Re:View 19 September 2025
Research Manager and Head of Health
When biblical rain returns, light jackets reappear, and iced coffees give way to pumpkin spiced lattes, you know party conference season is upon us. Before every organisation in Westminster decamps from London for beige food and warm white wine over the next three weeks, it’s worth reflecting on this brief window of parliamentary return.
From restructure to scandal to reshuffle to scandal, the actual policymaking machine of Government has received scant attention since Parliament returned. However, if one theme slightly distinguished itself (albeit briefly) from the political theatre of the last few weeks, it’s that the Government are centring their work on the idea of delivery.
This motivated a complete restructure of No.10. And in the past fortnight we have seen substantial shifts in NHS policy, which also mirror the strategy deployed by New Labour’s No.10 Delivery Unit. The reintroduction of hospital league tables stole headlines last week while on Monday we saw a new performance-based pay system for NHS leaders.
The NHS is unique in its breadth, depth, and complexity, and as a result, often seems impervious to policy reform. To the public, the NHS looks like a government-owned monolith that can be bent to its will. But in reality it is a fragmented body of thousands of highly autonomous organisations with their own leadership, funding model, workforce and clinical demands – the list goes on.
Forcing change in the NHS is therefore a challenge that has plagued consecutive governments. It has often been a focus of government delivery units in their various incarnations over the years.
Indeed, in many of the research interviews for 'Hospital of the Future', reflections on the early 2000s delivery agenda were commonplace. Attention will often be drawn to the more adversarial policies they drove, such as league tables. But one of the most insightful conversations I had on this topic centred around the Prime Minister’s Delivery Unit’s (PMDU) ability to ‘problematise’ in the early 2000s.
A key factor in their success was their ability to pinpoint precisely the different issues which arose in different hospitals, and why. ‘Carrot and stick’ approaches only work when you know what you need to solve. As such, the PMDU would conduct rigorous problem analyses on the ground in different hospitals to figure out what was needed to get targets over the line – was it prioritisation, skills, workforce, leadership? Once they had this information, they could act effectively.
The temptation for Wes Streeting and Darren Jones will be to focus on the top-down discipline of NHS leadership. This will arguably only get them so far, compared to a genuine bottom-up appreciation of difference in the health system.