Cowper’s Cut 399: Now we rise, and we are everywhere
“We need reform of the state, reform of our public services, reform of the economy, and only by doing those things and having people feel change are we going to rebuild trust in politics … there are green shoots of recovery in the NHS, in the economy, in our public services. But there is also so much more to do.”
Health Secretary Wes Streeting, interviewed by Trevor Phillips on Sky News 26.10.25
Nobody could accuse Sir Keir Starmer’s Labour government of failing to leave itself ample room for improvement.
It is particularly true in the sphere of health (and it is also true more generally) that fairly basic planning for being in government either was not done well, or was not done at all.
One of the most telling moments of their tenure in office so far was the appointment last December of classic civil service timeserver Department For Health But Social Care permanent secretary Sir Chris Wormald as the new Cabinet Secretary and head of the Civil Service.
And this was not just to be any old Simon-Case-a-like CabSec (a role last held with distinction by Jeremy Heywood); but a dynamic new type of CabSec who could bang heads together, and get action this day, if not this hour or minute!
(If you want a glimpse of just how bad a choice Simon Case was as a CabSec, this piece by him in the Boris Johnson Fanzine provides an excellent index.)
And, I repeat, Labour picked Chris Wormald. Who had been DHBSC Perm Sec for the last eight years, since 2016. Which was not a period where the DHBSC civil service was known for its dynamism, effectiveness, innovation or working differently.
Sir Chris may or may not be a delightful man, but he was a well-known quantity. And Labour‘s antennae, networks or both were so very bad that they made him Cabinet Secretary.
Patrick Maguire, Chief Political Commentator | Gabriel Pogrund, Whitehall Editor
To the considerable surprise of absolutely nobody, this week saw sulphurous briefings to The Times’ political top team that the 10 Downing Street leadership consider Sir Chris’ performance inadequate, and that as a courtesy he will be allowed to complete a year in the job before being defenestrated.
The article says that “the cabinet secretary has been criticised privately by ministers for a lack of dynamism and excess of caution. One senior Labour source said he had proved to be “the embodiment of Whitehall groupthink” during his ten months in the post.”
And Labour did not know that Chris Wormald was like this.
One must have a heart of stone not to laugh.
The mooted replacement is Starmer ally Baroness Louise Casey, whose dance card had hitherto been busy up until 2028 chairing the Government’s ‘Independent commission into adult social care’. Since last week, Baroness Casey was also charged with supervising the political hot-button national grooming gangs inquiry
If the long grass of social care is willing to relinquish the noble Baroness Casey, and a safe-enough pair of hands can be found for the grooming gangs inquiry, she would make a formidable appointment, provided the infrastructure of central government is prompt and punctual to do what she says and get out of her way.
Time will tell.
Assuming that this briefing is broadly correct, this is, at least, a sign that the Starmer administration has spotted that it is deep in the smelly brown stuff, and needs to not stay there. The associated even-further-long-grassing of social care reform is depressing, but unsurprising.
Team Treasury monsters SOS Streeting over NHSE redundancy cash confusion
Somebody in The Treasury has an artist’s eye for the particularly wounding briefing. SOS Streeting has been assiduous in his embarrassingly fulsome efforts to court the approval of the Boris Johnson Fanzine, as I again noted last week.
So, does courting the BJF get Young Master Wesley good coverage when he really needs it, then?
Erm, no. Not in the slightest, as this Treasury-inspired hit piece shows.
The BJF reported that “the Chancellor is resisting demands from the Health Secretary to spend more than £1 billion of the Treasury’s reserves on redundancy payments when the agency is scrapped … Mr Streeting racked up a potential bill of a reported £1.3 billion in redundancy payments as part of the reforms. The Treasury declined his request for a loan to pay off staff, which could then be repaid by DHBSC from future savings.
“The Treasury suggested it would provide around half the money for redundancies on the condition Mr Streeting absorbed extra pharmaceutical costs under a deal with the US … The Treasury is also thought to have asked Mr Streeting to pay for the cost of any future resident doctors’ strikes, rather than receive a bailout from the reserve, as Conservative health secretaries have in previous years”.
It’s intriguing and unsurprising to see the Treasury’s explicit refusal to countenance further NHS fiscal exceptionalism with this unmissable briefing.
And once again, it calls into question the political and economic judgments of those behind the decision to countermand SOS Streeting’s comments to HSJ back in January 2025 that he would not abolish NHS England.
