Let's start this morning by hearing from the Health Secretary, West Streeting, who's with me now. Good morning, Health Secretary. Good morning. I want to come to health matters in a moment. Can we talk about the vote this week on the winter fuel allowance? Just practical thing. Will Labor MPs who vote against the government's proposal have the whip withdrawn?

Well, that's a matter for the Prime Minister and the Chief whip. But the reason we're having the vote this week is because we've come into government. There is a £22 billion black hole in the public finances this year. The previous government had spent the National Reserve three times over. It was an unprecedented degree of in-year recklessness. We have got to stabilize the finances so we can fix the foundations and build a better home, a better future in our country. Let me tell you that whether it's pensioners or anyone else in our country, they won't forgive us if we duck the difficult decisions now now and end up leaving the country with a bigger bill, the bigger price of failure in the future. That was a conservative way. That's not the approach we're going to take.

Well, you raised two questions there, which I'd like to talk a bit more about the pensioners and also the blackhold. As you know on this program, we're never far from a chart. You've provoked me into one this morning. Let's just have a look at this 22 billion question. There is a total government spending, 1.2 trillion or thereabouts, 22 billion. I mean, seriously, the so-called 22 billion back hole, it's not the biggest thing in the world that you have to face, is it?

That was the conservative approach. It doesn't matter about the scale of the hole. Let's just carry on splurging, carry on spending. That was tested to destruction with this trust and the money budget.

That's not what I said. In a 1.2.

Trillion spending bill. It's a significant amount of money. What I couldn't do with 22 billion.

You're making 22 billion sound like if you don't fix it, then I think the economy is going to crash. I mean, let's just get practical.

We'll just go on spending more than we've got. Nobody's saying that. We'll just carry on ratcheting up the debt, running with a deficit. Who cares, right? That was basically where the last conservative government got to. Had they been reelected, they would have done it all over again because as we exposed during the course of the election campaign, their manifesto was built on a whole range of unfunded spending commitments and tax cuts. That's reckless. It's the conservative way. It's not the labor way. That's why we're taking tough decisions to fix and stabilize the public finances so we can fix the foundations and build a better-I'd like to spend some of this interview, at least, talking about your decisions rather than the conservative past.

On this question of the Winterfuel allowance, which is your choice. There are many things you could do, and you've chosen to do this one. One thing that puzzles me is why you're so defensive about it. The chancellors basically apologized. The Prime Minister said, Al, sorry, he is. But as the Chancellor has also pointed out, it affects people who are about to get a £400 increase in their pensions anyway. Having had pension increases ahead of the rise in earnings for a decade. Surely that's what labor should be about. You're taking a little money away from relatively affluent pensioners and handing it over, for example, in pay increases to health workers. Why are you so defensive about Because we didn't come into government determined to take away people's winter fuel allowances.

That's not the primary motivation here. The motivation is to balance the books. We have had to take into account context. By the way, it's not just pensioners. We've got the budget and the spending review coming up. There are difficult choices coming, and we're going to have to look carefully at how we make sure we can build the future for our country. We want to see whether that's getting NHS waiting lists down, making making sure that kids from the poorest backgrounds have the same chance as those from the wealthiest backgrounds, and crucially, to make sure we get the economy growing so we can invest in our public services and cut taxes.

You are making a choice. You're making a huge big deal about this. You are in a big I agree about it. The House of Lords Scrutiny Committee said this week, There's no need to rush this measure through at the pace you're doing, and actually, it's not giving them the chance to scrutinize it properly. I wonder if the truth here is that This is not economics at all. It's politics. You want to make it sound like you're making a terribly tough choice when this isn't, in fact, the most tough choice you've got to face.

I think it is a tough choice, and we've had plenty of political criticism for it, I think, which demonstrates You're happy about that? The political pain. I'm not remotely happy about it, and I'm not remotely happy about having to say to some of my constituents, I'm sorry that I'm going into work this week to vote for something that will take money away from you. You're right to put it in the wider context of the fact we're protecting the triple lot, the fact that the pension, state pension will continue to rise, that's been above inflation pay increases. There are still free prescriptions, free eye tests, and other targeted support available. You're right to point out all of those things, but it is also important to say to people why when you're taking something away, why that choice is necessary. I think there are lots of people out there, actually, particularly pensioners, who've seen governments come and go and have seen what happens when politicians duck the difficult decisions, who, even if they don't agree with this choice, I hope, we'll take some reassurance that this isn't a government that ducks difficult decisions or pretend you can spend money you don't have or pretends that the stability of the public finances is not an essential ingredient to the future growth, prosperity, and success of our country.

