There’s more than one way to skin a cat, and there’s more than one way to run the Department of Health and Social Care.
Some secretaries of state for health have chosen to dive into the detail, immersing themselves in white papers and policy minutiae. Others have preferred to exert control through the press office, gripping the system via the grid.
The House has spoken to MPs, ministers, political advisers and civil servants, as well as health experts and officials, to get an understanding of how Wes Streeting runs his department.
The portrait that emerges is of an intensely political politician – the opposite of a micromanager or a technocrat lost in spreadsheets. Supporters say this has helped him in having a clear view of what needs to be done to transform the NHS. Critics argue he has been distracted by his own broader ambition.
Unlike many of his predecessors, Streeting knew he was going to be secretary of state for health for a good period – almost three years – before assuming the role. This gave him the chance, while still a shadow, to consult with previous secretaries of state and permanent secretaries.
The NHS is broken
“He used the access talks a lot,” says a source who works with Streeting, referring to meetings between the Civil Service and opposition party in the run up to a general election.
“But when you go in the day after an election, it’s different. The thing he did to set his seal on day one was say: ‘The NHS is broken.’
“That was a dramatic input, which nobody in the department expected to happen. And nobody had come in as secretary of state saying that before.”
Streeting was also confronted on his first day with a vastly different situation to that encountered by any previous Labour health secretary: the department he heads no longer runs the NHS – that is NHS England’s job. Those responsible for NHS waiting times, for example, are not found in the department.
“For every meeting he has with the department, he has to have another with NHSE – sometimes two separate meetings and sometimes he has to construct joint meetings. Over the first six months, he realised that was clearly not working,” recalls the same source.
So, with DHSC not able to pull levers in the way other departments of state can, unwinding the Lansley reforms became a priority for Streeting. This culminated in Keir Starmer’s March 2025 speech announcing that NHS England would be abolished and its responsibilities brought in-house over a two-year transition period.
Streeting and Starmer during a hospital visitAnother well-placed source agrees that Streeting has found the “invisible barriers” to getting things done in government – the subject of complaints by former No 10 head of political strategy Paul Ovenden and other departing spads – “harder than most”.
“He has struggled to get his priorities through,” they say. “He’s a very sharp guy. But when he came in, after getting his own way on policy in opposition, he was shocked about needing Treasury sign-off… It was a rude awakening.”
A difficult start
Streeting had a difficult start in terms of Civil Service churn, the source points out, with long-serving permanent secretary Sir Chris Wormald being lost as he was chosen by Starmer to be cabinet secretary (before being forced out after just a year in post). Chris Whitty was an interim (“as brilliant a mind as that man has, he’s not a permanent secretary”), then Samantha Jones – formerly of Boris Johnson’s No 10 – became the permanent successor last year.
Streeting welcomed a totally new leadership, including Alan Milburn as lead non-executive director of DHSC (referred to as “the brain of the department’s policy output” by one source), Sir Jim Mackey as chief executive of NHSE and Dr Penny Dash as chair of NHSE. “That has really helped turn things around – the right people in the right jobs.”
Streeting’s allies say he is clear about what he sees as his job: set thevision and define broad outcomes, then ensure the system deliversit.
“He cares about the details, but he doesn’t let them get in the way of narrative, drive and direction,” says a staffer. “He paints a picture and then leaves it to the Civil Service to deliver – but that’s normal. That’s his job.”
“He is acutely aware of the political context that he operates in, which is really important for getting things through,” adds a different source.
While Starmer seems irritated by Westminster, Streeting – who cut his teeth in student politics – is animated by it. “He’s political up to his eyeballs,” as one source puts it. This is not always taken as a positive.
Politics so shapes Streeting’s approach, one source says, that he tendsto hire politically sympathetic civil servants to his private office.
This is disputed by a source close to him who points out that he has brought in people who have worked for Nick Clegg, Gordon Brown and David Cameron.
Wes Streeting cut his teeth in student politics (Photo: Jack Taylor/Getty Images)Some question whether Streeting lacks a ‘North Star’, while others say he has a (Michael) ‘Goveish’ focus on projects for short periods. Multiple sources who have worked with him and met him in his role as health secretary say he often does not give the impression he expects to stay in post for the long term.
One Labour source who used to work directly with Streeting when the party was in opposition says they are convinced that he never wanted the shadow health secretary role in the first place – likely preferring a job in which he could be more overtly political.
A senior health policy expert who has worked with Streeting and his team says it is “quite a hard bit of government to play politics in, because it’s really hard to secure quick wins”.
