have long-term health issues. Oral health is actually really vital for long-term health.

It is not just, “Oh, we want everybody to have nice smiles and we do not want children going into hospitals because they have rotten teeth.” It is about their much deeper health. Some of these initiatives are really important, and there is a lot of science behind them for the long-term health benefits. That is a good example of it. 

Giving people more control over their health as well, and stopping this fight to get yourself heard sometimes. Using the NHS app, where all your health records are stored and shared between services, can also improve transparency and patient involvement. I quite like this. You can see what the doctor is writing about you, so they cannot be as dismissive necessarily of your health concerns that can happen, especially if you are a woman. That is really good, but I think we need to look at education. I referred back to the beginning of the interview about these longer-term approaches that we have, and I am really keen on the idea of this neighbourhood care system and Neighbourhood Health Service that they are talking about. Where it is within our neighbourhoods, because there is so much that we have in our really positive communities. One charity I visited, called Walk Talk Action, is just one example, and there are many others, but what they do is very simple. They encourage people to go for a walk. It is very low-key, just walking out in parks, but it gets people physically active. Physical activity helps. It gets people out of the house, which helps combat loneliness; it gets them talking and connecting with others. So it helps with mental health and loneliness. From that very simple activity, other services can connect and offer support, creating communication links. These Neighbourhood Health Services would provide that wraparound care.

These often complex problems that will start with one and then you just end up spiralling, can actually be preempted. 

I would love a future where we realise we have an ageing population. I spoke to a large housing developer recently and said, “Okay, you have around 250 houses here, but not one bungalow. That is interesting, we have an ageing population now. Where and how are you planning for that?” They were designing it so that everything was wheelchair friendly, and they had the idea of accessible living. But I think we need to have real conversations about the lifelong needs that people have and build them within all of our systems. If we are building 1.5 million houses, we need to think about what those houses are and how we can have that assisted living going on. It is quite exciting.

But again, in terms of preventative healthcare, trying to catch illnesses early and treat them before they become serious is really key. This is diagnostics, but I would also say just better access to the GPs, making sure GPs are better supported, so they have time to listen to patients. Not 10 minutes where you can talk about one issue, but actually, what you do is you have a complex range of issues that are all interlinked, and it allows that deeper conversation.

One thing I really welcome is the promise that we are going to have our named family doctor again, and we do not see a different GP every time where you have to start explaining yourself every time, that’s tiring! I say that not entirely from personal experience. It is true.

Torrin Wilkins: Thank you so much for joining me today and discussing everything from health, artificial intelligence and social care. It has been really great to speak to you as well. 

Allison Gardner: Oh, it has been lovely to speak to you, too. Thank you.

Note: This interview has been edited for grammar, clarity, and flow. The original recording is the final and definitive version.