The BMA Resident Doctors 2008 Pay Differential Historical Re-Enactment Society rides again!
British Medical Association
You’ve missed them? I know, I’ve missed the BMA Resident Doctors 2008 Pay Differential Historical Re-Enactment Society too.
Mr Andy Cowper
But the Slim Shadys of health policy are back! Their industrial action in late June was not a success. At that time, their mandate for strike action was not quite what they’d have hoped. There was a 90% vote for industrial action, but it was on a 55% turnout: the previous campaigns for strikes saw vote turnouts of over 70%.
This time, the mandate is not much stronger: a 65% turnout among FY1s still suggests that fewer doctors are energised by industrial action than was routinely the case under the last Conservative government. Strike ballot turnouts across all BMA resident doctors then routinely exceeded 70%: sometimes, by some margin.
DHSC Media Team
And of course, the Government press release pointed out that the BMA membership is not what it once was: “the turnout (55.3%) meaning that under half of resident doctors in the BMA have actually voted in favour of strike action (49.78%). Of the 77,000 resident doctors working in our NHS hospital and community health services, only around a third actually voted for strike action.
“The BMA launched a second ballot of first year doctors (FY1s) in autumn. In June 2025 there were over 8,200 FY1 doctors working in NHS Hospital Trusts. With only 3,950 voting in favour of a strike, based on these figures, under half (48%) of FY1s voted to strike in the FY1 ballot.”
Most pertinently of all, public support for the resident doctors has not risen: the most recent polling by YouGov found that 51% of respondents opposed further strikes, with only 38% in support.
And mid-November will be a cold time to be on the picket lines without popular support. Their June strikes impacted an NHS grown quite used to strikes, with 93% of planned activity going ahead. The June industrial action saw NHS national leaders taking a firmer line, ordering NHS providers not to cancel scheduled work unless essential and being more assertive on derogations on grounds of safety, when doctors on strike can be ordered back to work.
In June, UCLH staff told The Sunday Times that they had managed to keep over 95% of planned care going ahead as planned, and that only 27 per cent of their resident doctors walked out on the Friday: their medical director reported, “last year that (striking turnout) would have been in the thirties, forties and on some days 50 per cent”.
The resident doctors’ media campaign sensibly placed less emphasis on ‘full pay restoration’ to the 2008 differential (which BMA chair of Council Tom Dolphin regards as “based on a principle”), and instead tried to highlight the more credible points of specialist training place shortages and residents’ general career progression uncertainty.
The non-Doctors Vote new residents committee chair Dr Jack Fletcher focused his statement on “better employment prospects and restoring pay - are a credible way forward that would work for doctors, work for Government and work for our patients.
“The Health Secretary’s 11th hour letter to us today makes vague promises for some degree of change to jobs and training for two years hence, showing little understanding of the crisis here and now, or a real commitment to fix it.”
Mmmmmmm. If there really was only waffle and jam-tomorrow on offer, then SOS Streeting has not been taking the prospect of further industrial action sufficiently seriously.
The lack of clarity on career progression for resident doctors is a pertinent and serious issue. If finding workable solutions to it has not been prioritised, then this reflects badly on Team Milburn-Streeting.
Recommended and required reading
The Financial Times reports on Google’s claims to have gained an edge in the race to demonstrate the first practical use of a quantum computer, revealing an algorithm that it claims may help to open up new techniques in drug discovery and the development of new materials.
In their written evidence to the Public Accounts Committee inquiry on reducing NHS waiting times, Guys and St Thomas staff highlight their actions, which included the introduction of a patient tracking list (PTL). I beg your pardon? Does any NHS provider organisation not have such a basic thing as a PTL in place and properly functioning? Most of what is highlighted in this seems quite worryingly basic management procedure.
The FT also highlights CoMind: a British start-up developing technology to monitor blood flow and pressure in the brain, without having to puncture the skull.
DHBSC media team this week prioritising publicity for the increased activity from the independent sector: half a million more treatments and appointments this year, over last.
The FT reports that the loss-making Tony Blair Institute will restructure, downsize and double-down on its focus on AI. Of course. What could conceivably go wrong?
NHS England’s Medium-Term Planning Framework: Delivering Change Together 2026/27 To 2028/29. For those who like this sort of thing, this is the sort of thing they will like.