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
Prevention is the new cure podcast – all things health and politics