Truth over triumphalism: Yvette Cooper must paint fuller picture of NHS progress than her predecessors

Yvette Cooper is the sixth person to hold the health and social care brief in four years, but unlike most recent incumbents she brings deep Cabinet experience and prior time in the Department of Health. She will need it: Andy Burnham has put social care reform at the centre of his premiership, the NHS is midway through a major reorganisation, and the 10-year health plan now needs to move from promise to delivery.

On the NHS, Cooper will need to turn the immense activity around NHS reform and reorganisation into a credible programme for the government that delivers noticeable and lasting improvements for patients. That means being clear-eyed about the difference between real progress and political mirage: what is improving and what is not. 

Here are six tests she should apply to her in-tray when it comes to the NHS.

Is waiting list progress real?

When Wes Streeting resigned as Health Secretary, he told the then Prime Minister that the NHS was “on track to achieve the fastest improvement in NHS waiting times in history”. There has indeed been progress in reducing the overall planned care waiting list.

But the headline does not tell the whole story. Nuffield Trust analysis suggests some of the fall reflects waiting list validation – legitimate data-cleaning exercises, but not the same as treating more patients – and some reflect “unreported removals” where it is much less clear where patients have gone. Cooper should encourage transparency about how much progress is linked to more care being delivered, and how much is down to people coming off lists for other reasons.

Is A&E improving, or is crisis care becoming normalised?

A&E pressures remain one of the most publicly visible signs of NHS pressure. Some measures have improved from the worst post-pandemic lows, particularly waits for admitted patients and for people being transferred to hospital by ambulance. But major A&Es are still far from meeting national ambitions, demand has reached record levels and, as forthcoming Nuffield Trust work will show, long waits at A&E have become normalised. 

The new Secretary of State should be wary about claiming progress against this backdrop. Social care reform can help in the long run, but a large chunk of delayed discharges in hospitals are due to issues within hospitals themselves, including a relatively low number of hospital beds.

Does the NHS have enough staff, or are they in the wrong places?

The NHS workforce has grown substantially. Over the decade to December 2025, hospital and community health service staff increased by more than 350,000, or 35%, while staff in general practice rose by 48%. Hospital doctors have risen by 47% since 2015.

But more staff overall does not mean the NHS has the right staff in the right places. While children’s nurses increased by 41% over the decade, learning disability nurses fell by 10%, and the number of district nurses has fallen by more than 40% since 2009 – even as ministers promise to shift more care out of hospital and into people’s homes. Cooper should be wary of any claim that the NHS now has “enough” staff. The real test is whether workforce growth is in areas where boosting numbers will have the greatest positive impact, such as health visitors, district nurses and GPs. 

Is NHS dentistry too far gone to restore universal access? 

NHS dentistry may be the clearest warning of what happens when a universal service becomes universal in name only. The test for the new Secretary of State, as we await long-delayed details on dental contract reform, is whether she is prepared to be honest that the offer has become something narrower: urgent care, prevention and protection for those least able to pay. 

As we argued almost three years ago, the idea that the government will ask taxpayers to foot the bill to restore universal access, amid other demands from social care to defence, is far-fetched. It is time to set out a realistic roadmap to a more equitable and practical NHS dental service. 

Is the NHS Bill devolving power or centralising it?

Andy Burnham’s premiership has put devolution and a shift of power away from Westminster at its heart. And before Burnham even became PM, ministers used similar language, promising neighbourhood health, local flexibility and more power for patients and communities. But the Health Bill contains a major contradiction: it gives the Secretary of State sweeping new powers to direct ICBs, cap trust spending, appoint foundation trust boards, change licences and remove individual directors.

That risks creating the worst of both worlds. Local systems are being asked to deliver neighbourhood care, prevention and the shift from hospital to home, while money, people and major decisions sit increasingly in Whitehall. Cooper will need to be clear about which decisions are genuinely moving closer to patients and communities, which powers ministers are taking back, and how local leaders will be protected from being blamed for choices they cannot really make. There is still time to make the NHS Bill one that devolves power more decisively. She should take the opportunity. 

Is the medicines deal good for the NHS, or is the health service a bargaining chip?

The UK-US medicines deal may be presented as good news for patients, promising faster access to some new treatments. But Cooper should be clear about whose interests are being served. Higher NHS spending on new medicines may support wider trade, diplomatic and industrial goals, but that does not automatically make it good for the NHS.

The deal may help some patients access new drugs, but it will also pull money away from the more cost-effective care used by many more. Cooper should publish the impact assessment and be honest about the trade-offs, rather than allowing the NHS to be used as a bargaining chip in wider economic policy.

Let’s not forget the genuine bright spots 

None of this means Cooper should dismiss the signs of progress she inherits. The NHS is not standing still, and staff deserve credit for real and tangible improvements.

NHS productivity has improved, even if it remains well below where it would have been on pre-pandemic trends. Public satisfaction with the NHS has nudged upwards from historically low levels. Most measures of GP experience have improved, and important work is underway (and must continue) within the government to address inequalities in GP funding. Use of the NHS app continues to grow. And, most significantly, the Prime Minister has put social care reform back at the centre of government after decades of drift.

But the difference between a recovery story and a recovery mirage lies in how honestly ministers describe what is changing, how fragile it is, and what it means for patients. After years of low public satisfaction, repeated reform promises and visible pressure on services, the new Secretary of State will need to rebuild public trust that improvement is not only possible, but meaningful: better care that is easier to access.