Before Downing Street even knew whether Sir Keir Starmer’s talks with Donald Trump would be a success, they had put up Wes Streeting as their ministerial media face to deal with the aftermath.
The Health Secretary was ostensibly booked for broadcast interviews on Friday morning to talk about the resolution of the GP contract dispute, but of course he ended up answering questions on that meeting in the White House.
His line was that “as well as delivering abroad, the Prime Minister is delivering at home”. He had probably been chosen for that round because he is one of the best Cabinet performers in any tricky interviews, but it was also appropriate that it was him – because this week has been one of the most defining for the Government on the health service as well as on global strategy.
And more defining than that GP contract was the departure of Amanda Pritchard as chief executive of NHS England (NHSE). She decided to resign after it became clear that Streeting wanted to make changes to the structure of the health service that were too radical for her. But she was already clearly on her way out: while Streeting had always taken care not to criticise Pritchard in public, some of his parliamentary colleagues had been rather more forthright, with two select committees taking the highly unusual step of saying they were “disappointed” with her lack of “dynamism and drive”.
As with the resignation of international development minister Anneliese Dodds over the cut to her department’s budget, Pritchard’s exit is a chance for the Government to reduce the friction with key figures charged with delivering its agenda.
Pritchard’s replacement Jim Mackey is, according to a source in the Department of Health and Social Care, “totally aligned with Wes on the future of NHS England, on where it is currently getting things wrong and where there is space for big productivity improvements”.
The productivity target for the NHS is really tough: Rachel Reeves has set the challenge of increasing it by two per cent this year, but the latest data from the Office for National Statistics suggests it is still falling. Parliamentary select committees had been particularly unimpressed with Pritchard’s answers on how the health service would meet the productivity target, while she had separately made clear, on repeated occasions, that she didn’t think resources were sufficient.
Mackey will be expected to make major cuts to central management, creating a “leaner centre”. Streeting and colleagues have been unimpressed by the number of teams in the NHS and his department which are essentially doing the same job, and want to merge them.
There is also a desire to make procurement more centralised, rather than medical technology companies having to trudge around the country selling products to individual trusts, and patients in one area benefiting from technology far earlier than others. Given central government has a mixed record on procurement too, this is unlikely to solve all the NHS’s problems with equipment and tech.
This is not the first time ministers have tried to pull the NHS leadership closer: when he was Conservative health secretary in 2022/23, Steve Barclay demanded that Pritchard and other senior figures work from the department on a regular basis. His intention was the entirely reasonable one of ensuring ministers and health service figures were interacting properly. But the NHS leadership saw it as a charade they just needed to perform regularly, rather than anything meaningful.
Labour thinks its changes will be far more radical than simply sitting people at certain desks. Perhaps, but they also sound very familiar. A chief executive with whom there is little friction is the dream for a health secretary who enjoys control freakery, and on that, Streeting has learned from the best, with former ministers such as Alan Milburn advising him.
Milburn is rightly praised for the improvements he oversaw to the NHS in the New Labour years, but he was also well known for being part of a control-freak tendency in a government so obsessed with delivery that it created a health service that grew obsessed with targets rather than quality.
Department of Health and Social Care sources insist that this isn’t what they’re after at all, and that the radical changes are in fact about slimming down the centre and boosting trusts themselves. “We don’t want to replace NHSE control freakery with DHSC control freakery,” says one. “The thing that will drive improvement and innovation in the NHS is an extra step of devolution which is to give more information, choice, and control directly to patients.”
Mind you, that’s what New Labour promised too, and this week has probably been this Government’s most New Labour yet.
Isabel Hardman is assistant editor of The Spectator
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