A day in the life of the Health Secretary
Every day Streeting gets the car in at 5.45am if he is goingto the gym, or half past six if he is not. The red box is worked through in the back seat and again at his desk in Victoria Street.
Mondays are for planning the week ahead and delivery meetings. Performance data is reviewed with his private office, departmental officials and NHS leaders. Over the last few months, with pressures intensifying, there have been weekly winter sessions.
Tuesdays bring Cabinet and external meetings. Once a fortnight, Streeting blocks out time to meet what he calls “the victims of the NHS” – maternitycampaigners, families caught up in care failures, relatives of patients who have died after systemic errors. A source close to Streeting says he was advised by the department not to meet with victims of the maternity scandal, nor to set up inquiries into such failings, on the basisit would set an undesirable precedent, but he has gone ahead regardless.
Wednesdays are for the longer-term agenda, such as negotiations with theBritish Medical Association.
On Thursdays, he tries to get out of Westminster, visiting hospitals, GP surgeries and dental practices.
Fridays are for Ilford North – a constituency day, as is typical for all MPs at the end of the week.
Weekends are often spent campaigning or attending regional party conferences
“He can be quite up and down with his satisfaction with how the department is performing, but I think that happens with any health secretary – the job is so stressful. I think it’s second only to chancellor in terms of cabinet positions which are just the worst,” an insider agrees.
“You’re dealing with the largest employer in Europe, with a budget the size of a small country, and it feels like however much money you throw at it there’s nothing you can do.” An ally of Streeting counters claims he lacks focus, saying: “Wes has got a North Star around inequalities and opportunities. His whole biography is about that.”
NHS waiting times are seen as a bureaucratic problem – but Streeting, the source continues, understands that it means millions not knowing what is going to happen to them and when, because the NHS is currently such a “passive” experience. “Politics is about changing the nature of public experiences. Wes has a strong North Star that the NHS is not good enough,” they say.
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They add that Streeting being intensely political should be taken as a positive: “We do need politicians to be good at politics. If a perm sec were good at politics, that would be a problem – but for a secretary of state, that’s a good thing!”
The charge that Streeting is “driven by press” surfaces repeatedly. In meetings, say those who attend them, he often reframes technical advice in political terms.
“You’re sitting around a table talking to him about a complex bit of policy – like the neighbourhood health service – and he’ll start to develop a narrative. ‘How am I going to explain this?’ becomes an important part of forming it. I’ve never seen a secretary of state do that before,” says a source.
Most meetings, reports another insider, eventually circle back to the question: “How will this land?” Some will see this as cynical politicking, but it is not always cited as a criticism. “He knew that communication was half the battle, so it is justifiable from a policy perspective,” the source notes.
Scrapping NHS England
The biggest gamble of his tenure has been the decision to scrap NHS England and fold it back into the department. Supporters say the old arrangement had become dysfunctional, with blurred accountability, blocking and leaking making ministers miserable. “Everybody hated it. Policy dreams went to die with NHS England,” says a source.
The risk for Streeting is that by 2029, his major achievements could amount to having cut the waiting list to the trajectory that it was already being cut under the Conservative government, and ditching a large administrative body whose role the public was unlikely to have recognised.
While the government has achieved a fall in NHS waits for elective care, experts warn that this could prove to be a complicated legacy for Streeting when waiting lists for other services remain high.
What will Streeting’s legacy be? One health expert offers a damning verdict: “The picture will be a person who talked a big game about reform, and talked a big game about transforming the NHS, but didn’t really have the tenacity to see it through.”
Allies insist the perception he is driven by ambition for his own career is not borne out by the facts: he has not run away from Ilford North, he has no plans to take out a sitting PM, and he has done the toughest press rounds when the government has been at its lowest.
But that in itself is seen by some as a negative for becoming a revolutionary health secretary.
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“You can’t be the guy who shovels the s**t for the government at the same time as being the person who is delivering a policy revolution in your department. One thing totally distracts the other,” says a source who knows Streeting well.
“Because he’s got political ambitions elsewhere, Wes has wanted to have views on everything from Palestine to social media bans. That implies to me that you’ve got a secretary of state who is much more interested in the wider political context the department operates in than the infinite number of problems at his doorstep.
You only have so much bandwidth. “I think he’d be the first to admit that he’s been too distracted by what’s going on elsewhere on Whitehall, and too eager to jump in and involve himself in the other stuff going on. But that’s because he’s ambitious – he’s got eyes on the prize,” they added.
This article was first published in The House Magazine. Additional reporting by Adam Payne.
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