What can Wes Streeting’s successor learn from his record on the NHS and social care?

Whoever succeeds Wes Streeting as Secretary of State for Health and Social Care will follow one of the most prominent personalities to hold the office – and the only one from the previous six who leaves hoping that their next job might be an upward move. They will be tucked into what Conservative health secretary Ken Clarke called a “political deathbed”, responsible for decisions every day which cost or save lives, running the institution British people are most proud of at a time of public rancour.

Streeting’s triumphs and disasters across his 23 months in office have several lessons on how to stave off political demise, keep signs of NHS recovery going, and avoid the ongoing neglect of social care.

Get a grip on the torrent of targets

Streeting has talked about cutting down the number of targets in the English NHS – a service described academically as having a “priority thicket” of clashing goals and commitments, and by one of our recent interviewees for a report as plagued by “people who think it's their job to look at the impossible pile of things to do and take their little rock and put it on top”.

Streeting deserves credit for facing up to this. Last year’s planning guidance for trusts and ICBs slimmed down goals for the NHS. He was right to say that the merging of NHS England into his department might make it easier to stop the avalanche of demands.

However, that only works if the Secretary of State themself does not announce targets that are too high or too many in number – and this has still been happening.

Only a few weeks ago, an ill-considered target for hospitals to bounce one in four referrals for certain conditions back to GPs had to be almost immediately scrapped, and while trusts improved to hit their flagship annual target for waiting lists after a late funded sprint, goals for A&E and ambulance waits proved a stretch too far. There will be political logic for the new incumbent to promise more, faster. Experience suggests they would regret it.

Resist the temptation of reorganisation

The strongest temptation facing a health and care Secretary of State seems to be reorganising the service’s structure. In his first few months, Streeting promised it was “the last thing I would do”. A few months later, he announced plans to abolish NHS England and multiple other safety and patient voice bodies; add multiple new models to shift care out of hospitals; and switch up the duties, size and power of ICBs.

Streeting could argue that this is minor compared to the reorganisations in the early years of New Labour, or those in 2012 and 2022. There is a real problem with distrust and duplication where DHSC and NHSE host teams doing overlapping jobs, and concrete cost savings are on the table.

But merging and restructuring public bodies, not just in health but beyond, distracts officials and staff from their day jobs while often doing little to resolve longstanding problems. In this case, the arbitrary 50% job cut requirement risks worsening matters. Reorganisations often drag out longer than expected: these changes were delayed by six months of deadlock over redundancy funding. Extra changes tend to get added and contribute to legislation being mired in controversy, as we see with the removal of independence for HSSIB and for patient voice organisations in the current NHS Modernisation Bill.

The new Secretary of State should think about how to minimise disruption without prolonging the process, dropping unnecessary extra changes and identifying where making staff redundant might be a false economy – for example, where local IT staff, or management consultants, would end up being needed instead.

Success comes slowly and choices are hard

Streeting’s period in office saw slow but real gains in waits for planned care and GP satisfaction, and a stable picture in urgent care.

These represent a gradual recovery, not sudden or dramatic permanent shifts. In part this reflects that there were limited pots of spare funding for reform and change. Funding is far from all that matters – for example morale, training, and convincing staff to stay are very important in workforce policy. But money is a necessary resource for any policy where the total amount of staff and equipment needs to increase. The flagship commitments to shift care out of hospital and increase prevention have little money behind them, despite this being required to build up services for similar shifts in other countries.

Tight finances are here to stay. Limited spending increases will continue for the rest of the parliament. The US-UK medicines agreement will see an ever-larger share of the NHS budget eaten up by new pharmaceuticals, often with fewer health benefits than the care they displace. As with targets, the new Secretary of State will need to choose only a few limited areas where additional funding can lead to more transformative changes.

Maintaining progress on general practice

Streeting made general practice one initial priority, and increased early spending in a 2025/26 contract increase of over £950 million, faster than the overall health budget. A number of policies allowed that extra spending to convert into increases in appointments and patient satisfaction. He avoided the crude deadline targets for all patients to see GPs which plagued the last Labour government, and freed up special “ARRS” workforce funding to employ more GPs. The GP Patient Survey suggests new standards for access through the NHS app, or improvements to practice websites, accompanied a shift to patients finding it easier to book appointments online.

Easy GP appointments are the public’s single most common priority for the NHS, and general practice is the universal front door for the service. The new minister has several options to maintain improvements – but they inherit a much tougher funding picture. 

In the current year, Streeting changed tack, setting a course for a slower spending increase for general practice than for the NHS as a whole. Outstanding problems include the dominant role of ARRS funding in recruiting new GPs, the lack of doctors willing to take on partnerships, and protecting core general practice alongside expanding new separated services. The laudable commitment to rebalance GP funding to poorer areas will cost money, and the long-overdue combining of data into a Single Patient Record will need careful political judgement. 

Social care reform cannot be dropped again

Marked against the 2024 Labour Manifesto, the greatest failure has been dropping any prospect of delivering an English adult social care service that meets people’s needs during this parliament. This is not specifically Streeting’s fault. The incoming government, like its predecessors, simply didn’t make social care a priority, or find the money required for the scale of improvement needed.

Last year, Baroness Casey was appointed to find more stable proposals. She rightly drew attention to the years of neglect and decay. The moment of reckoning she envisages would require the bravery from politicians to engage voters in greater understanding of how bad things are, and then to find a source of stable funding for the scale of reform needed. A Secretary of State who wants to escape the cycle of failure, and become a historic figure by securing England’s missing public service, needs to support this by first being brave enough to raise public awareness of the scale of the problem, and then make a case to their colleagues to find sources of funding.

A positive prognosis

The British Social Attitudes Survey shows a despairing public, with only one in four satisfied with the way the NHS runs. But this measure did see a statistically significant improvement last year, reflecting the flickers of improvement in performance under Mr Streeting’s rule.

It should be possible to keep this on course and carefully choose priorities to broaden the improvement. Throwing out last year’s 10-year plan for a new set of long-term aims might worsen the existing issues of a distracting reorganisation and the excessive level of targets and promises. But three new major policy decisions – a new dental contract, a workforce plan, and interim recommendations from Casey – will arrive almost immediately for the new Secretary of State to make their mark. 

If he or she can avoid the pitfalls that trapped so many predecessors with the lure of short-term political gain, they can expect to leave health and care in a better place than they find it.