Ed Kennedy is an NHS primary care leader with experience in healthcare policy and management.
Wes Streeting entered office promising to rescue the NHS. Instead, his legacy may ultimately be one of costly reorganisation, questionable waiting list politics, and reforms that risk undermining one of the few NHS models that still delivers value for taxpayers.
Most ironically of all, a Labour Health Secretary may ultimately be remembered as the man who pushed general practice towards the same mixed NHS-private model now seen in dentistry.
At the heart of that failure was a deeper misunderstanding of how healthcare systems actually earn public confidence.
Streeting repeatedly pointed to falling waiting lists as proof Labour’s NHS reforms were working. But patients understand the difference between political statistics and lived reality.
Concerns have increasingly been raised that some reductions have come not simply from expanded NHS capacity, but from increasingly aggressive “list validation” exercises removing duplicate referrals, inactive patients, or those no longer seeking treatment.
Of course, NHS records should be accurate. But deleting names from spreadsheets is not the same thing as rebuilding the NHS.
Patients judge healthcare on whether they can get an appointment, access treatment locally, and receive care within a reasonable timeframe. They do not particularly care whether Whitehall has become more sophisticated at statistical housekeeping.
That same disconnect was visible in Streeting’s approach to general practice – one of the last parts of the NHS still built around local leadership, personal responsibility, and ownership rather than central bureaucracy.
The GP partnership model is simple: small business owners delivering public healthcare. GP partners employ staff, manage premises, carry financial risk, and build organisations rooted in their communities.
For all the criticism directed at general practice, this model still delivers around 90 per cent of NHS patient contact for a remarkably small proportion of NHS spending.
Yet Labour’s growing enthusiasm for “neighbourhood” structures and greater centralisation risks slowly replacing independent partnerships with large trust-led systems that often struggle to control enormous deficits of their own.
A centrally managed salaried service may appear tidier to policymakers and NHS think tanks. But incentives matter. GP partners must balance the books because, unlike much of the modern NHS, they cannot simply run deficits.
The uncomfortable truth is that the NHS often functions best where ministers exert the least day-to-day control.
The danger is that politicians kill the golden goose: dismantling the very model that quietly sustained British general practice for decades.
That same instinct towards centralisation also shaped Streeting’s approach to NHS management itself.
He embraced the increasingly fashionable political obsession with attacking NHS “management” and “bureaucracy”. His flagship decision to abolish NHS England certainly turned heads… and chopped plenty of them too.
But healthcare systems do not become simpler simply because politicians announce redundancy programmes.
Even the Department of Health and Social Care admitted NHS restructuring redundancy costs could exceed £1 billion, raising the obvious question: will taxpayers simply fund huge payouts only for many of the same functions and personnel to quietly reappear elsewhere under tighter ministerial control?
The NHS does not suffer from too much local leadership. It suffers from too much political churn, constant restructuring, and the belief that Whitehall can reorganise its way to better healthcare.
Ultimately, Streeting’s poor relationship with large parts of the medical profession may prove one of the defining failures of his tenure.
The scale of that breakdown was shown bluntly on his final day in office, when GP leaders openly voted to explore whether general practice should move towards a model akin to dentistry, something not long ago would have been politically unthinkable.
For decades Labour warned that Conservatives would privatise the NHS. Yet Wes Streeting may ultimately be remembered as the Health Secretary who convinced growing numbers of GP practices that the traditional NHS model is no longer sustainable – accelerating general practice’s drift towards private healthcare.
Ed Kennedy is an NHS primary care leader with experience in healthcare policy and management.
Wes Streeting entered office promising to rescue the NHS. Instead, his legacy may ultimately be one of costly reorganisation, questionable waiting list politics, and reforms that risk undermining one of the few NHS models that still delivers value for taxpayers.
Most ironically of all, a Labour Health Secretary may ultimately be remembered as the man who pushed general practice towards the same mixed NHS-private model now seen in dentistry.
At the heart of that failure was a deeper misunderstanding of how healthcare systems actually earn public confidence.
Streeting repeatedly pointed to falling waiting lists as proof Labour’s NHS reforms were working. But patients understand the difference between political statistics and lived reality.
Concerns have increasingly been raised that some reductions have come not simply from expanded NHS capacity, but from increasingly aggressive “list validation” exercises removing duplicate referrals, inactive patients, or those no longer seeking treatment.
Of course, NHS records should be accurate. But deleting names from spreadsheets is not the same thing as rebuilding the NHS.
Patients judge healthcare on whether they can get an appointment, access treatment locally, and receive care within a reasonable timeframe. They do not particularly care whether Whitehall has become more sophisticated at statistical housekeeping.
That same disconnect was visible in Streeting’s approach to general practice – one of the last parts of the NHS still built around local leadership, personal responsibility, and ownership rather than central bureaucracy.
The GP partnership model is simple: small business owners delivering public healthcare. GP partners employ staff, manage premises, carry financial risk, and build organisations rooted in their communities.
For all the criticism directed at general practice, this model still delivers around 90 per cent of NHS patient contact for a remarkably small proportion of NHS spending.
Yet Labour’s growing enthusiasm for “neighbourhood” structures and greater centralisation risks slowly replacing independent partnerships with large trust-led systems that often struggle to control enormous deficits of their own.
A centrally managed salaried service may appear tidier to policymakers and NHS think tanks. But incentives matter. GP partners must balance the books because, unlike much of the modern NHS, they cannot simply run deficits.
The uncomfortable truth is that the NHS often functions best where ministers exert the least day-to-day control.
The danger is that politicians kill the golden goose: dismantling the very model that quietly sustained British general practice for decades.
That same instinct towards centralisation also shaped Streeting’s approach to NHS management itself.
He embraced the increasingly fashionable political obsession with attacking NHS “management” and “bureaucracy”. His flagship decision to abolish NHS England certainly turned heads… and chopped plenty of them too.
But healthcare systems do not become simpler simply because politicians announce redundancy programmes.
Even the Department of Health and Social Care admitted NHS restructuring redundancy costs could exceed £1 billion, raising the obvious question: will taxpayers simply fund huge payouts only for many of the same functions and personnel to quietly reappear elsewhere under tighter ministerial control?
The NHS does not suffer from too much local leadership. It suffers from too much political churn, constant restructuring, and the belief that Whitehall can reorganise its way to better healthcare.
Ultimately, Streeting’s poor relationship with large parts of the medical profession may prove one of the defining failures of his tenure.
The scale of that breakdown was shown bluntly on his final day in office, when GP leaders openly voted to explore whether general practice should move towards a model akin to dentistry, something not long ago would have been politically unthinkable.
For decades Labour warned that Conservatives would privatise the NHS. Yet Wes Streeting may ultimately be remembered as the Health Secretary who convinced growing numbers of GP practices that the traditional NHS model is no longer sustainable – accelerating general practice’s drift towards private healthcare.