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Chris Ham's avatar

Fascinating interview. Wes Streeting may have been quicker off the mark than many Cabinet colleagues, but from an NHS perspective his approach felt too slow. The 10 year plan did not appear for a year, for example. If Streeting and advisers had prepared better, it would have taken half this time.

On welfare reforms and NEETs, surely this requires serious work across Whitehall and history is not encouraging on this. Alan concedes that Labour’s missions have not got traction and these above all demand cross Whitehall leadership with visible and sustained leadership by the PM. We’ve not seen that sadly

Andy Cowper's avatar

Some remarkable assertions about current health reform, which don’t tally up with events.

Mr Milburn claims that there was “thinking behind the scenes. Wes Streeting did that and could hit the ground running as a result”.

The notion that Mr Streeting had done the work and so hit the ground running is not widely held. It is not evident in delivery, where RTT waiting list reductions (Labour’s one quantified 2024 manifesto commitment on health) are happening, but desperately slowly: far too slowly to hit the pledge for 2029 https://www.hsj.co.uk/quality-and-performance/year-end-elective-sprint-off-to-a-slow-start/7041526.article.

It is not evident in policy, where Mr Streeting’s major change in abolishing NHS England https://www.hsj.co.uk/integrated-care/nhse-to-be-formally-abolished/7038852.article is something that he said he would not do ten weeks beforehand https://www.hsj.co.uk/acute-care/exclusive-govt-abandons-commitment-to-hit-cancer-mental-health-and-aande-targets/7038590.article.

It is not evident in strategy, where the NHS Ten-Year Plan is essentially a wish list, without any means of delivery https://www.hsj.co.uk/policy-and-regulation/exclusive-10-year-plan-published-without-delivery-chapter/7039607.article.

Mr Milburn also claims that “with something like the [health department] 10 year plan, that ended up being written by a small group of people, me included, with the mainstream machine largely exempted from that process, which is just an odd thing to do”.

This is an odd statement: there was a very large consultation exercise https://www.gov.uk/government/publications/enabling-working-group-reports-10-year-health-plan-for-england. If the 10 Year Plan was then written by a small group who largely ignored the output of that consultation, it would explain a lot about its many deficiencies.

Mr Milburn’s political philosophy is outlined in the section where he says, “What the government’s got to be is an agent for change. You do it through strategic clarity and narrative creation. The biggest job of leadership today in any setting, corporate or politics, is a job of explanation. What is going on in the world. Why is it happening? What are the choices before us? You create narratives and one of the things that worries me most is when people say: the answer to all of this doesn’t lie in any of that stuff, strategy or narrative but in delivery.”

The New Labour health reforms of the 2000s had a coherent narrative, and were largely based in ‘New Public Management’-style incentives for more activity; helped by earned autonomy for providers; spiced up at the margins by competition https://www.kingsfund.org.uk/insight-and-analysis/reports/understanding-new-labours-market-reforms-english-nhs; but largely lubricated by a huge amount of extra money. The NHS’s annual budget went from £49 billion in 2000 news.bbc.co.uk/1/hi/in_depth/uk/2000/budget2000/684419.stm to £131 billion in 2010 https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/nhs-budget-nutshell.

Apart from some wafty rhetoric about a triple shift that is clearly not happening and some ‘tough’ rhetoric about failure not being tolerated, it is extremely hard to discern what the current Milburn-Streeting era’s NHS strategic clarity and narrative creation is meant to be.

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