Nov 2, 2025 6 min read

Cowper’s Cut 400: When is a choice not a choice? When it’s another vintage week for Team Milburn-Streeting

“When the PM and Secretary of State for Health and Social Care published the NHS 10-Year Plan on 3 July 2025, they made it very clear that the NHS faces a choice; reform or die, and that the only answer was to choose reform.”

Department For Health But Social Care submission to the SSRB 2026-27 round

Of late, it feels as if ‘Cowper’s Cut’ has become ‘The Cautionary Tale Of The Misadventures Of Young Master Wesley Streeting’, doesn’t it?

Dear reader, I am not sure that such a diet of eye-rolls, pursed lips and occasionally audible ‘tutting’ is wholly good for either of us.

This week, I hoped to avoid the topic of the Health But Social Care Secretary’s increasingly evident mission as a performer, not a reformer. I intended to write about some changes that might actually help make things better. (I still will do this one, in a future ‘Cut’.)

Then I read the above-quoted line, which was clearly from Team Milburn-Streeting’s desk.

And it is, in its own small way, perfect.

“The NHS faces a choice; reform or die, and the only answer was to choose reform” is blatantly, 100% not a choice. A situation where there is only one possible answer is not a choice. It’s not even a Sophie-style choice. It might just be an mis-phrased rhetorical question … but it is certainly not a choice.

In health policy and politics, as in life, words matter.

So does the ability to think.

Nobody with the ability to think would have let this go out in an official document. But Team Milburn-Streeting did.

Mr Streeting did not stop there, releasing to the Sunday Times data that led to the paper’s claims that the DHBSC “published evidence that a third of GP partners — self-employed doctors who ran their own practice — made more than £175,000 last year. Sir Keir Starmer was entitled to a gross annual salary of £172,153 for the roles of MP and prime minister.

“The Department of Health stated that one in six GP partners earned more than £225,000 in 2023–24. Over the past half-decade, it said, partner earnings increased by £37,000. Over the past year, the increase was £18,500. The department added that the highest 10 per cent of GP partners earned more than £256,400 … The figures on GP earnings were based on research by NHS England Digital, which examined anonymised tax data from HMRC self-assessment records”.

Among the rather unusual things about this story is that DHBSC has not, in fact and as stated, published this data. You’d tend to think that in a properly-functioning media, ST Whitehall editor Gabriel Pogrund might have checked this.

Then comes the philosophical question of whether it is the business of the Government or DHBSC to decide what GMS GP partners - who are private contractors to the NHS - should pay themselves.

Let alone whether this statement of the PM’s salary adequately includes the benefits in kind of the various official residences, to say nothing of what has usually been a lucrative post-office career after being PM.

Perhaps most importantly, this move seems to be completely divorced from the question of how well the NHS would function without these people.

One assumes that Team Milburn-Streeting are aware of the notoriously socialist Daily Mail’s long-running campaigns against high-earning GPs (who were usually, although not always, significant outliers working in single-handed prescribing practices in under-doctored areas).

For Team Milburn-Streeting to decide that emulating this would be A Good Look is what we might politely call a niche decision. Less polite descriptions of it are also available.

The future isn’t what it used to be

Media strategy-wise, this has been a vintage week for niche decisions for Team Milburn-Streeting. They briefed the Boris Johnson Fanzine that Young Master Wesley’s sacking NHS middle managers is helping to turn the NHS around.

Isn’t that an epic headline for the BJF, and for Young Master Wesley’s less-than-subtle ambitions to be the next Labour leader?

The BJF reports, with every appearance of a straight face, that “officials said slashing back office staff, such as managers, and reinvesting the savings in front-line doctors and nurses had helped fuel the improvement”.

There is a minor problem here in The Real World, alas.

This is that, due to their having no budget to fund the redundancies, Team Milburn-Streeting have not got the NHS England/Department For Health But Social Care leadership to do any sacking of NHS middle managers.

They have announced that it will happen, to an as-yet unspecified timescale.

But it has not happened.

So this claim is round objects.

NHS management by psychic reverse osmosis

Unless Team Milburn-Streeting’s proposition is that this NHS productivity gain is the result of a kind of psychic reverse-osmosis, where future redundancies are causing past productivity gains.

This would perhaps win them all sorts of awards in the area of quantum mechanics if it were indeed the mechanism of the success, but in reality, this is simply Team Milburn-Streeting pulling off bullshitting a degraded bad joke of a national media brand that isn’t smart enough to know any better.

Well done, Team Milburn-Streeting. Clap-clap-clap.

The BJF article also asserts that Mr Streeting “went into last year’s election vowing to bulldoze through NHS bureaucracy, identifying it as one of the key things holding back patient care”.

This is another intriguing line, but once again, what it isn’t is true. This was not a pre-election theme of Mr Streeting’s. Masochists among you could re-read Mr Streeting’s 2023 speech to the Labour Party Conference, or his 2022 speech to NHS Providers, or his 2023 speech on reforming primary care.

I wonder who briefed that line to the BJF.

The future isn’t what it used to be

NHS management by psychic reverse osmosis

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