Wes Streeting’s hard medicine is not what the NHS wants – but exactly what it needs

The health secretary’s reforms – which will re-introduce hospital league tables and see underperforming managers barred from other NHS jobs – offer the ailing health service its best and final chance to survive in its current form, says Andrew Grice

Wes Streeting gets full marks for boldness: he delivered an unpalatable message to 800 health leaders at their annual conference in Liverpool. He didn’t need to announce his NHS reforms in the lion’s den, and some ministers would have shied away from that. In the event, his message received polite applause, and nothing worse.

The health secretary told NHS Providers that the 215 health trusts in England will be ranked in league tables, based on performance indicators (likely to include waiting times, leadership and finance); senior managers who persistently fail will be sacked, barred from moving to other hospitals or receive no pay rises. “Turnaround teams” will be sent into struggling health trusts.

Answering questions after his speech, Streeting claimed poor senior leaders were the NHS’s “guilty secret”, adding that his move is “about weeding out the rotten apples so the excellent leaders are not tarred with the same brush”. He insisted he was not “manager-bashing”.

However, there are predictable protests from health organisations. I have bad news for them: today’s announcement is only the first stage of Streeting’s reforms.

He will set out further changes in a series of speeches. It seems the Starmer government really means it when it says the NHS’s Budget boost – £22.6bn over two years – will be matched by reform.

While Streeting declared he would not turn “a blind eye to failure”, he will also reward success: he will pay more to high-performing managers who move to poorly performing hospitals. Trusts that run a profit will have more freedom to invest in buildings, equipment or technology. This is sensible because previous NHS reforms have often been “top-down” shake-ups imposed from Whitehall. And trusts have little incentive to balance their books, overspending by £3bn in the first three months of the current financial year.

Some Labour backbenchers will be wary of Streeting’s statement that the NHS should be “run as efficiently as global businesses”. There are echoes here of the intense debate during the Blair-Brown era about how far to reform the cherished NHS. Tony Blair brought in patient choice but a sceptical Gordon Brown insisted the NHS was not a marketplace.

Alan Milburn, health secretary under Blair, introduced hospital league tables in 2001, though they were scrapped four years later. One reason: while school league tables were viewed as useful, parents and pupils enjoy more choice over their school than most NHS patients have over where they are treated.

It is no coincidence that league tables are coming back just when Milburn has been appointed by Streeting as lead non-executive director at the Department of Health and Social Care – one of several Blairites now at the heart of Sir Keir Starmer’s operation.

Streeting insists he will learn from New Labour’s experience and “update” its reforms for new times. Indeed, today’s challenges are different: the Blair-Brown era saw waiting times cut sharply and record patient satisfaction levels, but the economy was growing then and Milburn received annual budget increases of seven per cent from Brown. Streeting’s initial boost is about four per cent, and might not last beyond two years.

Milburn believes the bleaker fiscal position means even more reform is needed today. It seems he has unfinished business. “It’s the old battles in new times,” one New Labour insider told me.

While some Labour MPs will be uneasy, Milburn’s warning that the NHS must end its “more, more, more culture” of always demanding more money was vindicated when NHS Providers warned the extra £22.6bn might not deliver the Starmer government’s pledge to reduce waiting times to 18 weeks by the next election.

This has gone down badly with ministers after Rachel Reeves’s generous downpayment. “Some people in the NHS just don’t get it,” one government source groaned.

However, health bosses have a point about the possible impact of league tables on morale, recruitment and retention. Tables can be crude, might skew priorities in a bad way and leave poorly performing hospitals stuck in a vicious cycle of failure.

Streeting needs to take the NHS workforce with him. His reforms will work only if staff buy into them; as he admits, he cannot run every hospital from a desk in Whitehall and he is committed to devolving decisions to the front line.

Yet repeatedly branding the service as "broken" (but “not beaten”) is hardly good for morale. I think the NHS does need what Streeting called “tough love” today. He insisted he would “name and praise” good managers after being warned by the NHS Confederation that “naming and shaming” bad ones could backfire.

But he should recognise that “tough love” does require a little love as well as the necessary tough medicine he prescribed today.

In turn, the NHS should realise this Labour government offers its best and final chance to survive in its current form. There is no alternative government of its dreams ready to pour even more money into a bottomless pit. It’s now or never on reform.