Wes Streeting has gone – what does it mean for the NHS and social care?

So, that’s it then.

Wes Streeting won his seat in Ilford North by just over 500 votes in the July 2024 general election. The next morning, he walked into his new office at the Department of Health and Social Care and told staff and the press, ‘From today, the policy of this department is that the NHS is broken.’

This then, would be a far-from-boring tenure. And Streeting, using the categories from Virginia Bottomley, was clearly going to be more of a window-breaker than a glazier. But even on day one, few would have expected just how much glass would end up on the floor at the end of his nearly 700-day reign (Figure 1).

Phase one – reset expectations and buy time

Autumn and winter 2024 started off fast and slow for the new government.

Within three weeks the government agreed a new pay deal that brought a pause to two years of resident doctor strikes. And within three months, Lord Darzi published his investigation into the challenged state of the NHS.

Over the same period, and after a spending audit by the chancellor, the government cancelled plans to reform adult social care charging and delayed plans to build new NHS hospitals. But health and care would be relative winners in the Autumn Budget 2024 later that year, with more funding promised in return for a rise in employer National Insurance contributions.

And the government also fired the starting pistol to develop a new 10 Year Health Plan (the race would go on for nine months), and deliver the ‘three shifts’ that would turn the NHS into a more prevention-focused, community-centred and digitally-enabled service.

What to make of this first phase in office then? It was a combination of three things: early wins, like ending the industrial action deadlock; resetting expectations through continued talk of a ‘black hole’ in the public finances; and following the advice of Alan Milburn – a former health secretary and current government adviser – who once said, ‘Buy time. The best political trick I ever pulled off was to publish a 10-year plan.’

I remembered that quote in October 2024, when the government launched its Change NHS website as part of its ‘plan to develop a plan’. I was doing a media interview on the announcement and said tough choices would be needed in the plan, so it made sense for the government to take time to test those with patients and staff. Once the cameras were turned off the journalist said, ‘I think you were being very generous to them [the government]’. I asked why and they turned red, looked away for a moment, and then said in anger, ‘how can they not have a plan for what they want to do? What the f*ck were they doing for all those years in opposition?’. It was an early disquieting sign that the plan would have to be worth the wait.

Phase two – reform, reform, reform

The second phase of Wes Streeting’s era as health and care secretary would be defined by a vigorous reform agenda, which took place against the returning spectre of industrial action.

First, in January 2025, Baroness Casey was appointed to chair an independent commission on adult social care reform. But while Lord Darzi was asked to complete his work within three months, Baroness Casey’s final report would not be expected for three years.

Second, a smorgasbord of policy announcements was made. Some moved health policy towards the future, such as extending the soft drinks levy (the ‘milkshake tax’) based on new evidence of harms to children. And some were more ‘back to the New Labour future’, as performance league tables from the early noughties were reintroduced, with all their flaws intact.

Third, was the quiet dropping of a major manifesto commitment. The ‘health mission’ was meant to bring the different parts of government together to create a fairer Britain where everyone lives well for longer. It didn’t quite happen like that. Instead, the government set a hospital waiting time target as its main ‘health milestone’ and disbanded its health mission with nary a public peep from the DHSC.

Fourth was the publication of the 10 Year Health Plan. While most of the plan was well-received, the biggest criticisms were around the ‘missing delivery chapter’ that would turn the plan from a document into reality.

And fifth was another NHS restructure that you could ‘see from space’. It happened ‘gradually and then suddenly’. Richard Meddings, the chair of NHS England, announced he would be leaving in late 2024. In early 2025, the chief executive and much of the board of NHS England said they would leave their jobs. And then in March 2025 the government announced the abolition of NHS England and the loss of thousands of jobs in national and local NHS bodies.

Phase three – beyond health and care

The final phase of the Streeting era was characterised by a broadening of what he talked about and why people talked about him.

Regarded as one of the ablest media performers in government, Streeting would increasingly front attacks on other political parties, using the NHS as a political dividing line for Labour. And he would use his brief to talk about wider societal issues, such as assisted dying and ‘mental health over-diagnosis.’

And Streeting would find himself in the spotlight (or rather, a political drive-by) during November 2025, when negative briefings emerged from reported ‘allies of the prime minister’ about a leadership challenge. Streeting shrugged off the accusations as ‘the worst attack on a faithful since Joe Marler was banished in The Traitors final’ but the speculation about his leadership ambitions was a constant companion throughout his tenure.

And what about the day job? Despite repeatedly talking about how waiting lists were falling, and that anyone saying otherwise was a ‘doubter and doomster’, waiting lists for planned hospital care fell by a small amount despite this being one of the government’s top priorities.

What next?

A change of health and care secretary is a big deal. Each political leader has their own priorities which gears the focus of their department. The focus on digital technology surely dipped once Matt Hancock left office, as did the focus on place-based working and tackling backlogs inclusively when Sajid Javid left. Energy dissipates. Priorities change. It matters.

So, what might now happen? Nobody knows of course, but there are some clear choices for a new health and care secretary. Do they continue with the NHS Modernisation Bill in its current form – which will dominate their day-to-day job as health and care secretary? Who do they appoint as the next NHS chief executive and what qualities are they looking for? Do they keep the same timetable for the Casey Commission or ask it to speed up? These are just some of the political choices that await Wes Streeting’s successor.

And what then of Wes Streeting? How will he be remembered? There are clearly positive entries in the legacy ledger. He helped pass the Tobacco and Vapes Bill and had constancy of purpose in sticking to the three strategic shifts. And by the tests of former politicians, he achieved some of the goals of any health and care secretary in getting out of the job with his political reputation mostly intact, getting a decent funding settlement out of the Treasury for his department, and seeing some green shoots in public satisfaction with the NHS emerge during his tenure.

But, although he has long been associated with Alan Milburn, perhaps Streeting’s name will be more often mentioned alongside Andrew Lansley’s in the years to come. Both men wanted to reform the NHS but will be remembered more for restructuring it.

Being health and care secretary is a difficult job at the best of times. And Wes Streeting was faced with a stagnating economy, a health system still recovering from Covid-19, rolling waves of industrial action and a febrile political environment. A bad hand to be dealt then. But despite that bad hand, he chose to raise the stakes – with him and people close to him repeatedly saying the NHS needed to ‘reform or die’ or that it was in the ‘last chance saloon.’

Despite saying on his first day in the job that the NHS was broken, Wes Streeting hasn’t stuck around long enough to fix it. And so, much like the 10 Year Health Plan he published, the story of Wes Streeting’s tenure as health and care secretary is ultimately missing something – the chapter on delivery was started, but not completed.