Apr 12, 2026 10 min read

Cowper’s Cut 423: The ‘W1A’ification of the NHS

Health But Social Care Secretary Young Master Wesley Streeting has excelled himself. This is as scant an achievement as it sounds.

Writing about hospital corridor care in this risible opinion piece for the Boris Johnson Fanzine, Young Master Wesley (who has now been in his job for twenty-one months) has Reached A Conclusion. Dear readers: the Young Master has sent down his word from the mountain, engraved on tablets of hearts of stone, that corridor care in the English NHS is A Bad Thing Which Must Stop Now.

Thanks for that.

Young Master Wesley’s choice of language is unintentionally revealing: he tells the BJF’s Labour-loving readership that “no Health Secretary or NHS leader ever told the service to start treating patients in corridors. But as the practice continued and became more common, those in positions of power turned a blind eye to the problem and normalised it”.

For fuck’s sake.

Really?

For.

Fuck’s.

Sake.

An argument of Titanic stupidity

Let’s imagine Young Master Wesley having an alternative career in crisis PR: “no White Star Lines leader ever told the Titanic to start using the life boats. But as the water poured in, and the ship began to break apart the practice continued and became more common, those in positions of power turned a blind eye to the problem and normalised it.”

It’s adorable naïvety that Young Master Wesley thinks that the NHS provider sector tends to do what the Health But Social Care Secretary tells them to do. Were it as linear, miraculous and simple as that, then RTT waits would be tumbling vertiginously towards 18 weeks, in exactly the way that they aren’t.

It’s our dear old friend, the Tinkerbell Effect in action once more.

In all fairness, a SOS-centric NHS has been the intended direction of travel since the White Paper that became the 2022 Act: the legislation that “unambiguously puts the Secretary Of State For Health back in charge, in a massive political land-grab. This is in charge of both the overall system; of each local Integrated Care Systems; and of the NHS Commissioning Board (known now as NHS England)”.

Young Master Wesley (and indeed all of Team Milburn-Streeting) will be furious, just furious, when they find out what incompetent’s been the Secretary Of State for Health But Social Care these past twenty-one months, when corridor care has, erm, continued to be normalised.

What could Team Milburn-Streeeting say of a person who’s just been letting corridors care run on and on and on?

Only strongly-worded opinion pieces in the Boris Johnson Fanzine can save us now.

Annoying as it is, we need to be fair to the Young Master: corridor care is in no small part the consequence of the longstanding problem of poor operational management in the English NHS.

In his BJF magnum opus, Young Master Wesley cites the example of his local hospital, Queens in Romford: their significant improvement in reducing corridor care was to some extant about changing a mindset of ‘it’s a fact of acute life’ acceptance, but very largely about a significant expansion of and investment in local operational management.

So what does Young Master Wesley think about the importance of operational NHS management?

As the Young Master told Health Service Journal editor Alastair McLellan in a surprisingly contemporaneously un-reported conversation on the eve of YMW’s taking ministerial office in 2024, Mr Streeting “was constantly presented with evidence for the claim the service had too few managers by think tanks, NHS leaders, and others. But – at the same time – he said, most NHS staff and members of the public he talked to believed the opposite.

“His suggestion was that while that belief existed, the case for management resource remained unproven. He gave no indication that he thought this belief was founded on ignorance or that he saw it as his job to challenge it, regardless of any evidence he was given”.

As Alastair’s recent editorial rightly noted, “this is populism, pure and simple”.

The very thing that demonstrably works to reduce corridor care - improving operational management within providers - is also the thing on which Team Milburn-Streeting have placed no value whatsoever.

Simply the best crack teams (from the best crack dens)

But what does Young Master Wesley’s BJF article tell us will make all the difference to end the scourge of the very corridor care that he has overseen these past 21 months?

Ah yes, it’s our old friends “crack teams of top clinicians” (carefully smoked out of their crack dens), spreading completely unspecified “best” practice.

Has this “crack” best practice on corridor care been evaluated, or proven sustainable?

Need we even ask? (Yes, obvs.)

Oh and let us not forget the impact of these very crack teams from their crack dens in the massive reductions in RTT waiting lists. Ahem.

Young Master Wesley preaches the gospel to the BJF faithful about the very same-day emergency centres, urgent treatment centres and community diagnostic providers that were the results of planning and policy changes in the 2019 NHS Long-Term Plan. Does the Young Master acknowledge this fact? Don’t be silly!

This bathos-drenched article ends with the pitiful acknowledgement that “Wes Streeting is the Health Secretary”. Byline as auto-j’accuse is quite a novelty, but I don’t expect it to catch on - nor that those involved will spot the irony.

The W1Aification of the NHS is now largely complete. Let’s hope it’s reversible.

Team Milburn-Streeting are The Pathetic Sharks of health policy.

Oh, and if all of this wasn’t bad enough, Young Master Wesley has just put the NHS on the table as an issue in the May local elections.

This is startlingly unwise. He told The Guardian that “the founding principles of the NHS are at greater threat than at any time since the NHS was founded in 1948”, warning of “a particular jeopardy” for the NHS in Wales.

Streeting called Labour’s progressive rivals “rookies”, adding that he’d “refuse to believe that many people in Wales would vote for Reform if they knew where Nigel Farage stood on the NHS … The idea that the country that gave birth to Bevan and the NHS would elect into government in Wales a party that would dismantle it just sends shivers down my spine”.