Let's talk about what I think might be some, frankly, larger challenges. The Prime Minister has described vividly what he says is a broken NHS, and it's based on the view that you've commissioned from the former Labor Health Minister, Lord Darcy. We know the headlines, but what does Lord Darcy's report suggest that you do about this broken NHS?

I think we'll see the report this week, the final report. I've not seen the final report. I have seen the headlines coming out of the report. I think what Lord Darcy, who is a very experienced clinician with decades of experience in the NHS and experience of serving both labor and conservative governments in different capacities. What he essentially says is the NHS is broken but not beaten, and the investment matters, but so does reform. And if we don't change the way that the NHS works as a system, then we will continue to see a heavy price for failure. And the reason why we asked Lord Darcy to do this report was if you don't provide an accurate diagnosis for the patient, you're not going to prescribe the right treatment.

Secretary, the reason I'm asking about this is that, okay, you say that the Windfuel Alliance and so on is a tough choice, but There are some people who would say that you'd rather talk about that than this challenge, which you know very well you're facing, waiting lists. Let's have a look at what's happening here. Of course, waiting lists were at their highest, year a year or so ago. The thing is that at the moment, at the current rate at which they're falling, it's going to take until 2039 for NHS waiting lists to return to pre-pandemic levels. Now, I know you want to do better than this. Let me first ask you, would you like to commit to bringing that graph down so that waiting lists are below pre-pandemic levels by the end of your term of office?

Well, I'd certainly like them to see them come down faster. We've committed to return the NHS by the end of this Parliament to the constitutional standards we expect. Things like being able to see within four hours in A&E, making sure that you are treated, for example, to treatment for cancer is within 62 days. Those are the sorts of constitutional standards we want to see the NHS return to.

That's all the NHS Constitution, but which actually is recommended by Lord Dardy himself.

Yeah, exactly. Also to get to constitutional standards, NHS waiting lists will need to be millions lower by the end of this Parliament. That's why what that chart shows, which is the status quo, is not tolerable or acceptable. One of the reasons why within weeks of coming into government, I agreed to deal with the junior doctors was because I saw it as an essential ingredient to bringing waiting lists down and delivering better care for patients.

You're going to do better than that.

Yeah, and that's why I'm not just Lord Darcy. I've got people like Alan Milburn, former our Labor Health Secretary with a track record of delivering rapid NHS improvement on my side. I'm lucky that I can draw on people who worked for the last Labor Government. I feel sorry for Victoria Atkins, who you've got in this morning when she was the conservative Health Secretary, she couldn't turn to her conservative predecessors because every single one of them left waiting lists higher than they found them.

Well, look, let's talk about how you're going to do it. You said several times that you want reform and that part of the solution is increased use of the private sector. How?

With the independent sector, there is sometimes spare capacity that we can use and things like hip and knee replacements.

You do that already?

We do, and we want to do an independent sector deal so that we can do more of it where the capacity is available. But fundamentally, it's a means to an end. The end is to not just get the NHS back on its feet, but make sure it's fit for the future so that we're not relying on the independent sector in the longer term. How do we do that? We need three big shifts, a shift from hospital to community, better primary care, community services, mental health, social care, a shift from analog to digital, make sure we've got the latest treatments and technology, but also the improvements to the systems, the waste, the inefficiency, the bureaucracy we see in the NHS, and thirdly, a shift from sickness to prevention. We pay a very heavy price in this country, a price of society's sickness. Actually, if we help people not just to live longer, but live well for longer, that's not just better for them, it's better for the taxpayer, and that's how the NHS is sustainable. This is very interesting.

There are 40,000 people waiting for hip or knee replacement. But what is emerging is that there's a definite drift towards the use of private health health care. The main reason that people who do buy their care give is the length of time they are waiting.

That's right.

Is what you're saying that you want to outsource more of the work which currently is rationed by waiting list to the private sector so you can speed that up?

