Where does Wes Streeting’s departure leave national health policy?

James Murray MP, former Chief Secretary to the Treasury, now holds responsibility for one of the most ambitious NHS reform agendas in over a decade.

Within his resignation letter, Wes took the opportunity to showcase the work he had delivered in health following Labour’s 2024 General Election victory. His departure now prompts questions about the durability and impact of his reform agenda, including whether his tenure has delivered tangible strategic and structural change across the NHS.

The central challenge facing the Government is no longer defining the direction of NHS reform, but whether it can successfully translate that ambition into meaningful improvements for patients and for a system under strain.

A reform agenda built on modernisation

Streeting secured several early political and operational successes, including striking a pay deal with resident doctors in September 2024. However, his tenure quickly shifted beyond crisis management and towards a modernisation agenda to fundamentally reform the NHS.

Central to this was the 10 Year Health Plan, which sought to tackle the challenges that Lord Darzi’s investigation deemed contributed to a “broken” NHS in 2024. The Plan’s three key shifts were widely welcomed across the sector as the right strategic direction for a health service crippled by rising demand, a deficit of productivity and a lack of fresh thinking.

However, there is concern that these reforms could become constrained by operational and financial pressures – limiting the pace and scale of reform delivery. For example, there has been growing concern that funding intended to support neighbourhood health and wider system transformation is increasingly being redirected to address acute sector pressures and short-term financial recovery.

This strategic vision also shaped policy development across major disease areas, including cancer, through the National Cancer Plan, as well as wider health plans, including the Men’s Health Strategy and a renewed Women’s Health Strategy.

The Cancer Plan is undoubtedly ambitious, with the potential to improve the lives of cancer patients. But, again, its success will depend on how well the specific measures are implemented in practice. The sector has called for implementation plans, robust accountability mechanisms, workforce capacity, and sustained resourcing and funding for the bodies responsible for delivering change, including Cancer Alliances.

A structural transformation of the NHS

Streeting’s reform agenda also involved a structural transformation, best exemplified through the abolition of NHS England, with its integration into DHSC by April 2027.

Whilst there are potential benefits from the removal of unnecessary duplication across parts of these bodies, and cost savings estimated to release approximately £500 million, there is also a risk associated with such a significant reorganisation.

Inevitably, this fundamental structural change has resulted in a high degree of disruption, not least to ICBs, which the government has consolidated from 42 into 26, with significant staff cuts by around 50% of overall headcount across NHS England and DHSC. With a significant portion of ICB resources focused on reorganisation, forward planning for service provision over the coming years has become increasingly challenging. This has also been compounded by a loss of commissioning expertise across the system, reducing strategic capability at a time when effective local-level planning and service redesign are crucial to delivering improvements for patients.

Introduced to Parliament on the same day as Streeting’s resignation, the NHS Modernisation Bill aims to provide the legislative framework to implement previously announced changes to the central architecture of the NHS. Notably, there is further clarification on the role of ICBs as strategic commissioners, with greater transfer of responsibility for most commissioning functions, including primary care, leaving national responsibility for highly specialised services. It will be a central priority for James Murray to progress this Bill through Parliament, given it is the legislative mechanism underpinning the restructuring of the NHS.

The challenge of translating ambition into positive change

Examining Streeting’s work to deliver measurable patient-focused improvements, the picture is mixed. He has been successful across many NHS targets, including for the number of patients waiting 18 weeks, with the greatest improvement in waiting times in 16 years. However, this has been met with a degree of caution, with 17.1% of the reduction in appointments being due to unreported waiting list removals.

Importantly, national-level success has not been achieved evenly across England, with 68 of 150 NHS Trusts not meeting this level of improvement, demonstrating the persistence of geographical health inequalities. Honing in on specific disease areas, there are further caveats to progress. For example, all three key cancer waiting time standards – the Faster Diagnosis Standard, the 62-day referral to treatment standard, and the 31-day decision to treat standard – were missed in England in March 2026, with two of these targets having not been met for five and ten years respectively.

Delivering an impactful NHS transformation amidst fiscal and political pressures

Inheriting this direction of national health policy, Murray now faces the considerable challenge of translating Streeting’s policy ambition into lasting improvements for patients and the wider health system. While a clear direction of travel for NHS reform has been set out, the success of these plans will ultimately depend on their implementation amidst significant fiscal constraints, political turbulence, and entrenched health inequalities across England.

The enactment of the NHS Modernisation Bill is likely to prove particularly demanding as Murray’s first key task, given the scale of structural reform required and the potential for parliamentary resistance. While Wes Streeting has presided over the first increase in public satisfaction with the NHS since 2019, voter expectations for tangible change are at a high.

Murray’s ability to deliver measurable progress is set to be critical in proving a Labour Government’s credibility on health policy and – in the face of increasing challenge from Reform – that a publicly funded healthcare system can truly deliver for patients.