Young Master Wesley also asserted that the leaders of the Reform Party, Nigel Farage and Richard Tice, “hope voters will go into these elections thinking Reform is a safe protest vote. They are not. They are a risk to the NHS”.

In what way is this a positive case for people to vote Labour?

Strikes update: “You smell of poo!” “No, YOU smell of poo!”

It’s been yet another edifying week in the industrial dispute over pay, terms and conditions between NHS Employers, oh, sorry, the Government and the BMA Resident Doctors Committee 2008 Pay Differential Historical Re-Enactment Society.

There have been what we can only assume were meant to be ‘defensive’ interviews with BMA ResCom chair Dr Jack Fletcher in The Times and The Guardian. These both bid for public sympathy by claiming that the Government’s negotiators reduced their offer on pay increases at the last minute.

Is this true? We have no means of knowing, other than taking the word of the BMA committee chair. Anecdotally, I’ve heard plenty of reports about extremely frayed sympathy from nurses, consultants and other NHS staff towards the striking residents’ leadership’s conduct of the dispute.

Everyone gets their points about rotation frequency and poverty of planning, teaching and training places.

But the top line of the BMA campaign remains about Full Pay Restoration to the 2008 differential. It is well worth a few minutes to read The Times’ Tom Calver’s data briefing about the resident doctors’ means of numbering up their claim.

Given that yet another pay rise above inflation seemed to be on the table, I suspect that time will tell that sympathy within the NHS, like public sympathy, is slipping further away from the resident doctors.

They should blame their leadership, if this proves to be so.

Mr Streeting’s PR offensive during this week’s strikes included claiming that any further pay rise for doctors would “understandably” spark similar demands among the health service’s 1.4 million-strong workforce, including nurses. “This would be more like £30 billion a year. That is more than the entire cost of the Ministry of Justice’s entire budget for running the criminal justice system”.

Young Master Wesley also told BBC Radio 4’s Today programme that doctors had been “the biggest winner by a country mile of public sector pay increases since this government came in”.

The Pathetic Sharks: let’s ban doctors’ strikes!

The Government’s negotiators’ line to the Finanical Times was that “BMA negotiators had reached an agreement during talks last month, only to backtrack once it became clear it was unpopular with the union’s resident doctors’ committee”.

If that’s true, it’s clearly very irritating. But that’s once again an ‘if’.

This was briefed anonymously to the FT as part of an article which floated the threat of banning doctors from taking strike action. The FT’s Chris Smyth writes that “senior health officials have discussed banning UK doctors from going on strike, in a sign of growing desperation inside the government at resolving a three-year-long campaign of industrial action over pay. Health secretary Wes Streeting has not ruled out the idea”.

It’s an embarrassingly bad idea, even if it’s only political kite-flying by Team Milburn-Streeting. The right to withdraw one’s labour is widely recognised as valid in representative democracies. Exceptions to this are pretty universally made for the police and the military, on obvious public security grounds.

Most of the population is considerably more inconvenienced day-to-day by strikes among train drivers or fuel tanker drivers: the NHS works at all because most of us do not use it most of the time.

Derogations exist as a legal lever in the event of genuine safety concerns during medical industrial action.

Ming hearts the FDP

As she is all but walking out of the door of NHS England, its data chief Ming Tang leaked her memo on the Palantir-led Federated Data Platform to the Financial Times. In this memo, she is keen to emphasise the wonderfulness of the FDP.

Ms Tang told senior colleagues in NHS England that the FDP was delivering “outstanding results” by speeding up surgery and getting patients home quicker. She pledged to achieve “maximum product penetration” — the use of all available tools on the FDP — in an initial group of hospitals over the next 12 months, the FT reported.

These claims of Ms Tang’s will of course be backed by publishable evidence and evaluation. Won’t they?

They won’t, you say?

In much the same way that the evidence basis of the 2022 PR claim to - yes! - the FT that a “recent pilot of Palantir’s Foundry system at the Chelsea and Westminster Hospital Trust helped reduce the inpatient waiting list by 28 per cent — the equivalent of tens of thousands of patients — for all non-emergency surgeries, including for cancer treatments” was never published either?

(When I was a paid member of the Palantir health advisory panel, I repeatedly asked for this information to be shown to the panel and released into the public domain. Despite some reassuring-sounding waffle, it never was.)

Mmmmmmmm.

This is quite the turnaround from Ms Tang’s position eighteen months ago, which was managing expectations of the FDP downwards. She told a conference audience that the FDP would “not be that spectacular”, as HSJ reported.

Any readers who attended last summer’s Cambridge Health Network summer drinks hosted by McKinseys may recall that I asked a Q&A panel including Ming Tang what lessons national technology leaders and the service could profitably learn from the fact that after many years of implementations, new hospital installations of electronic patient records (EPR) systems were still usually accompanied by dramatic collapses in the hospital’s performance.

Ms Tang tried to suggest that this was an inaccurate statement, to sharp intakes of breath and laughter from those present. I realised at that moment that I had T-shirts which were better-informed about tech in the NHS than Ms Tang.

An argument of Titanic stupidity

Simply the best crack teams (from the best crack dens)

Strikes update: “You smell of poo!” “No, YOU smell of poo!”

The Pathetic Sharks: let’s ban doctors’ strikes!

Ming hearts the FDP

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