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Sajid Javid- Five priorities of the new Health Secretary

Capital isn’t glamorous, but it’s where health reform succeeds or fails

Drawing on his experience as a Health Minister and Chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine argues the real challenge is delivering, not announcing, NHS infrastructure investment.

There is an old saying in politics that ministers like cutting ribbons more than fixing roofs. Reading the Government’s new 10-Year Capital Plan for Health and Social Care, I was reminded just how true that is.

Having served as a Health Minister and later as chair of the cross-party Health and Social Care Select Committee, I’ve learned that while politicians understandably focus on services, patients and waiting lists, none of those can be credibly improved without investing in the infrastructure that underpins them.

Estates, equipment and digital capability are not simply operational issues; capital isn’t glamorous – but it’s where health reform succeeds or fails

That is why I think this document matters, even if it contains fewer headline announcements than some may have wanted. It’s more of a capital investment framework than a capital spending announcement and while it is important because it starts to join together a series of previously announced commitments into one strategy, if you’re looking for lots of new money or major projects, you’ll likely be disappointed.

For investors, suppliers and those looking to support the transformation of health and care, this is best understood therefore as a statement of strategic direction. The Government is attempting to provide something the NHS has too often lacked: a long-term framework that links capital investment directly to service reform.

The themes will be familiar and re-enforce the view many of us held that the capital plan would essentially be the infrastructure companion to the 10-Year Health Plan which is now just over one year old.

Investment in neighbourhood health centres, modern diagnostic equipment (see my last piece), digital infrastructure, community facilities and the maintenance of the existing estate have all featured in previous announcements.

What is new is the attempt to bring those priorities together and explicitly align them with the Government’s ambition to shift care from hospitals into communities, from analogue to digital, and from sickness towards prevention.

As a minister, I learned very quickly that capital policy is health policy. You can’t expect clinicians to embrace new models of care if they are working in buildings designed before England last won the World Cup, nor can you promise a digital NHS without investing in the infrastructure that powers it. Too often, capital has been treated as something separate from healthcare delivery whereas in reality, it is one of its principal enablers.

That lesson stayed with me when I chaired the Health and Social Care Select Committee. Alongside colleagues on the Public Accounts Committee, we scrutinised the New Hospital Programme, asking not simply whether Boris Johnson’s ambitions were right, but whether they were deliverable.

That experience reinforced a rather obvious point: announcing infrastructure programmes is relatively straightforward; delivering them consistently over a decade, through changing political and economic circumstances, is considerably more challenging!

That is why I think investors should read this document with cautious optimism. The opportunities are clear. If the Government is serious about expanding community-based care, modernising diagnostics, digitising the NHS and addressing the maintenance backlog, there will inevitably be demand for expertise, technology, construction, data, equipment and innovative delivery models.

The direction of travel is now clearer than it has been for some time. The question not answered is pace. The plan sets out the destination far more clearly than the route to get there. There is relatively little detail about sequencing, procurement, prioritisation or delivery milestones.

History also provides a note of caution. During my time in government, I saw how easily capital budgets could come under pressure when day-to-day NHS spending became squeezed. Every government says it will protect long-term investment; not every government manages to do so.

And I note how one of the strongest themes is ‘repair first’ as large sums are earmarked for tackling the maintenance backlog, replacing obsolete equipment and of course removing RAAC. £6.75bn for hospital repairs over nine years and £2bn to remove reinforced autoclaved aerated concrete.

Overall, I see this as a welcome piece of strategic thinking. It provides a clearer signal than we have had for many years that infrastructure is no longer being viewed as an afterthought but as a prerequisite for NHS reform. For those looking to invest, that matters.

The real test, however, will not be whether the strategy is well written, but whether successive governments (including the new one about to start work) have the discipline to stick to it.

Community pharmacy settlement brings stability, but long-term challenges remain

As a former Pharmacy Minister, I watch the annual community pharmacy contract negotiations with interest because I know how important they are. This year’s settlement is notable for one reason above many in that it was agreed! That may sound like a low bar, but in today’s NHS it is anything but.

At a time when ministers find themselves in dispute with almost every part of the health workforce, the fact that Government and Community Pharmacy England have reached an agreement matters.

Negotiation remains preferable to imposition. It provides stability, certainty and, perhaps most importantly, a platform for future reform. The settlement itself is better than many in the sector (including me) were expecting. Indeed, compared with the rest of primary care, community pharmacy has secured one of the stronger funding settlements available anywhere in the NHS.

Minister Stephen Kinnock deserve praise for recognising that pharmacies cannot carry on indefinitely with rising costs. The increase in funding, the uplift in retained medicines margin and the write-off of historic over-delivery all sit on the positive side of the ledger.

But we should be honest about what this settlement is – and what it is not.

It is not a recovery plan. The uncomfortable truth is that a decade long funding gap – which I absolutely take my share of responsibility for – has not been closed. The additional investment announced for 2026/27 is largely consumed by increased activity levels and of course inflation. This matters because while the settlement should help stabilise the sector, I suspect it will not halt pharmacy closures.

