Editorial: There is still work to do to fix the NHS

As the 14th round of industrial action by doctors in their current pay dispute draws to a close, just in time for a Christmas truce, a version of the famous words of John Lennon comes to mind: “Another strike over, and what have you done?” For the health secretary, Wes Streeting, it’s an awkward question. He can certainly point to more funding for the NHS, which is something tangible that the voters who elected them to “fix the NHS” will benefit from. He has overseen a reduction in waiting lists, although some say the achievement has been exaggerated. Also, the figure of 5 million extra appointments across the NHS has not been seriously challenged. Yet the strikes drag on, and sap confidence in the NHS and in Labour’s capacity to reform it.

Polling suggests that public satisfaction has not yet started to improve appreciably, but the state of the NHS has sharply declined in the list of their greatest concerns – reflecting some faith that Mr Streeting will indeed fix what he’s called a “broken” NHS. Thus far, the winter “flunami” hasn’t pushed the NHS into collapse, and neither has the latest strike by the resident, formerly junior, doctors. That, though, may be more a matter of luck and the ability of NHS trusts to manage their workloads ever more efficiently.

Politically, Mr Streeting can end the year satisfied that he is one of the few members of the cabinet formed in 2024 to have avoided scandal, retained his dignity and improved his reputation. He even survived an ill-advised “drive-by” attack by unnamed figures associated with the prime minister’s team, bemusedly returning their badly aimed fire, and ending up more prime ministerial than the prime minister himself. In an end-of-year interview, he plays down his ambitions again, remarking that “I wonder why anyone would want to be PM”. It feels an unconvincing rejoinder, but he will understand better than most that if the post ever did fall vacant, his own performance as health secretary will be central to his chances of getting the top job. Without question, Mr Streeting is a superior communicator to Sir Keir Starmer, more quick-witted and persuasive. But he still needs to show he can “do” as well as talk, and that means ending the strikes in the NHS.

When they look back, the leadership of the British Medical Association (BMA), which increasingly behaves less like a genteel professional body and more like an industrial trade union from the dark ages of labour relations, can feel more satisfied. They can boast that since the election of a Labour government last year it has secured a 28.9 per cent increase for its members. That was granted, in effect, by the incoming chancellor, Rachel Reeves, to stop the incessant disruption in the hospitals. However, no such assurances were given to NHS management or the Department of Health and Social Care, and the current demand for pay restoration to 2008 levels involves a further 26 per cent rise in earnings. The resident doctors seem just as willing as ever to pocket concessions, such as improved opportunities to progress into higher-paid specialisms and consultancy, and still ask for more money.

So it is that Mr Streeting finds himself in more or less the same dismal predicament as his Tory predecessors, such as Steve Barclay and Victoria Atkins, whom he used to torment so much by telling them they should just “get round the table” with these dedicated professionals, and talk and talk until they settled the strikes. Now it is his turn to declare himself “disappointed” about the BMA’s grinchy actions, and condemn the doctors for their “irresponsible” behaviour and their “cynical attempt to wreck Christmas“.

There is a difference, however. The Conservatives never claimed to be “the party of the NHS” and, whatever else, the voters didn’t really expect them to place it at the top of their priorities in government. By contrast, they do expect that of Labour.

Can Mr Streeting end the strikes? He may have more success in 2026. Public sentiment may slip away from the resident doctors, and support for further strike action within the profession may erode. He is winning the arguments. But his scope for being more generous on pay is limited by the state of the public finances, which remain vulnerable to economic shocks. Meanwhile, the economy is struggling, and the public is growing impatient with progress on immigration and welfare reform. The prime minister’s and the government’s ratings are at record lows. Mr Streeting has the opportunity to show the difference a Labour government can make to the wellbeing of the nation, and thus provide at least one strand of the “narrative” the government has been so poor at composing. Whether or not he’s thinking of his next role in government, he hasn’t yet finished his current job.