I want to bring it into the two-tier system you've just described, where those who can afford it are paying to go private and those who can't are being left behind. There's nothing about my centre-left principles that says, Because I believe in the NHS as a public service, I'm willing to see working-class people waiting longer, even where there's spare capacity in the private sector that we could use via the NHS to get those people treated faster. I have sympathy with people who say, But shouldn't the NHS have the staff, the equipment, the theater space that they need to treat everyone? Of course it should, but rebuilding that takes time. In the meantime, I'm looking to pull every single lever I can to make sure that people get treated as fast as possible and as safely as possible. We can get those waiting lists down, get people back to health, back to work, or back to enjoying their lives in retirement.

Reformed this costs money. You're going to have to pay for an independent sector deal. You've already spent billions in pay settlements for nurses and junior doctors. The GPs are saying they want 11%. Let's just start, by the way. Are they going to get the 11%?

Well, we've already seen a significant uplift in the GP contract. Also, one of the first things I did, which I think is a statement of intent, was put around £100 million into employing 1,000 GPs by the end of this year who otherwise would have been unemployed. That was the situation I walked into. There were people who were qualifying as GPs this autumn with no jobs to go to, even though patients are struggling to see a GP.That's.

The answer to a different question.That was the conservative way. That's not our way. Are they going to get their 11% uplift?

Look, one of the things I want to do is work with GPs, but these things are negotiations. We have to work together. I think it has been a significant statement of intent on the part of this government. One of the first things we did was deal with GP unemployment in the way that GPs were calling for us to do.

But you've got to settle this before winter comes in, haven't you? Have you met them yet?

I've met the BMA GP Committee many times, the Royal College of GPs. I've been in general practices talking to GPs on the front line.

Maybe you met them as Health Secretary.

Yeah, since the general election. Met them prior to the general election. I've met the BMA GP Committee a number of times now. One of the things I've said to them in the context of this dispute, I understand how you ended up in dispute with the last government. You got a new government now, so work with us rather than against It sounds to me like they're going to get a deal.

It sounds to me like you're saying they're going to get the money.

No, I don't want to set expectations in the wrong place. You can see from the conversation we've had about winter fuel allowance, there are difficult balances to strike in the public finances. We've got a spending review coming up. I can tell you one of my priorities for the spending review will be helping to shift the center of gravity in the NHS out of hospital into the community. That includes better primary care, better access to general practice. That's the hope I can offer GPs, but you've We've also got to give us a bit of time. I understand how the GPs ended up in dispute with the last government. There's a new government now that wants to work with them. Let's work together rather than against each other to build the NHS we both want to see.

A word about another big problem that the government faced. It's not in your department, but the jails are full. Is the government actually considering renting space in foreign jails? Estonia, for example.

I honestly don't know because to be honest, I've got enough to deal with health and social care. I do think, by the way, as a colleague, seeing what the Prime Minister and the Lord Chancellor, the Justice Secretary, have had to deal with in terms of prisons is an intolerable situation that no incoming government, no Prime Minister, no Justice Secretary, should ever have to face in terms of the state of our jails. The fact that the last lot knew that and didn't do anything about it is one of many, many reasons why they should be in opposition for a very long time.

We can talk about the last lot till the cars come home.

Don't let them off the hook as well, Trevor. Don't let them off the hook because they should be held to account for That's what they've done to our country.

You've got the gig now. Is there anything in principle that you think should prevent a Labor government from sending prisoners abroad?

All I will say for the Justice Secretary, she is dealing with an unprecedented situation in our prisons, and we have got to make sure that we don't allow the prison crisis to bleed into a crime crisis where criminals think they can go unpunished because they've seen headlines about the jails being full. As we showed this summer with the riots, if you are engaging in lawless, riotous, thuggish behavior, and you deserve a custodial sentence, we will make sure we find the cell for you. No criminal should be walking about the streets under a Labor Government thinking that because the prisons are under pressure, that we won't find space for you. We will.

All right, just very quickly before you go, the topic that pretty much everybody in the country is talking about, should the England manager sing the national anthem at this week's game against Finland?

Everyone thinks they can do a better job as the England manager. I always give full-throated voice to the national anthem, but it's up to him to decide what he does in terms of singing the national anthem or standing there quietly. I've not heard him sing. He might be terrible.

Yeah, but that's true about all footballers. But does it make you feel at all queety, or do you think, literally, that it is a matter of no import?

To, to be honest. I've got other fish to fry. But whenever I'm at an England game, I always give full-throated voice to the National Anthem.

West Streeting, thank you very much for your time this morning. Thank you.