Cowper’s Cut 354: Will the real Wes Streeting please stand up?
Health But Social Care Secretary Wes Streeting is a man in a hurry.
This is true both literally (in his needing the English NHS’s operational performance to turn around in an electorally viable timescale to bolster his prime ministerial ambitions) and metaphorically (in the way that having hopefully survived kidney cancer probably tends to make a person).
He has a fair amount going for him. He can be very personable; he is clearly mentally sharp; he can think on his feet. This is much of the reason why he was one of the best-performing shadow ministers over the past few years.
But opposition is not government. Opposition is about saying things (and being quoted) and FOIing things the government of the day would rather stayed obscure: Government is about doing things that improve matters for the sector in question.
Thoroughly mythologising Milly
I have for some time now observed in these columns with disfavour Mr Streeting’s tendency to act like an Alan Milburn tribute act. As Pablo Picasso said, “to copy others is necessary: to copy oneself is pathetic”. And Pablo Picasso never got called an asshole.
This would not necessarily be that unhelpful, if Mr Milburn’s analysis of the problems facing the NHS today were cogent and current.
Unfortunately, all of the available evidence - ranging from Mr Milburn’s NHS Providers lecture in 2014; to his 2023 Health Foundation podcast hypebeasting the magic-bullet potential of genomics and AI (“the alliance, the synergy if you like, between the genetics revolution and the machine learning revolution can potentially create a very different type of system. One that's much less focused on diagnosed and treating illness rather than predicting and preventing it … the galvanising principle has really got to be, how do we harness the big benefits that technology is going to bring to produce a very different type of healthcare system?”); and on to his recent ‘Last Chance Saloon’ interview with Chris Smyth in The Times which referred to “his own efforts to give patients more choice, enforce transparency to exercise it, and pay hospitals for better performance” - tells us otherwise.
Hypebeasting AI is obviously the default New Labour Revivalist position, but it’s just going to remain so much carnival barking until there is wider agreement among system leaders on a cogent analysis of how AI might actually add value any time soon in NHS operational reality.
Fortunately, the one person who has done some serious thinking about this topic, Dr Jess Morley, has provided us with a good chunk of this.
However, I note that Dr Morley is not even involved in the 10 Year Plan working group on digital.
Indeed, imagine my optimism when I see that this working group is led by Tim Ferris and Ming Tang: the pair who clearly did such brilliant leadership jobs that the former quit NHSE after two years and the latter could recently be found talking down expectations of the very same Federated Data Platform whose contract winner she recommended.
Milburn is a former Trotskyist, whose time inhaling the substances at the Days Of Hope (‘Haze Of Dope’ according to locals) radical bookshop in Newcastle may have given him a taste for permanent revolution.
Alas, his current belief that patient choice was important to the New Labour NHS reforms is unsupported by the research evidence. Frankly, I have shat more convincing hypotheses than this.
Curiosity killed the shat
If Mr Milburn (and indeed Mr Streeting) were curious about what did work, they could ask MP for Shipley Anna Dixon to explain her, Nick Mays’ and Lorelei Jones’ seminal 2011 piece on ‘Understanding New Labour’s Market Reforms Of The English NHS’, which shows conclusively that the vast bulk of backlog-busting 2000-10 was done by existing NHS staff working overtime sessions in existing NHS facilities.
They could also read Professor Chris Ham’s balanced account of that decade, and indeed his pointed piece for the Financial Times about the very real limits of top-down pressure, which acknowledges that New Labour’s version of NHS reform “also gave rise to perverse incentives. Data was gamed and, in some cases, misreported to avoid sanctions for underperformance. Areas not covered by government targets received less attention.
“This is one reason why the shift to care in the community, now promised by health secretary Wes Streeting but which has been government policy for two decades, has never materialised. On the front line, the delivery regime created a culture of compliance and risk aversion, inhibiting innovation. Leaders and staff working in the NHS were disempowered and sometimes felt bullied by politicians and those acting on their behalf.”
Which Wes?
Wes Streeting
Reading Mr Streeting’s bylined piece for the Sunday Times is just like deja vu all over again: one wants to ask ‘will the real Wes Streeting please stand up?’
Talking about his recent visits to overstretched A&Es, Streeting writes, “I feel a combination of pride and shame. Pride in the people who work in our National Health Service, who bust a gut to give people the best possible care. Shame at the sight of people on trolleys in corridors, many of their waits avoidable if the right care had been available closer to home — often in their homes”.
His assertion in the article that “we’ve gone hell for leather on vaccination” holds little water, given that the UKHSA has twice pointed out that current vaccination rates are disappointingly low, leading to the current quad-demic of respiratory illnesses swamping NHS services.
Hell, things are currently so bad that even NHS England has noticed!
This is a pointless sort of untruth: all the more so when you read this ST piece on how things are going at my old local hospital, St Helier.
Department of Health and Social Care
He has not been doing everything wrong: this week’s decision to announce funding boosts for general practice and hospices are welcome. It is indicative of Labour’s ludicrous lack of a health policy that doing the incredibly obvious thing of boosting primary care funding has taken six months (and even now, the quantum is evidently too small).
Mr Streeting’s periodic tough-guy noises and his ‘NHS is broken’ rhetoric are not actually advancing the case for reform. They couldn’t possibly, since the only case for reform that has been made in any detail so far by Lord Darzi was mainly an (effective) attempt to allocate blame wholly to the Conservatives.
There is another, more interesting Mr Wes Streeting, and I noted the duality between the two Wes-es in my review of his NHS Providers speech. The Better Wes told this week’s Commons Health But Social Care Committee that “a political culture geared around sparing political blushes and reputations of governments is one that very quickly bleeds into backside-covering by senior leaders, thinking that if they acknowledge problems within their organisation that they are going to find themselves in news headlines or [receiving] a punishment beating by the secretary of state via the telephone.
“It also persists into a culture right down into the frontline where patient safety isn’t taken seriously: where whistleblowers are silenced in the most extreme cases. And you end up in a situation where, on pretty much every front, care in this country is not as good as our counterparts.”
But hang on! Didn’t The Worse Wes extensively brief the nation media about how he would bring back league tables, and make sure there were no rewards for leadership failure?
Well, yes. Yes, he did indeed do just that.
But the select committee day was a ‘Better Wes’ Day, and so he told Parliament, “when I talk about getting rid of rotten apples in senior management, what I do not want is us to go around beating up the best leaders who have been sent into the most troubled areas because after six months or 12 months, they are still at the wrong end of the league table. Change takes time.
“We’ve got to make sure we incentivise people to go to the hardest hit areas, the lowest performers so we are genuinely taking the best people in the NHS to the worst parts of the system to drive up performance and standards … We will build in some capital incentive for NHS leaders to drive up their performance. So there is some carrot there.”
He even promised nice things for nice people: the best performers would get “earned autonomy… where we’re not looking over their shoulder so much”. Asked whether that meant fewer central performance targets, Mr Streeting said: “I think we can let go of some of the control. I’m up for a debate throughout the NHS about which targets are useful and which ones are not.”
Confused by which Wes is on duty today? You will be.
Oh, and in a blow to festive tradition, we learned that the 2025-26 planning guidance will not make its traditional appearance on Christmas Eve. Humbug!
Happy Christmas
It may be inopportune for me to wish all subscribers a professionally Happy Christmas, as we have all known for some time that (as I have repeatedly written here) this winter is going to suck extremely badly indeed.
That said, clearly I wish you all a Happy Christmas personally.
Thank you all for your ongoing support of ‘Cowper’s Cut’, and my best wishes to you and yours for a better 2025.
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