Cowper’s Cut 410: The age of miracles
“This excuses culture does the centre-left no favours. If we tell the public that we can’t make anything work, then why on earth would they vote to keep us in charge? In the NHS, we have an initiative called ‘GIRFT’ — Getting It Right First Time. That should be our new year’s resolution for 2026. Let’s try and get it right first time.”
Health Secretary Wes Streeting, speaking at the Institute For Government annual conference
Zoe Tidman
“Under-delivering on elective activity is a challenge … but a much easier problem to solve than a system that routinely spends beyond its means without consequences. Because of the changes we are making, the NHS is working to financial balance for the first time in years. This is a system that is rebuilding trust in its ability to deliver to budget.
“This isn’t risk free. There are some parts of the service that have over-steered and are therefore under-delivering on elective activity … [current immediate dilemmas include] how are we going to recover the service quickly in January to deliver our goals by the end of March?”
The very same Health Secretary Wes Streeting, speaking at the Institute For Government annual conference
In these columns, I have previously written about the ‘And Then, A Miracle Happens!’ tendency in English health policy and politics.
As best we can tell, if our current national leadership - the Milburn-Streeting School Of NHS Reform - has a theory of change, then this is it.
It has the attraction of simplicity.
There are no discernible incentives, structures and systems in place to deliver the Triple Shift and the Neighbourhood Health Service: instead, we mouthe these phrases and we just wait for a sudden miracle to happen, and lo!
The NHS will be transformed, modernised (probably with all the AI we can eat, courtesy of the Tony Blair Institute and Euan Blair’s unprofitable company), and Young Master Wesley Streeting will be carried aloft by a grateful nation into 10 Downing Street.
Theologians don’t know nothing about my soul
I mean, maybe. As theories of change go, it’s a bit more faith-based than we might tend to think ideal. As Loudon Wainwright III wrote in ‘The Man Who Couldn’t Cry’, “the theologians were finally found out”.
Department of Health and Social Care
Our latest ‘ATAMH!’ moment came this week in Young Master Wesley’s comments in his speech to the Institute For Government annual conference wondering “how are we going to recover the service quickly in January to deliver our goals by the end of March?”
The answer is simple, albeit unpalatable: the English NHS is not going to do this, in aggregate or individually.
The whole speech is here, on the IfG’s YouTube channel, for those with strong stomachs or a big laughter deficit. It is a masterpiece of narration over reality.
Young Master Wesley asserts that “my approach to modernisation of public services is based on five principles:
- power to the people
- freedom to the frontline, with accountability
- shifting from crisis response to prevention
- productivity and potential unleashed through technology
- spending taxpayers’ money with care”
Mmmmmmm. Looks good written down, and we’ve seen none of it whatsoever.
The speech contains heroic amounts of self-delusion: YMW seems to believe his own PR when he says that “despite the criticism that league tables would, quote ‘undermine public confidence’, I didn’t back down because the public deserve to know what their taxes are paying for.” Cough, cough: league tables in the English NHS were abolished for a good reason. Try reading Gwyn Bevan’s piece for the LSE public policy blog for further information.
There is also something massively funny about the line that “when it comes to the running of the service, the people who best understand what’s broken are the people who work in it every day”. Young Master Wesley’s chief advisor is Alan Milburn: a man who left the health brief back in 2003, and whose subsequent interventions in the conversation show little knowledge of the NHS’s current set of problems, and much hyping of the private sector and tech.
‘Centralisation infantilises’, says massive NHS centraliser
One must have a heart of stone not to laugh at Young Master Wesley’s statement that “centralisation has infantilised NHS leaders and stifled the frontline. You cannot effectively run a public service the size of the NHS from 2 offices a mile apart from each other in Whitehall and Wellington House.”
This is quite the line, coming from the man who is overseeing the biggest recentralisation of power in the Department For Health But Social Care for two generations. And its relationship to YMW’s comment, just a few lines later, that “I’m constantly told that I will have to fight NHS leaders to deliver change. Quite the opposite, in my experience. They are some of the strongest advocates for it” is quite the thing.
Are NHS leader infantilised, or are they huge advocates for change? Pick one hypothesis or the other, and you might have some credibility - and indeed start to develop an actual argument. Pick both, and you show that you don’t have any real interest in your brief - and you think that your audience are very stupid indeed.
Later on, YMW tells us that this huge recentralisation has a purpose: “the abolition of NHS England and changes to ICBs are about removing the number of bureaucratic layers in the service. Fewer checkers and more doers. But they are also about making sure that every pound going into the service is well spent and spent to the best effect. The IfG describe it as a ‘distraction’. You can’t have it both ways. You can’t complain that money is tight and then oppose changes to put money wasted on duplication to better use.”
Mmmmmmmm. It is very hard to see that there was any real plan on Young Master Wesley’s part for abolishing NHS England, what with his having told HSJ he wasn’t doing it in January 2025, and then announcing his intent to abolish it seven weeks later.
