Starmer’s Strategic Moves Amid NHS Leadership Changes
Before Downing Street could ascertain the outcome of Sir Keir Starmer’s discussions with Donald Trump, they preemptively positioned Wes Streeting as their ministerial media representative to address the ensuing fallout. The Health Secretary was ostensibly scheduled for broadcast interviews on Friday morning to discuss the resolution of the GP contract dispute; however, he inevitably found himself fielding questions about the White House meeting.
His stance was clear: “As well as delivering abroad, the Prime Minister is also delivering at home.” Streeting was likely chosen for this role due to his reputation as one of the most adept Cabinet members when it comes to handling tough interviews. However, his selection was also fitting, as this week has proven to be pivotal for the Government, particularly concerning the healthcare sector and its global strategy.
More significant than the GP contract resolution was the sudden departure of Amanda Pritchard from her role as chief executive of NHS England (NHSE). She opted to resign after realizing that Streeting intended to implement changes to the health service’s structure that were too radical for her to endorse. It was evident that she was already on a downward trajectory; while Streeting had refrained from publicly criticizing Pritchard, some of his parliamentary colleagues were less restrained, with two select committees taking the unusual step of expressing their disappointment in her perceived lack of “dynamism and drive.”
Pritchard’s resignation, similar to that of international development minister Anneliese Dodds following budget cuts to her department, provides the Government an opportunity to alleviate tensions with crucial figures responsible for executing its agenda. Her successor, Jim Mackey, is reportedly “totally aligned with Wes on the future of NHS England, on where it is currently falling short, and where there is potential for significant productivity enhancements,” according to a source within the Department of Health and Social Care.
The productivity expectations for the NHS are daunting: Rachel Reeves has set a target of a two percent increase this year, yet the latest data from the Office for National Statistics indicates a decline in productivity. Parliamentary select committees have been particularly critical of Pritchard’s responses regarding how the health service plans to meet this productivity benchmark, especially since she had consistently indicated that available resources were inadequate.
Mackey is anticipated to implement substantial reductions in central management, aiming to create a “leaner centre.” Streeting and his colleagues have expressed dissatisfaction with the proliferation of teams within the NHS and his department performing redundant tasks, advocating for their consolidation. Furthermore, there is a push for a more centralized procurement process, eliminating the need for medical technology companies to individually market their products to various trusts, which has resulted in patients in some regions gaining access to technology much sooner than others.
Considering that central government has a mixed history with procurement issues, this approach may not entirely resolve the NHS’s challenges regarding equipment and technology. This is not the first instance of ministers attempting to tighten the leadership of the NHS: during his tenure as Conservative health secretary in 2022/23, Steve Barclay insisted that Pritchard and other senior officials regularly work from the department. His objective was a valid one: to ensure proper interaction between ministers and health service leaders. However, the NHS leadership perceived it as a mere formality rather than a substantial engagement.
Reflections on Labour’s Approach
Labour believes that its reforms will be significantly more transformative than simply assigning individuals to specific desks. However, these changes also echo familiar themes. A chief executive who aligns closely with the health secretary is an ideal scenario for a Health Secretary known for his control-oriented approach, and Streeting has gleaned insights from past leaders, such as Alan Milburn, who has been a key advisor.
Milburn is widely regarded for the advancements he facilitated within the NHS during the New Labour era, yet he was also noted for fostering a control-oriented culture within a government that prioritized delivery to the extent that it fostered a health service overly focused on targets rather than quality care.
Sources within the Department of Health and Social Care assert that they are not pursuing a similar control-oriented approach. Instead, they claim that the radical changes are intended to streamline the central authority while empowering local trusts. “We don’t want to replace NHSE control freakery with DHSC control freakery,” remarked one source. “The key to promoting improvement and innovation in the NHS lies in decentralizing power, giving patients more information, choice, and control.” Yet, this echoes promises made by New Labour in the past, and this week has arguably marked the Government’s most New Labour-like moment to date.
Isabel Hardman is assistant editor of The Spectator
