The NHS should respond well to Wes Streeting’s ministrations

Editorial: Making top brass work for their pay – and be held accountable for their failures – will help focus minds within a health service that is broken but not beaten. In Labour’s hands, the prognosis is improving

Whether Britain “needs an Elon” or not, as some are wondering, what it has got is a Wes. And, on the early evidence, the health and social care secretary is launching like one of Elon Musk’s famous SpaceX rockets.

Unlike Mr Musk, Wes Streeting has no glaring conflicts of interest to complicate his work, but he is faced with an array of vested interests and shows admirable determination to face them down. He has little choice because if he does not, then he has little chance of completing his mission to revive the NHS.

As he points out, the NHS may be broken but it is not beaten and his prescription – of funding and reform – is surely the best approach.

To ensure that “reform” is more than a mere mantra, Mr Streeting has chosen as his first initiative of (hopefully) many to focus on those responsible for running our NHS trusts. It is offensive and demoralising that so many of those on the boards of these trusts, along with their senior managers, should be so well paid and yet preside over indifferent provision of services, and, worse still, little evidence they have been sufficiently energetic in putting matters right.

They may plead that they are short of resources and the pressures on them are intense, but that is also true of any other executive in the private or public sector. For far too long, the pay of those in charge of NHS trusts has been determined solely on the basis of the organisation’s turnover. That situation is now ending and Mr Streeting has made it clear that failing managers will get the sack.

Conversely, those who improve their institutions will be incentivised to do more through financial rewards. Their staff should similarly be given appropriate bonuses for their efforts. The NHS only functions as well as it does because of its pronounced ethos of teamwork; the rewards for radically improving health outcomes should reflect that collective effort, as well as strong and inspiring trust leadership.

The wellbeing of patients and the treatment of staff is too important to allow trusts to drift. It is essential for the future of the NHS that its extra funding is not only not being wasted but should also be seen to be put to the best possible use. Taxpayers deserve to know where their money is going, and why. There should therefore be no more rewards for failure – and central to that is a clear and transparent system of measuring performance; hence the return of “league tables” for hospitals.

Tables have their flaws. They are, or can be, crude and, if misused, can stigmatise particular hospitals and their staff who are doing their very best. Yet the public has a right to know how their local services are performing – not least because they pay for them.

If a hospital is suffering from unusually long waits, or is in financial crisis, then that is a signal for the causes to be identified and, so far as possible, remedied. No hospital, including its management and clinical staff, should be penalised, for example, if the area it serves has been subject to rapid demographic change, or buildings are out of use because the roof is leaking.

But if it has been badly run, and money wasted on the wrong priorities, then that too needs to be addressed, and with some force. Those at the top need to be accountable.

It’s worth asking, in this context, about how many serious scandals in, for example, maternity care and mental health provision could have been discovered sooner had there been more scrutiny brought to bear on trusts. The NHS trusts were given their autonomy and taken out of intense local authority and central government oversight some years ago, to help make them more efficient. Evidently, that has not always proven to be the case.

Politically, there is much more for Mr Streeting to do. He has to win the arguments for the NHS and its funding model. He has to show the voters that their taxes are not being wasted. The familiar, often lazy, claims about waste and inefficiency that get thrown around have to be answered head on.

Making the trust chief executives and top managers work for their pay is one step. He also has to carry the public with him on the increase in junior doctors’ pay – and show that it was essential to retain skilled staff and end the incessant strikes, not merely to appease “trade union paymasters” (especially given that the British Medical Association is not affiliated to the Labour Party).

He must also answer the misleading allegations from the hard right that too much money is spent on diversity, equity and inclusion, on translation services and on “health tourism” by non-UK residents. Similarly, there are those on the left who abhor any role for the private sector, even though GP surgeries have always been private enterprises.

There are concerns about the arrival of “physician associates” to improve access to care; such innovations do need care but they are probably inevitable. These sorts of arguments about change cannot be allowed to be lost by default, for the misinformation to gain traction. The NHS does need to be defended, and it’s a case of “reform or die”.

It is Mr Streeting’s task to push back with the actual truth about what’s right and wrong with the NHS and produce tangible results to match. He has made an excellent start and, with some luck and much application, the NHS should respond well to his treatment.