Wes Streeting has been accused of taking a “chaotic and incoherent approach” to reforming the NHS in England, which makes it unlikely the government will hit its own targets, according to a damning report by the Institute for Government (IfG).
The report praises elements of how the health secretary has managed the health service in his first year in office, including improving performance and staff retention in hospitals. Thepay settlement he reached with resident doctors last year avoided a winter plagued by NHS strikes
But it also criticises significant aspects of his performance, including the way he handled the abolition of NHS England and his lack of action to stem the exodus of senior GPs.
The findings threaten to puncture Streeting’s reputation after a turbulent week during which he was forced to deny accusations from allies of Keir Starmer that he was lining up a leadership challenge against the prime minister.
Stuart Hoddinott, the IfG’s associate director and the author of the report, said: “There have been some positive steps: performance is trending slowly upwards in hospitals, there’s been a genuinely large increase in GPs and the rate at which hospital staff are leaving their jobs is the lowest on record outside the pandemic.
“But that has been undermined by a chaotic and incoherent approach to reforming the service. The announcement of NHS England’s abolition was abysmally handled and management cuts in integrated care boards have been a needless distraction.”
He added: “Worse than that, nothing the government has done will address the ongoing exodus of GP partners, and it has taken decisions that may actively harm the adult social care sector.
“The further decay of general practice and social care would be a disastrous legacy for Streeting and the government.”
A spokesperson for the Department of Health and Social Care said: “While the report acknowledges our success in delivering record numbers of GPs and appointments, it ignores our work to reform primary care and shift care out of hospitals, including £1.1bn extra investment, and the creation of new neighbourhood contracts to deliver a truly neighbourhood health service in every part of the country.
“Far from diverting money to hospitals as the IfG claims, integrated healthcare organisations will ensure funds are diverted towards prevention and community care to keep people out of them.
“We are succeeding in our efficiency drive, with our move to bring NHS England back into the department freeing up more than £1bn a year that will be reinvested into frontline services, and a recent report showed we are exceeding our targets in improving NHS productivity.
“We reject the notion we should go slower or do less, with our reforms and modernisation to date already delivering millions more appointments, cutting waiting lists and ensuring patients can benefit from the latest treatments and technology.”
Government officials believe their political success hinges on whether they can improve NHS performance, and the chancellor, Rachel Reeves, has made it one of the top three priorities in this month’s budget.
As Streeting is widely tipped as the person most likely to replace the prime minister should he leave before the next election, he is facing even closer scrutiny over his performance at the health department.
Despite Streeting’s promises of sweeping reforms to the way the health service is run, the report finds that in many areas performance has stagnated in the past year, and in some cases even declined.
It criticises the health secretary’s decision to abolish NHS England as a rushed, poorly explained distraction, calling it “a case study in how not to make complex policy decisions and announcements”.
Streeting has in recent days been rebuffed by the Treasury in his demand for over £1bn to cover redundancy costs stemming from that abolition.
The report also accuses the health secretary of pulling the NHS in contradictory directions, for example, by saying he wants to shift more care into the community but then proposing new “integrated health organisations”, which could end up allocating more money to hospitals.
The report adds that Streeting has provided very little detail on how his plans would be implemented, beyond relying on emerging technology such as voice-capture tools to take notes for GPs.
The NHS is still struggling to improve productivity, the report finds, with fewer than 10% of areas managing to raise the number of elective procedures they carry out by any more than the number of extra staff they hire.
As a result, it warns: “The government will struggle to meet its flagship target that 92% of patients should wait no longer than 18 weeks from referral to starting consultant-led treatment of non-urgent health conditions. And it has little chance of meeting national waiting time targets for A&E and cancer treatment.”
