Jun 22, 2025 4 min read

Cowper’s Cut 381: The NHS Ten-Year Plan and Mrs Doyle’s ‘cup of tea’ paradox

I haven’t been chasing down every riddle or rumour about what’s in The 3:7 Forward View (AKA The NHS Ten-Year Plan). Life is too short.

But thinking about The Plan (blessed be The Plan), one thing has been going through what passes for my mind: Mrs Doyle’s ‘cup of tea’ paradox.

‘Cowper’s Cut’ readers are to a woman and man classicists, and so do not need to be introduced to the canonical work that is ‘Father Ted’.

Relentlessly tea-proffering housekeeper Mrs Doyle asks Father Jack Hackett “and what do you say to a cup?”.

Father Jack’s reply: “FECK OFF, CUP!”

It’s reasonably likely that once the Ten Year Plan has been unveiled to an expectant health policy nation, the collective Mrs Doyles of our system and political leadership will then turn to the workforce and ask, “and what do you say to a Ten-Year Plan?”

“Feck off, Ten-Year Plan!”

My suspicion is that the NHS workforce of 2025 will be minded to look to the gospel according to Father Jack Hackett for inspiration, as to their reply.

It bears a lot of repeating that 2025 is not 2000, although you’d scarcely know it looking at the accretion of Blairite retreads around the place.

2000 was a far more hierarchical version of the NHS and medical power and authority structures.

In that era, a quarter of a century ago, there was a degree of meaning in then-Health Secretary and now-eminence grise Alan Milburn’s convening what Nick Timmins characterised as the “regular dinner of the ‘top ten’ – leading figures from the medical royal colleges, the BMA and the like” to issue warnings about being in the biggest Last Chance Saloon ever, and of the concerted efforts from DH and 10 Downing Street to get the leaders of just about every health organisation going to sign up to the preface and principles of 2000’s ‘The NHS Plan’.

The issue here is Core Principle Number Six: “The NHS will support and value its staff - The strength of the NHS lies in its staff, whose skills, expertise and dedication underpin all that it does. They have the right to be treated with respect and dignity. The NHS will continue to support, recognise, reward and invest in individuals and organisations, providing opportunities for individual staff to progress in their careers and encouraging education, training and personal development. Professionals and organisations will have opportunities and responsibilities to exercise their judgement within the context of nationally agreed policies and standards.”

It’s remarkable that that feels like quite a remarkable statement. It certainly didn’t totally happen in the 2000s, although DH national director of workforce, the late Andrew Foster, certainly gave national workforce leadership drive and energy.

A requiem for staff goodwill

But that statement feels like a very long way from where we are in 2025. The NHS staff survey gives us one valuable source of insight into staff attitudes: this Nuffield Trust analysis of the latest is cogent.

The staff goodwill that was long deemed the operating system without which the NHS would collapse has been gone for some years now. A succession of brutal winters in the 2010s from which the managerial and operational lessons remained unlearned steadily eroded it, before the Covid-19 pandemic killed it off completely.

And in a vastly less deferential age, it is not coming back.

We should regard this positively, by the way. Other than for genuinely exceptional and necessarily short periods, staff goodwill is not remotely reliable as a management tool. As a permanent fixture across much of the NHS (which it had become), the appeal to staff goodwill to cover system inadequacies of all kinds was emotional and moral blackmail masquerading as public service selflessness: a shitty tool, used by shitty people.

The failure to genuinely prioritise recovering the workforce after Covid has been ably pointed out by Kevin Fong and Nigel Edwards, among others. This might have been the cardinal sin of the Pritchard era of NHS England. The staff noticed this.

The year of living dangerously

It is a remarkable tell of Health But Social Care Secretary Wes Streeting’s addiction to the Milburn’s playbook that he has taken Bouncer’s 2015 ‘Glaziers And Windowbreakers’ imprecation to take time to make a plan so literally.

It has taken a year for the forthcoming Plan to be put together: this when a week is a long time in politics.

In the interim, Mr Streeting’s principle national media activity has been to shout “REFORM OR DIE!” at the NHS and its workforce. No kink-shaming here: to each their own fetish. But it certainly isn’t clear that this bracingly robust approach to workforce motivation has proven terrifically effective at laying the ground for The Plan (blessed be The Plan!) to land, in a “really retail headline-grabbing” kind of way.

The next point is so obvious that I am almost embarrassed to write it down. But I need to, because there is no evidence that it’s been given due consideration.

Here goes: The Plan may be very good once we get past the inevitable barrage Blair-inflected tech-Utopianism and over-claiming bollocks about AI. (My fellow health AI stans should read this superb Financial Times interview with AI-sceptical computational linguist Emily Bender (because these AI schticks are Large Language Models, innit) to savour its crucial phrase that AI technologies are “stochastic parrots”.)

But plans are not, in the lovely phrase of Florence Nightingale, “self-executive” things.

They will require the English NHS workforce - from the managerial class who have just seen their jobs thrown into jeopardy via the jolting U-turn on redisorganising the whole management system, through to the staff at all levels and of all disciplines - to do things that are different and difficult.

How much effort has gone in to preparing the ground for this?

“Feck off, Ten-Year Plan!”

A requiem for staff goodwill

The year of living dangerously

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