There is another challenge too. I have great respect for Community Pharmacy England but there will come a point where it must decide whether it believes a deal is acceptable or not.

Last year, and now this, we hear of an agreement reached quickly followed by explanations setting out why the agreement is not good enough. I understand why this occurs, but it is not a position that can be sustained indefinitely and many in the sector will feel that. Ministers won’t much care so long as it’s done and they will come to rely on that.

At some point, the sector, government and negotiators alike need true alignment on what success actually looks like. The government’s clear priority in this settlement is independent prescribing. As a manifesto commitment and a central part of the neighbourhood health agenda, it is easy to see why ministers are keen to deliver here.

The principle is absolutely right. For years I have argued that community pharmacy is one of the NHS’ most underused assets. Everyone should want pharmacists diagnosing, prescribing and managing more patients – ‘hospital to community’ as they say.

My concern is whether the funding stamped on this settlement will be enough to deliver independent prescribing at a meaningful scale. Training people is vital. Creating the capacity, infrastructure and incentives to make independent prescribing a systemic part of community pharmacy practice is another challenge.

My verdict? This is a better deal than many anticipated and best in class in primary care. It provides some level of stability and demonstrates that constructive negotiation is still possible with this government.

But stability is not transformation.

The question facing us all is whether the settlement represents the first step towards a realised clinical future for community pharmacy – or merely another year spent managing decline, albeit a little more slowly.

This article from Steve Brine also appears at the Chemist + Druggist online magazine.

Treasury to Treatment: James Murray Appointed Health Secretary

As predicted, England has a new Health Secretary – James Murray.

Above all else, he deserves the goodwill that comes with inheriting one of the best jobs in government.

The Department of Health and Social Care is unlike any other brief. It combines immense public affection for the NHS with relentless operational pressure, difficult fiscal realities and an almost impossible expectation that Ministers can ‘fix’ deep-rooted problems decades in the making.

So my advice to James above all else would be this; you inherit a Ten Year Plan (and numerous other strategies) so don’t waste time and try the patience of the sector by re-writing them.

Focus on operationalising them and give your civil servants (as well as Jim Mackie who I suspect will be feeling deflated right now) a very clear steer from day one on your top three policy areas. Not the infamous three ‘shifts’ – they’re the means to the end – but the areas they know you personally will never drift from.

James takes office with a formidable in-tray. NHS waiting lists still high and a media (as well as a sector) that is sceptical recent falls weren’t more about politics than clinical reality.

Access to primary care continues to define the ‘retail offer’ in health, while care reform of course remains the great unresolved question of British domestic policy.

Not to mention a Ten Year Workforce Plan that remains illusive, medicine shortages (which I predict will grow as an issue in 2026) and rising demand because we are living longer, but often not healthier, lives.

And hanging over all of this is perhaps the biggest challenge of all; how we finally move from a sickness service to a genuine health service.

That is why the NHS Modernisation Bill he inherits matters. Much of the early discussion around it has understandably focused on the proposed Single Patient Record — a potentially transformative attempt to join up fragmented patient information across the NHS.

Done properly, this could save lives, reduce duplication, improve productivity and finally give clinicians the information they need at the point of care. Done badly, it risks becoming another expensive digital programme which loses public trust before it delivers meaningful change. The new Secretary of State will need Number 10 (whoever occupies it) to back him fully when the going gets tough.

But the Bill goes wider than that. It is likely to include measures aimed at modernising NHS structures, expanding the use of technology and AI, improving data sharing, reforming procurement and accelerating innovation adoption. And that’s before Labour MPs, increasingly keen to reject incrementalism, get their hands on amendments come the Bill Committee stage.

The challenge, of course, is delivery. Every Health Secretary arrives in office promising reform. Most discover the system is better at absorbing change than enabling it.

The NHS is enormous, complex and deeply institutionalised. Structural reform alone rarely changes outcomes unless accompanied by cultural change, workforce support and political honesty about priorities.

And that brings me to Wes Streeting. I know how hard it is to leave that Department so it can’t have been easy.

Politics is often too tribal to acknowledge effort when people leave office or move on from major briefs. But it is right to recognise the energy, seriousness and determination Wes brought to the health debate.

Whatever one’s politics, he helped force difficult conversations into the open — about productivity, reform, prevention and the need for the NHS to modernise if it is to remain sustainable.

Wes deserves credit for that as well as the HIV Plan, the Men’s Health Strategy and some lesser noticed progress around things like the Rare Diseases Plan or England (finally) testing newborns for Spinal Muscular Atrophy as a result of his work with Jessy from Little Mix.

The new Health Secretary will quickly discover there are a thousand competing voices telling him what matters most.

My hope is that, amid the noise, he keeps sight of a simple truth: the future sustainability of the NHS will depend not only on how we treat illness, but on how seriously we take the business of creating a healthier society in every sense of the word. We should all wish him nothing but success.

Steve Brine, consultant, podcaster, trustee, former MP for Winchester & Chair of the Health Select Committee

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