Wes Streeting has just given a striking statement on arrival at the Department of Health and Social Care in which he announced that ‘from today, the policy of this department is that the NHS is broken’. Parties make campaign threats that there are ‘24 hours to save the NHS’, but this description of Labour’s sacred cow as ‘broken’ goes far beyond that. It recognises the seriousness of the situation for the health service and is a declaration of Streeting’s intent to reform.
Streeting has become health secretary during an existential crisis. Voters are still committed to the principles of free healthcare but increasingly losing satisfaction with the way the NHS tries to deliver that. He will be well aware that those voters will start to question their faith in the NHS itself if Labour fails to turn it around: he told staff today that ‘this government has received a mandate from millions of voters for change and reform of the NHS, so it can be there for us when we need it once again’.
Streeting only mentioned his first step: trying to stop the junior doctors’ strike. ‘I have just spoken over the phone with the BMA junior doctors committee, and I can announce that talks to end their industrial action will begin next week.’ The unions want a 35 per cent pay rise, saying this would make up for 15 years of below-inflation increases under the Tories. Streeting has said this is too much, but that he would negotiate.
Streeting’s tone is very different to Tory health secretaries, who have often positioned themselves as NHS fans who only wanted to say how great it is. Andrew Lansley used the slogan ‘NH yes’ and Jeremy Hunt went to work wearing a NHS lapel badge. Saying ‘the NHS is broken’ is something the Tories could never have done (it would raise the question as to who broke it) and establishes the principle that serious action is needed.
Streeting has been very clear for a good while now that he is going to be a health secretary who fights the producer interest on behalf of the consumer (he talked about it in his interview with The Spectator back in 2022). That is going to be very uncomfortable for the people working in the health service as it will involve a great deal of institutional change.
There has been strong speculation that he will replace Amanda Pritchard as chief executive of NHS England. Pritchard seems to be aware of this too: her speech to the NHS Confederation recently was all about how ready she was to work with a new government and to switch to the preventive agenda that Streeting has been talking about for a long time. The Health Secretary recently told the Health Service Journal that he had ‘total confidence’ in Pritchard, which is largely meaningless: he’s not going to fire the NHS chief executive on the first day in the job. But it would be a surprise if Pritchard were in place this time next year. There’s a hard winter ahead for the health service.
Streeting’s prescription involves a radical reshaping of where funds and political attention go, so that the focus is not on acute but more on the primary, community and preventive services that mean people don’t end up in hospital needing more expensive treatment. He will also not be able to turn around the NHS without social care reform, as the dysfunction within that sector is one of the drivers of inefficiency in the health service.
Labour said very little about social care reform in the election campaign for fear of scaring voters in the same way that Theresa May did in 2017. But now it is safely in government, and the time to reform won’t get any better than at the start of being in power.
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