NHS restructure is greatest danger to Streeting’s effort to revive service | NHS

At the University of East London’s Great Hall last Wednesday, the ever-optimistic Wes Streeting was radiating more positivity than ever. He said that after years of neglect by the Conservatives, the NHS was starting to revive thanks to Labour’s medicine.

In a flamboyant performance before an audience of health service bosses, policy experts and student nurses in blue and green uniforms, Streeting outlined a long list of progress in his 20-month tenure as health minister.

NHS backlog: reduced by 374,000 since Labor’s takeover in July 2024. A&E waiting times: best winter in four years. Ambulance response times for heart attack and stroke victims: Best in five years. An extra 1,000 GPs were promised but 2,000 were actually delivered. Extra mental health staff, NHS dental appointments and funding for the NHS in England – £26bn, no less.

But he was also buoyed by the latest statistics on public satisfaction with the NHS, published that morning. Satisfaction in England, Scotland and Wales rose to 26% last year from an all-time low of 21% in 2024; This is the first increase in seven years. And dissatisfaction also dropped from 59% to 51%; This is the biggest decline since 1998. He added that this was further evidence that “the NHS is on the road to recovery” and “people are starting to feel that change”.

As he spoke, recovery seemed elusive at Leighton hospital in Crewe, 150 miles away in Cheshire. Last Wednesday, and indeed all of last week, he was under one of the most intense pressures he had ever faced. Even though winter was over, the emergency room was about to explode at one point.

At one point, while caring for an almost record 170 patients, 110 people on their ward were still sitting in a bed despite being medically fit to leave, adding to intense pressure on the A&E.

One member of staff said: “It was the worst few weeks of my career. I was ashamed to work for the NHS. You could see the desperation on everyone’s face. There was no response as there was no room for patients anywhere. Everyone was really trying to do the best they could. People were staying up late and missing breaks.”

Leighton’s struggles exemplified something else Streeting said: while he was “proud of our progress” he was also “often embarrassed when faced with the reality of an NHS that was still not there when people needed it”.

But he added: “The NHS is better today than it was when we came into power and will be better for years to come.”

The research, published last week by University College London Global Business School for Health, based on the views of 850 NHS leaders and senior managers, showed why the NHS still has a long way to go before returning to the generally well-performing service it had by 2010.

While staff goodwill remains strong, “people are exhausted”. Incessant demand for maintenance and limited resources mean that “operationally the system is running very close to the line.” And high vacancy rates mean NHS bosses are spending a lot of time ensuring services are safely staffed.

Streeting’s tenure so far has included three priorities. Firstly, action that will deliver on repeated promises by A&E to reinstate NHS waiting time standards for key areas of care such as access to GPs, cancer care and planned hospital treatment.

The second is a 10-year health plan that aims to modernize the way the service works through “three big shifts”: from analogue to digital, from treatment to prevention and from hospital-based care to community-based care.

Third, a radical restructuring of the NHS, including the abolition of NHS England (which he has previously ruled out), which he insists would ultimately save money and enable the service to revive more quickly.

Streeting knows that the public cares most about wait times. The UEL said waiting times for hospital treatment would certainly return to 18 weeks by 2029 but could not guarantee the same for others, such as four hours of urgent care, timely cancer treatment and instant ambulance calls after a 999 call.

But he was more positive when he spoke on the Guardian’s Politics Weekly podcast hours later, seemingly confident of success on all the key metrics.

The Guardian heard from trust leaders, think tank experts, senior NHS figures, current and former government health advisers and a former Labor health minister about Streeting’s progress so far. Streeting was also asked about the hurdles he must overcome to rescue the NHS from the mess he inherited in 2024 and make it a service that once again provides people with prompt, high-quality care when they need it.

NHS staff agree progress is slow on “three big changes”. Plans go well beyond on-site delivery, he announced. “I can’t hear the sound of the ‘three big shifts’ mechanism kicking into gear yet,” said a senior figure from the service. It is also politically important to deliver on promised plans to establish dozens of “neighborhood health centres” offering different types of physical and mental health services under one roof.

But the biggest danger to Streeting may come from an issue that has received little public attention: the (still unpublished) legislation needed to restructure the NHS and formalize the merger of NHS England with the Department of Health and Social Care.

The last government to reform the NHS (the Tory/Lib Dem coalition in 2010) spent a lot of energy trying to deal with the endless complications of doing so.

“The reorganization of the NHS has been a car crash,” said Bill Morgan, who advised Rishi Sunak on health until the 2024 general election and was otherwise impressed by Streeting. “They haven’t passed the law, which shows how little thought has gone into this issue.”

NHS expert Stuart Hoddinott, of the Institute for Government think tank, said he could understand why the health secretary was so frustrated with an agency that duplicated the functions of his own Department of Health and Social Care (DHSC) and limited its power to order change.

But he said the abolition of NHS England was “an incredibly hasty decision and appears to have been made with little consideration of the wide-ranging impacts. It has created a lot of turmoil”.

Halving staff at DHSC, NHS England and its 42 regional integrated care boards has a human and financial cost through redundancies. But Hoddinott added there was also a risk for Streeting that staff and organizations left demoralized, disengaged and possibly unemployed by the “chaotic” restructuring would be too distracted to help deliver their priorities.