If I Was Health Secretary Wes Streeting – What On Earth Would I Do?

May 22, 2025

Wes Streeting became Secretary of State for Health and Social Care on July 5 2024 and he immediately described the NHS as ‘broken’.

There’s no doubt he inherited the most challenging NHS portfolio in living memory. The system is in complete flux, NHS England is being abolished, Integrated Care Boards are going through a process of merger and we’re seeing major structural and financial reforms getting under way.

All of that’s against a backdrop of an exhausted workforce, really stubborn health inequalities that we just can’t seem to get to grips with and a service delivery you could argue is dangerously close to being completely overwhelmed.

Go back to the pandemic and the measures that were taken then – lockdown, extra beds, remote appointments – we were told they were brought in to stop the NHS from being overwhelmed.

Because of the complexity of the tasks he has in front of him to unbreak the NHS, if I was in Wes Streeting’s shoes I would start by cutting through all the noise and focusing on one thing – implementation.

The NHS does not need another Long Term Plan

For the first time in decades, we could argue that the Health Secretary needs to become the Secretary of State for Delivery. Let’s be honest, the last thing the NHS needs is another policy document, another vision, another 10-year plan.

It needs absolute action, it needs teeth, and it needs complete accountability.

Because policy on its own isn’t enough. In the 20 years that I’ve been here as a management consultant, just off the top of my head we’ve had:

These are all very well-intentioned documents, based on evidence, consultation and sound thinking. But the outcomes have always fallen short. Why? Because, as I keep being told, the Government does policy, not implementation.

It’s becoming hard to accept that line now. What’s the point in writing all these documents if we don’t actually implement their conclusions?

Policy without delivery is just a press release, a soundbite. For me, the absence of structured, accountable implementation mechanisms is what has repeatedly prevented all the visionary documents from making any tangible difference that they were designed to deliver.

I would implement Darzi’s three shifts as soon as humanly possible

I’m going to focus in on Lord Darzi’s review from last year, one of the most coherent pieces we’ve seen in terms of NHS thinking in recent years. If I was Wes Streeting, I would mandate the three shifts Darzi regards as essential to safeguard the future of the NHS:

1.       A shift from hospital to community care.

2.       A shift from treatment to prevention.

3.       A shift from analogue to digital.

If we are to continue to have an NHS that’s free at the point of access, each of these shifts must happen. But they won’t happen by osmosis. They require an agreement, a mandate.

And that’s more than an agreement between the providers and the commissioners. They absolutely need a mandate from Wes Streeting to happen, with real consequences for ICBs and providers who fail to deliver them.

Lord Darzi’s ‘left shift’ from hospital to community care has been talked about for decades. We’ve seen pilot projects, we’ve seen vanguards, but we haven’t seen mainstream national execution.

In my own work I’ve seen some pockets of brilliance with hospitals subcontracting and left shifting work out to General Practice. So, for me, the mandate needs to be to implement the left shift.

Every NHS trust and foundation trust should be required to identify the services that can be safely shifted to the community or into Primary Care / General Practice. It needs a timescale for transition agreed between the hospital providers and the ICB.

Subcontracting arrangements with General Practice – either through individual practices or through networks, practices or GP federations – should be introduced with full funding, opening up the potential for shared staff models between the hospital and General Practice. All the subcontracts need to come with the data, the digital tools, the workforce planning, and, of course, the money necessary for success.

Read my blog: The Subcontracting Route – A Great Opportunity For Pharma, Med Tech And Device Firms – here.

General Practice needs proper funding to take the strain off secondary care

Progress often gets stuck in an endless debate about how ready General Practice is. But the reality is General Practice won’t ever be ready until it’s funded, trained and trusted to deliver.

In those pockets of brilliance I mentioned, their readiness didn’t appear by waiting – it appeared because we had a hospital locally that agreed to invest in local General Practice, the left shift. The barn door is wide open on this to get going really quickly.

At many hospitals we have significant outpatient activity relating to first appointments and follow-ups along with diagnostic work – both in terms of diagnosis and interpretation – that could be done in Primary Care, but only if it’s properly supported.

What we definitely should not have is hospital respiratory teams reviewing spirometry results when we can have a trained nurse out in the community able to do that work to the same exact standard. That’s not care closer to home. It’s care closer to common sense.

There are so many things needlessly taking place in secondary care and that’s why Lord Darzi identified this as being an area ripe for reform.

Prevention is not a ‘nice to have – it’s an absolute necessity

Shift two, from treatment to prevention, requires a proper resourcing of primary care. It’s an impossible shift without serious investment into General Practice.

I’m not just talking about GPs. I’m talking about the entire primary care ecosystem – nurses, pharmacists, paramedics, social prescribing, link workers, behavioural support coaches, wellbeing – it needs a full team and that’s where the real work on reducing health inequalities will happen.

