Exclusive: Streeting has ‘total confidence’ in Amanda Pritchard

In a wide-ranging interview yesterday he also:

• Committed to a larger share of the NHS budget going on primary care and community services by the end of a first term;
• Said trust CEOs had told him that increasing funding of the acute sector would “be the worst thing” he could do;
• Argued that the perception of frontline staff that the service had too many inefficient managers “needed to be addressed”; and
• Expressed the desire to be health and social care secretary for the entire first term of a Labour government.

Wes Streeting also addressed a range of key operational measures, including stating that staff delivering Labour’s promised 40,000 new elective care appointments a week should be paid “time and a half”.

HSJ asked Mr Streeting whether, given the NHS’s struggles to hit performance targets, he backed the leadership of the current NHSE chief.

The Labour health shadow replied that he had “total confidence” in Ms Pritchard, and stressed this was a genuine belief and not a “political” statement.

However, asked whether that was true of other senior national NHS leaders, such as NHSE chair Richard Meddings, Mr Streeting said: “I’m not…getting into the business of being judge, jury and executioner on individuals who don’t have the opportunity to kind of speak back for themselves.”

It comes as the Guardian today reported Labour was “poised to axe” Mr Meddings from the chair role “and replace him with a party loyalist to help implement its [NHS] plans”. It reports names linked with the job include former Labour health secretary Alan Milburn; trust chair Jacqui Smith, who is also a former Labour cabinet member; and Sally Morgan, an adviser to Tony Blair who is now deputy chair of Guy’s and St Thomas’ Foundation Trust.

There’s been a wave of speculation in the sector about the future of the NHSE chair in recent weeks, which some believe could be held as a joint post by a junior health minister sitting in the Lords, to closely bind NHSE to the Department of Health and Social Care. Other Labour figures mentioned as potential candidates by sector sources include former Labour health minister and former NHSE non-executive director Lord Ara Darzi; integrated care system chair and former Labour health secretary Patricia Hewitt; and NHS Confederation CEO Matthew Taylor.

Shifting funding

On reform, the Labour shadow health and social care secretary argued “so many of the answers” to long elective and accident and emergency waits “lie outside of hospitals in primary care community services, [as well as] in mental health and in social care”.

He added that the “strong message I’ve had from hospital chief executives, [is that] ‘The worst thing you could do is just give us more money, because actually, we’ll just keep on pouring [it] into a black hole. The best thing you could do for us is to solve the problems that are outside of our control and outside of our institutions in [the] primary community, and mental [health sectors].’”

HSJ then asked Mr Streeting if he would commit to a greater proportion of NHS funding being spent on out-of-hospital care at the end of the first term of a Labour government.

“One hundred per cent,” Mr Streeting replied, adding it is “absolutely essential”. He said that “money talks”, and he was committed to shifting “the gravity” of NHS funding to improve patient outcomes, improve efficiency and make careers in primary and community care more attractive.

The commitment will require a new Labour government to tough choices given it has signalled it will not be in a position to significantly increase NHS funding for the foreseeable future.

Indeed, to date, Labour have committed to just three specific NHS funding pledges, none of which concern primary or community care. They are to fund 40,000 extra hospital appointments, increase the capacity of NHS dentistry, and employ an additional 8,500 mental health staff. The party’s manifesto says “we must over time shift resources to primary care and community services” but with no specifics or time commitment. 

In January, HSJ revealed that the proportion of the NHS budget given to general practice was on course to fall to its lowest point in at least eight years in 2023-24.

Research by the Nuffield Trust shows spending on acute hospital care rose by 29 per cent between 2016-17 and 2022-23; while growth for primary and community care in that period was 21 per cent and 3 per cent respectively; despite an NHS long-term plan promise to grow their combined share.

Leaders and managers

HSJ asked Mr Streeting whether he agreed with Conservative plans to further cut NHSE and integrated care board staffing to increase funding for frontline care.

He said: “It would have been the easiest thing in the world for me to go into this election, promising to cut NHS waiting lists by sacking some managers. [but] I don’t think it would [make] a blind bit of difference to what we’re trying to achieve.”

There has been “too much chopping and changing” at NHSE and ICBs, he added, with both being the victims of “politicians who are keen to look tough and look busy by changing some letterheads and shipping people around organisations with different names and titles. I think [that’s] utterly futile and wasteful.”

However, Mr Streeting added, “that’s not to say that the NHS couldn’t be better managed”, and he was unconvinced by the majority of research into the issue which suggests the NHS is under-managed.

“What’s interesting to me about this question,” he said, “is you’ve got a very obvious public sentiment that says that the NHS is over-managed, and there are too many managers not doing a good job. I’m afraid that is also a sentiment I hear regularly [from] front line… NHS staff too.

“So regardless of what the evidence says about international comparators, [of manager numbers] and that the NHS would run more effectively if there were more managers, what I’m struggling to swallow, is [that is] set against the views, perspectives and experiences of frontline staff.”

Mr Streeting argued this “frontline perception…needs to be addressed”, and said he had observed “far too many layers in NHS management structures…and lots of people holding other people to account”.

Future funding

Mr Streeting said he was not “naive” enough to think the NHS could succeed without increased funding. But he added that the service first needed to win back the confidence of the Treasury that any extra funding would be spent well.

He claimed the “trust” between the Treasury and DHSC and NHSE was at “rock bottom”, and added that he had “some sympathy” with His Majesty’s Treasury’s “cynicism” about the service’s ability to spend new funding efficiently.

HSJ asked Mr Streeting if he would try to persuade the Treasury to relax rules which restrict the NHS from sourcing capital funding from, for example, pension funds, property developers and local authorities, as many NHS trusts with unfunded construction projects such as Imperial College Healthcare Trust would like to do.

He acknowledged the difficulty of accessing capital funding was causing “immense frustration” to trust leaders, and said he was confident Labour’s shadow chancellor Rachel Reeves understood “the scale of the capital challenge in the NHS”.

However, he argued “Treasury rules exist for a reason” and there were “lots of competing demands” for capital which a Labour-controlled HMT would have to weigh up.

Mr Streeting said he was prepared to stay as health secretary for “the long term” to address this and other challenges, and that – while acknowledging it would be up to Sir Keir Starmer to decide – he would “love” to stay as health secretary for the entirety of the forthcoming parliament.

Updated at 12.15pm on 1 July to change the order of the piece.