Mar 29, 2026 11 min read

Cowper’s Cut 421: Make Young Master Wesley Streeting Grate Again!

The latest set of health questions in the 2025 edition of the long-running British Social Attitudes survey find a small net improvement in public attitudes towards the NHS. It’s statistically significant, but it’s not seismic - and it is starting from an extremely low recent bottom point.

The research found that “26% of British adults were satisfied with how the NHS runs – a statistically significant 6 percentage point increase from 2024, and the first increase in satisfaction since 2019. 2025 also saw the largest fall in dissatisfaction in 25 years, falling from 59% in 2024 to 51%”.

While the BSA survey found (as usual) strong support remains for the founding principles of a universal, tax-funded NHS largely free at the point of use, this rather conflicts with expectations about future NHS performance. Just 16% of all respondents thought the standard of NHS care would improve in the next 5 years: 53% said they expected care to get worse.

Among those who said they were satisfied with the NHS, 30% still said they expected NHS care to get worse or much worse, and 39% said it would stay about the same.

Tax and spend?

The questions on government choices on tax and spending on the NHS are interesting. The 2025 public attitudes as measured by BSA remain closely divided between raising taxes and spending more on the NHS (45%), and keeping taxation and spending at the same level (43%).

At this point, it’s salutary to remind ourselves of tax campaigner Dan Neidle’s 2024 survey with WeThink of how much more tax people said they were willing to pay for the NHS.

That survey found a majority of those sampled were against increasing tax to fund the NHS more. Importantly, it found that even among those willing themselves to pay more tax for the NHS, very few were willing to pay more than an extra £100 a year.

There is other intriguing cognitive dissonance on finance and efficiency: the BSA survey found that although just 13% of respondents agreed that ‘the NHS spends the money it has efficiently’, two-thirds (66%) of respondents said that the government was spending ‘too little’ or ‘far too little’ on the NHS.

Time to declare victory!

So there is now a small increase in net public satisfaction with the NHS, to sit alongside the recent small improvement in 18-week RTT performance.

And this recent comment piece-cum-study by Olly Harvey-Rich and Max Warner of the Institute for Fiscal Studies suggests that English NHS hospitals are outperforming those in Wales and Scotland.

Guess who has declared victory?

Streeting: fighting man

It is with regret that I return to the subject of Young Master Wesley Streeting, Health But Social Care Secretary and junior partner in Team Milburn-Streeting.

Off the back of the minor successes outlined above, Young Master Wesley gave this rather tedious speech: its misleading title was ‘NHS reform and the future of the health service’.

It is no such thing: a better title would have been ‘Young Master Wesley’s ambition and why he should be the next Prime Minister’.

Young Master Wesley is such a desperately poor health secretary. Perhaps this is unsurprising, given that he outsourced his thinking wholesale to time-expired former Blairite bully-boy Alan Milburn: a man last in contact with the real NHS issues all the way back in 2003, before he stood down as health secretary apparently to spend more time with his family (certainly with someone’s).

Again and again, I am told by those around him that Young Master Wesley’s command of detail reveals his extreme disinterest in the job. It appears that Team Milburn-Streeting have not noticed that since the 2022 Health Act, the Secretary Of State For Health is explicitly back in charge and the chief executive of NHS England is subordinate. This was obvious from the moment when I first got the leak of the relevant White Paper.

At the risk of patronising Young Master Wesley, if you’re actually and really in charge, then you have to pay close, deep and detailed attention. You can’t expect Alan Milburn to do so, when he’s got his AM Strategy/Bridgepoint Capital/PWC business and his other work for the government. Busy man, innit.

Holding out for a hero

No, Young Master Wesley’s speech is very much about Young Master Wesley and his heroic desire to save our faith in government and in politics itself: fighting “the fear that politics no longer works, that government cannot deliver, that public institutions are in impermanent decline, and that the big challenges of our time are beyond our power to solve.

“And from that story comes something that is even more corrosive. A quiet, creeping cynicism, a loss of faith, not just in politicians, but in the very idea that collective action can’t improve our lives. This is a dangerous place for our country to be in, a dangerous place for any democracy to be in. Because when we stop believing that change is possible, we stop demanding it. When we stop demanding it, we stop achieving it. And when that happens, decline doesn’t just continue, it accelerates …

“I have felt a particular responsibility resting on my shoulders as our country’s Health and Social Care Secretary. Not just the responsibility to rebuild the greatest institution this country has ever built. But to give this country a sense of hope, optimism, and confidence based on experience”.

I mean, where to even start? The idea that a gravely underprepared and frequently incompetent, U-turn-prone Starmer government means that people no longer want change or believe it is possible is the reddest of herrings.

Likewise his aim “to give this country a sense of hope, optimism, and confidence based on experience” sounds lovely. And then there are his achievements in office: the still-unresolved resident doctors strike; the small reductions in RTT waiting lists and small rise in net NHS satisfaction; the wholly-implausible and delivery-mechanism-free Ten-Year Plan.

Are these people who believe in the Streeting NHS turnaround here in the room with us now?

If so, Young Master Wesley has a mission for them: “I’m asking you to do just about the most radical thing that anyone can do in Britain today, to believe again, to believe that the NHS can be better than today, to believe that the NHS will be better than today”. This is the Tinkerbell Effect.

YMW hymns his “major reforms in how the NHS is run, removing unnecessary layers of bureaucracy, ending the culture of micromanagement, and directing resources and responsibility down to the front line. The progress we’ve made wasn’t by accident or by chance, or because the NHS has a natural predisposition towards self-improvement”.