It’s absolutely absurd that prevention is still seen as a ‘nice to have’, while the acute system is completely overwhelmed treating late stage disease.

Worryingly, in the last few days I’ve seen examples of ICBs and hospital trusts actually shutting down those kinds of services to save cash. I had a breathlessness service that was removed at the drop of a hat.

I’ve also heard in one area regarding oral nutritional supplements – if the patient is not under dietetics, the prescriptions will be completely stopped. That’s just bizarre. Shutting services down does not make the patients get better.

We’ll end up driving appointments into General Practice for those patients who will not get better, and they will end up being referred back into secondary care. But if the services don’t exist – or, as is already happening in the dietetic service, they’re starting to be overwhelmed by referral – we just put the cost in a different place.

It widens the inequalities, and it runs completely counter to early intervention and prevention led services.

So, if I was Wes, I’d mandate prevention led services as core NHS business and I’d make sure we fund them as such, and I’d measure that rigorously to stop people just closing down services in the hope of delivering financial balance.

Otherwise, the money ends up in the wrong place and hospitals go into overspend. We fund hospitals for all stages of a patient’s treatment but if we fund GPs and PCNs and federations for preventing the complications that put them in hospital, we’re much more likely to deliver a balanced financial position.

Preventative work in cardiovascular disease, respiratory disease and renal health could dramatically reduce admissions and costs. If the GPs are paid to identify the high-risk patients, initiate treatment and keep people out of hospital, we can then reverse the reactive culture that exists in the NHS.

This is evidence based, which is exactly why Lord Darzi talked about it. It has a clear return on investment and yet it’s ignored in favour of a model which pumps money into secondary care services, rather than primary care, prevention led services.

I would stop throwing money at digital projects that don’t work

The last shift is from analogue to digital. The journey so far with digital has been really patchy and sometimes, you might argue, completely counterproductive. Billions have been spent with limited ROI. If the digital shift is to happen effectively, the focus must shift from technology procurement to technology usage.

So, if I was Wes Streeting, I’d start by mandating interoperability standards across all integrated care systems and across all the providers. We’ve got to stop putting in systems that don’t talk to one another.

I’d also require every integrated care system to have a clear plan for virtual wards, remote monitoring, digital dashboards to track patients in real time and proper digital first care models.

That would mean funding digital transformation based on adoption and outcomes, not vendor promises about what they say they can deliver.

And importantly, I’d focus on training the workforce. The digital transformation is not about apps and portals. It’s about equipping people to use the technology as an enabler in patient management rather than an obstacle, which is how it’s seen now.

Read my blog: Digital Transformation and the opportunities it unlocks for Pharma, Med tech and Device Companies – here.

Accountability is the only way to get Darzi done

To summarise then – I would make the ICBs the enforcers of change. Implementation needs accountability and that means ICBs cannot continue as planning units. They must become delivery engines.

To do that, they must be given the authority and the obligation to implement Darzi’s shifts. The leadership needs to be performance managed on delivery, not on process and they must hold all providers, hospitals, General Practices, community services, mental health trusts and everybody else in the voluntary and private sectors to account.

Most importantly, they’ve got to be allowed to decommission services that no longer make sense in a rebalanced NHS. That’s controversial but it’s essential. The transformation absolutely requires courage. The Darzi outcomes will not be delivered in the way the NHS currently works.

Wes Streeting says he doesn’t want to be another Secretary of State who tinkers around the edges. He’s absolutely right to say that but the only way to avoid that fate is to build a delivery plan, not just a reform narrative.

So, if I was him, I’d introduce a national mandate for implementing the three shifts. I’d realign funding toward primary care and community care, proper investment into General Practice and primary care services.

I’d develop accountability mechanisms for ICBs and all providers, we’ve got to hold them to account for what they do and what they don’t do. That requires investment into workforce, into digital and into data infrastructure, and we must have regular public reporting on progress – no opportunity to hide away.

The country is more than ready for a brave Health Secretary

It’s time to break the cycle because we are at a fork in the road. If Wes Streeting falls into the pattern of his predecessors, promising reform without enabling delivery, we’ll be back here in the same place in five years only worse. We’ll be stuck with another plan, like all the others.

If I was him, I would choose to be the first Health Secretary who turns policy into action and into progress. He could be the one that saves the NHS from a slow decline, the one who shows real leadership.

It takes urgency and it takes real political bravery, but it’s the job and the country is absolutely ready for it – because all we want is an NHS that remains free at the point of delivery and one we can all trust when we need it.

Scott McKenzie helps pharmaceutical, medical technology and device firms get their products and services in front of the right NHS decision-makers. In 2023 alone, he helped land 53 new NHS projects. His 12-month mentorship programme – revamped and expanded for 2025 – offers tools, NHS customer insights and direct decision-maker introductions to get your projects over the line. Find out more here.

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