Within hours of Labour’s landslide victory in July, the newly appointed Health Secretary Wes Streeting issued a statement under the blunt headline: “The NHS is broken.”
It was designed to both condemn what he said was 14 years of Conservative failure and also force the health service to acknowledge its own diagnosis and need for reform.
Yet the words went down badly with some NHS managers – particularly those who were expecting a new era of “no longer being shouted at by ministers”.
One NHS insider told The i Paper: “That didn’t land very well. It felt unfair and landed poorly with staff.
“You’ve got committed staff doing really high quality work in long, difficult hours, and it is hard to keep people motivated when they hear that.”
By the time of Labour’s conference in September, however, NHS insiders noticed Streeting’s mantra had changed slightly to a more motivational slogan of “The NHS is broken but not beaten”.
While allies of the Health Secretary insist he had used this form of words in opposition, the shift in language was welcomed by NHS managers as a sign that Streeting was listening and not trying to force a confrontation with staff.
But Streeting faces many more battles in 2025 with one of the most difficult jobs in the Cabinet besides the Prime Minister.
His challenges include trying to cut record waiting lists, heading off the threat of further strikes by doctors, nurses and ambulance workers, imposing long-term reform on a beleaguered health service with a budget that is ever-more constrained, facing pressure to deal with the neglected issue of social care and introducing the most radical reforms to public health for decades.
And yet as Sir Keir Starmer and Chancellor Rachel Reeves face growing public anger over controversial economic decisions including the winter fuel cut, lifting the exemption for inheritance tax on farmland, and the refusal to fund compensation for Waspi women, Streeting has now emerged as the bookies’ favourite to be the next Labour leader – whenever there is eventually a vacancy.
Allies of the Health Secretary dismiss talk of future leadership contests, saying he is loyal to the PM and totally committed to what he believes is one of the hardest but most rewarding jobs in government.
Westminster insiders do note, however, how Reeves’ political share price has taken a hit since her Budget in October unveiled tax rises for employers, changes to inheritance tax rules for farmers and a refusal to budge over her winter fuel payment cut for 10m pensioners.
In October, Reeves was the favourite to be next Labour leader, with odds of 6-1 ahead of Streeting on 7-1. By December, the Health Secretary had nudged ahead to 5-1 with the Chancellor on 6-1. While political betting is not exactly a reliable predictor of future events, it does reflect a sense by some in Westminster that Reeves’ star power has dimmed since her Budget.
But as the man in charge of the most challenging of all the public services, Streeting may find his own political future is damaged if Labour cannot improve the NHS by the next election – including widening access to GP appointments, cutting the amount of time it takes to receive routine treatment, and reducing waits at A&E, all things the government has pledged to tackle.
Chris Hopkins, director of pollster Savanta, said: “Unfortunately for Wes Streeting, he’s at the very least guilty by association when it comes to Labour’s poor start to life in government in terms of public opinion.
“Labour’s numbers have tanked since a brief honeymoon in July, and Streeting is not immune: in Savanta’s polling, Streeting had a neutral favourability rating in the immediate aftermath of Labour’s landslide victory, but stands at -8 now.
“Streeting has not quite endured the drop in ratings other cabinet ministers have had – notably Starmer and Rachel Reeves – but he has not survived unscathed.
“Whether that puts him in pole position to be the next Labour leader remains to be seen but given the fractious state of UK politics at the moment, it would be no surprise to see the next Labour leader operating from the opposition benches rather than the government ones.”
During his first six months in office, the Health Secretary has shown how he is unafraid to take on vested interests and speak his mind – even when it has made him unpopular with colleagues.
He ruffled Cabinet feathers when he led opposition to the assisted dying bill, particularly when the issue falls under his brief as Health Secretary.
Streeting also risked a clash with Cabinet colleague Ed Miliband when he said the former Labour leader’s decision to oppose military intervention against Assad in Syria in 2013 had been a “big mistake”, telling the BBC’s Question Time: “With hindsight I think we can say, looking back at the events, that the hesitation of this country and the US created a vacuum that Russia moved into and kept Assad in power much longer.”
The Health Secretary insisted this was not direct criticism of Miliband.
On his own health agenda, allies say Streeting his “not afraid to take on difficult arguments” including telling a conference full of NHS managers that poor performers would be rooted out and following the clinical advice on the fraught issue of puberty blockers, even though it has pitted him, as a gay man, against the prevailing view in his own community.
He called the junior doctors – now called resident doctors – union the British Medical Association on his first day in the job to open up talks, which weeks later brought an end to that long-running strike – although fresh action is not off the agenda completely.
Streeting believes that the report by Lord Darzi published in the autumn, which found the NHS is in a “critical condition”, has helped break a “status quo mindset that led to managed decline”, an ally said.
While the Budget cost Reeves political capital, it delivered £25bn extra for the NHS, one of the best settlements for years.
But he has made clear to NHS managers that this extra cash cannot come without reform – of which more details will be set out in the spring.
His decision to declare the NHS as “broken but not beaten” is where he believes most health service staff are and is “totally undeterred” by complaints from “producer interests”, an ally said, and is firmly on the side of the patient rather than the provider.
There are currently four inquiries ongoing into NHS mismanagement, including maternity scandals and mental health failures.
An NHS insider said managers were willing and ready to have a more constructive relationship with the Labour government than they had with the Conservatives.
The insider said: “People in the NHS were used to being shouted at under Tories, now there is a sense that we are all in this together.
“There has been generally positive, sensible, constructive engagement and a recognition that the NHS has had a really rough 14 years. The difference is really significant.”
In 2025, Streeting faces a battle with special interest lobby groups as he tries to introduce the most radical public health reforms for a generation, including on smoking and junk food advertising.
The Health Secretary is understood to be “obsessed with delivery” including on improving the nation’s public health, which he sees as key to preventing the NHS being “bankrupted”.
But NHS insiders and his political opponents question whether Streeting is being honest about the state of social care in England.
This issue continues to put a huge burden on hospitals – some have as many as a fifth of their beds in general wards taken up by patients who could be discharged were it not for any suitable space in care homes or support at home.
A health service insider said: “People welcome his honesty but he needs to be honest about recognising the problem of social care.”
Allies say that the Health Secretary’s agenda for reform does include tackling this huge challenge, however.
And they say Streeting regards his two “brushes with death” – first with kidney cancer, and then coming close to a political death when he nearly lost his seat in July’s election, winning by a majority of just 528 votes – as his driving motivation to turn the NHS around.
But if Labour – and Streeting – can turn around the NHS before the next election, then the Health Secretary would be able to capitalise on that when the party’s succession comes into view, say experts.
Patrick English, director of political analytics at YouGov, said: “Public services are very high on the public priority list right now.
“If the NHS is markedly improved in the medium term, and Streeting can manoeuvre so that he is the face of that, then that will stand him in very good stead with the public.”
