Wes Streeting’s three-point plan could rescue the NHS. The problem is getting citizens to accept it | Sarah Boseley

4 hours ago 2

It’s a national treasure, beloved of the population, still brilliant in so many parts but also run down and crumbling at the edges, huge, expensive and heavily criticised. Who fancies running NHS England? After the panning the outgoing chief executive, Amanda Pritchard, got from MPs earlier this year (which may have precipitated her shock departure), her successor will need guts, determination and a very thick skin.

Crucially, they will have to support the NHS revolution that the health secretary, Wes Streeting, has declared. They will have to be a breaker of windows, not a polisher of glass. Streeting – and the public – want change to a service that has now recorded the lowest level of public confidence since surveys began in 1983. Just under a quarter of adults in last year’s British social attitudes survey said they are satisfied with what they get, even though their love for the NHS is undimmed. Above all, we complain we can’t get to see our GP, accessible on the day often only through a Glastonbury-style telephone queue at 8am, and that waiting times for hospital treatments are shocking. We fear the ambulance that arrives too late, or being left in a corridor because of staff shortages if we get to hospital at all.

Streeting has already marked his man, anointing Sir Jim Mackey, the chief executive of Newcastle upon Tyne Hospitals NHS Foundation Trust, as “transition CEO” of NHS England. He’s shown what he can do in slashing waiting times. He’s also national director of elective recovery, charged with reducing the backlog of routine surgery that built up during the Covid pandemic, and he has been chief executive of NHS Improvement. That’s a lot of boxes ticked.

But although waiting times are top of the list, it doesn’t end there. The Darzi report last year delivered a catastrophic verdict on the state of the NHS after years of austerity and cuts, from the late diagnosis of people with cancer and other serious diseases, particularly in deprived areas, to “crumbling buildings”. Pritchard has been working steadily and clearly wanted to carry on quietly and efficiently doing the job. Under her management, the NHS had set up community diagnostic centres, developed cancer vaccines and successfully popularised its app. “The NHS has achieved a great deal in the face of historic pressure thanks to a relentless focus on innovation and reform,” she said in her resignation statement.

But the writing may have been on the wall since she was hit with unprecedented criticism by MPs on the health select committee in January, who said they were frustrated by the lack of “drive and dynamism” from Pritchard and two colleagues giving evidence to them. Earlier the same day, a report from the public accounts committee said she and others from NHS England and also the Department of Health and Social Care (DHSC) were complacent and lacked the drive and ideas to transform the service.

Streeting wants someone who will make some noise on waiting times for a political win that may give the government space to work on other important areas later. He is a man in a hurry. And he wants more control over NHS England than ministers have had since Andrew Lansley’s reforms gave it a large degree of independence in 2013. Politicians will always have to take the blame for what goes wrong in the NHS, so they need to decide the direction of travel. That’s probably right, says Siva Anandaciva, director of policy at the King’s Fund: “I think there’s a benefit in having a body specifically dedicated to running the NHS, but politicians saying, ‘This is what I want you to achieve.’”

But sometimes the DHSC and NHS England officials are doing the same work, which is unaffordable waste. So streamlining is the aim – and in what some have called a power-grab, thousands of NHS England jobs are facing the axe.

While waiting times have to come down – because it’s important, as well as an issue of credibility for Labour – in the longer term, the success of the health service depends on other things. The government has laid down three priorities for transforming the NHS: the switch from analogue to digital, enabling quick access to patient records and data throughout the NHS (somebody once said garage chains nationwide have more info on your car); care in the community; and prevention rather than treatment.

These are all no-brainers, and yet the public is doubtful or even resistant in various ways. Patients are not yet convinced that an NHS digital system will keep their data safe. They don’t want employers, let alone insurance companies, knowing details of their diseases, and they are suspicious of what big pharma might do, reluctant to believe scientists want the info to invent new life-saving drugs. They are anxious that being treated by GPs and nurses in the community might mean they don’t get the best care, which they assume is in hospitals. And they are not sure they want NHS doctors and nurses telling them how to lead a healthier life with lectures on stopping smoking, cutting back the booze and eating vegetables.

Yet all of this is absolutely vital to the transformation needed in the NHS. Far too many people are getting unnecessarily sick, while hospital beds are occupied by elderly people, who need to be sent home or into care with community support. Waiting times matter, but the job for Streeting and the new CEO of NHS England is about far more than that. They will need a fair wind and a lot of luck.