And how well is Young Master Wesley’s new, centralised merged NHSDHSCEngland national leadership organisation doing? Well, just this week, its plans to publish something on a ‘model A&E’ had to be taken offline because the work was regarded as basically nonsense, as Health Service Journal revealed. I know: I’m reassured too.
Then, we got the beautiful line “prevention isn’t a slogan”. But it is, Young Master Wesley: it really is! It really, really is!
Hostage To Fortune alert: YMW went on to tell delegates, “I have been told since opposition that the NHS is a sinkhole for public money and it’ll never change. In fact, because of the changes we are making, the NHS is working to financial balance for the first time in years. This is a system that is rebuilding trust in its ability to deliver to budget.”
Joe Talora
Ahem.
Caitlin Tilley
Matt Mathers
(And have these columns of mine been warning for some time now about inevitably-emerging, previously-hidden signs of English NHS financial distress surfacing in Q4? Why yes, they have: thanks for asking!)
I could go on and on: Young Master Wesley did.
After months of deterioration, improvement in RTT waiting
After several months of deterioration, there has been some RTT improvement in the latest figures. Regression to the mean? Time will tell.
An estimated 7.31 million treatments were waiting to be carried out at the end of November 2025, relating to 6.17 million patients, down from 7.40 million treatments and 6.24 patients at the end of October. The number of treatments waiting to be carried out is now at its lowest level since February 2023, when it stood at 7.22 million. The list hit a record high in September 2023, with 7.77 million treatments and 6.50 million patients.
This is improvement: if you believe what Young Master Wesley’s PR folks write, it’s all about ‘crack teams’. There’s no actual evidence offered that these made the difference, of course.
Rob Findlay
Our most reliable and readable guide to what is and isn’t happening with English NHS waiting lists is Dr Rob Findlay, and his latest analysis piece in HSJ is as cogent and clear as ever.
Meanwhile from the Department Of Things That Are Not Surprising, new RCN research found that corridor care is dangerously unsafe. Where is Young Master Wesley’s ‘crack team’ for that when you need it?
Some definitely good news: Sir Ciaran Devane to be chief executive of NHS Confed/Providers
NHS Confederation
In a rare bit of highly welcome good news, Sir Ciaran Devane, ex-chief executive of MacMillan 2007-14 and the British Council 2015-2020, has been appointed as the new chief executive of the merging NHS Confederation and NHS Providers.
Sir Ciaran also served as a non-executive director of NHS England from its creation until 2015. In recent years, he headed the Centre for Peace and Security at Coventry University since 2021, and also chaired the Republic of Ireland’s Health And Safety Executive (their equivalent of NHS England) since 2019.
His experience is eclectic and relevant, and will enable him to see the many changes that are needed to make the organisation more effective, more influential and once again, genuinely independent.
For New Confed to have the independence and influence that it should, it will need to completely stop taking money from the Department For Health But Social Care and from the Government in any way, shape or form. In particular, the pig in a poke that is NHS Employers urgently needs to be offshored.
Particularly with the current return to complete centralisation of power in the DHBSC and with ministers, the English NHS badly needs a high-credibility truth-telling function, and because of the financial foot on the neck that NHS England has had over Confed, it has not been fulfilling this role for many years. (I write this as someone who played a small role helping NHS Providers in its rise: for my sins, teaching Chris Hopson to use Twitter.)
He’s a seriously smart man, and undoubtedly knows that this will be a hard job, but the potential result of doing it successfully and bringing the service along with it could be well worthwhile.
Recommended and required reading
Zoe Tidman
The Countess Of Chester’s woes continue, as former chief executive Dr Susan Gilby wins an enormous payout from the Employment Tribunal against the trust for some of the more blatant bullying yet proven, which included significant deletion of documents relevant to the case. Will anybody from NHS England’s regional or national presence be held to any account for having winked at this? Don’t be silly!
The English NHS is limiting ADHD assessments to do as it is incentivised and save money, The Guardian reports from FOI research. The FT has this on GPs tightening the rules for patients who obtain private diagnoses of attention deficit hyperactivity disorder before returning to the NHS for prescriptions: “waiting lists of more than a decade in some areas have pushed more patients to seek private ADHD assessments before entering into so-called shared-care agreements between specialists and NHS GPs”.
Have yourself a cheap laugh at President Donald J Trump’s ‘Great Healthcare Plan’. It’s two pages long, one of which is the cover. Then read this FT piece on why Americans are dying so young.
More US influence on the healthcare scene, with the FT writing up the JP Morgan Healthcare Summit predicting a pharma deals spree as patents expire.
Speaking of drugs and the USA influence, the new head of NICE Jonathan Benger told the FT (them again!) that UK drug prices should not rise for years, and that giving in to President Trump’s demands for higher payments would be a “huge backward step”.
The FT writes up speculation that the December 2025 resident doctors strike saw senior consultants taking more decisive choices, leading to fewer tests and more patient discharges. It’s almost as if trusts should have a look at their A&E front door staffing mix, no?
Not had enough FT? Their financial charity has been helping nurses with financial education.