At his last point here, the Young Master hits on an actual issue (even a broken clock is right twice a day): that of NHS performance and quality measurement, improvement capacity and capability. These are indeed real and vast issues.

And they are ones that Team Milburn-Streeting has done nothing whatsoever effective to address.

Crack teams, apparently

Yet he goes on “the lesson of success after 1997 and post 2024 is that it’s investment and modernisation that delivers results … We sent crack teams of top clinicians to hospitals around the country where the highest numbers of people are off work, sick, to help them cut waiting lists faster, using high intensity theatre lists that run like Formula 1 pit stops, getting more patients through, and more bang for the buck at the same time”.

Ah, good: the ‘crack teams’ nonsense again. Presumably at night, these crack teams return to their crack dens?

It’s adorable to see Young Master Wesley pushing this already-debunked nonsense yet again. Nothing like a bit of recycling: see also his line that “we published new NHS League tables, not to name and shame, but to confront the challenges we all face with grown up honesty”. Mmmmm. Does the Young Master remember why NHS league tables were abolished?

For fans of bathos, YMW also told a grateful public that the Care Quality Commission is being turned around. Nobody whatsoever in the English NHS believes this to be true.

‘Ever tried, ever failed. Try again. Fail again. Fail better.’

Another sub-reason for the speech was the announcement of a new NHS failure regime, which as Health Service Journal’s Alastair McLellan correctly pointed out, meant that the “five trusts … included in a new ‘intensive recovery programme’ which is expected to replace a ‘national provider improvement programme’ launched just weeks ago … three of these trusts were already informed on 4 March that they were being placed in the national provider improvement programme (NPIP). They are all currently in the bottom tier (4) of NHS England’s acute trust league table”.

If you wanted an explicit acknowledgement that those in and around Team Milburn-Streeting have no coherent ideas, narrative or theory of change about how to improve NHS providers’ performance (beyond me wearily repeating it here most weeks for the past eighteen months), then here it is.

I will say it yet again: there is no curiosity in DHSC, NHS England or Team Milburn-Streeting about the underlying causes of good, bad or middling NHS performance. And what you do not understand, you cannot spread (the good) or improve (the middling or bad).

But Young Master Wesley was not yet done with the threats: “I’m also going to enlist patients in my drive for a better quality service. We’re going to trial new patient power payments. Patients will be able to decide whether the NHS provider deserves full payment for the service they received, based on the quality of their experience”. Forget about half-baked: this idea isn’t even one percent of the way towards being ready to enter The Real World. In baking terms, this is still some eggs, flour, butter and sugar, in their packets and shells in separate storage cupboards or fridges, to be served with a side order of ‘what the fuck?’.

Wonderfully, we also learned that Manchester (which already has a devo deal including health) is going to get a health devo deal. Mr Streeting’s also made great play in his speech about how he was ‘quietly moving on’ poorly performing NHS chief executives because having them publicly shamed was not his style, which could make a cynical person wonder how this story got to The Times.

Make Young Master Wesley Grate Again!

In his peripheral media appearances and this excrementary op-ed for the Boris Johnson Fanzine, Young Master Wesley used the analogy-cum-pledge to “drain the swamp” of NHS failure and underperformance.

This phrase was, of course, a keynote pledge of Donald Trump for his first term as President of the USA. One starts to wonder whether Young Master Wesley’s next pledge will be to ‘Lock Her Up!’ (The ‘Her’ remains to be determined: not necessarily Amanda Pritchard).

This is not a speech that people should toss aside lightly. It is one they should tear up with great force.

All he is saying is give Keir a chance

Also in the peripheral media work, Young Master Wesley tried on statesmanship for size towards PM Sir Keir Starmer, telling Guardian journalists that “I don’t want to see Keir challenged in May. I don’t think that that will happen.”

Pressed on whether he would run if somebody else triggered the contest, Mr Streeting added, “I don’t even think that’s going to be a scenario. And honestly, I’d had the other month just about my fill of tedious, who’s up, who’s down, that kind of ‘politics is a parlour game’ crap. I’ve got a job to do. I’ve got a big job to do. This is the only job I want to do.”

This Uriah Heep-like humility on Young Master Wesley’s part would be rather easier to wear if we did not also learn this week from the Times political team that “Alan Lockey, the prime minister’s speechwriter, received an unexpected WhatsApp message while working in No 10 this week. Would he be prepared to help Streeting’s campaign in the event of a Labour leadership contest?

“The message was sent in error and Streeting’s outrider was mortified to learn that a senior member of Starmer’s team had been sent a text”.

Ahem.

To be at once so blatantly on leadership manoeuvres and so incompetent confirms a great deal about Team Young Master Wesley, even though what it confirms has been pretty evident to ‘Cut’ subscribers for some time now.

It is almost as if the right-of-centre-left hand doesn’t know what the further right-of-centre-left hand is doing.

Iron while the strike’s hot (part 397)

The fact of fresh resident doctors’ strikes scheduled for Easter shows us two things: the BMA Resident Doctors Committee is not yet tired of shooting itself in the feet, and the Government has again been dragging its feet in the negotiations.

Blessed be The Historical Re-Enactment Society For Resident Doctors’ 2008 Pay Differential.

Responding in the House of Commons, Young Master Wesley Streeting emphasised that this is a ‘blink and you’ll miss it’ chance for the creation of extra specialty training jobs, as the money will now go on strike cover instead. The lack of career progression opportunities has been one of the RDC’s stronger points.

There were equally bullish noises at the latest NHS England board meeting, from Interim Jim Mackey and others who will not be around to pick up the pieces of escalating the industrial dispute: HSJ covers all that here.