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I’m sure you’ll have had enough of me for one year…
… you’ll be anxious to get on with the wrapping, plucking and stuffing that makes Xmas the joy it is!
Just before you hoist your ‘ding-dong’, merrily on high and I succumb to the worst sore throat it is possible for even an heroic man to endure…
… I have a couple of reflections.
This year has been defined by contrast.
A front line that has worked relentlessly to keep patients safe in the face of unprecedented demand, workforce gaps and operational fragility.
A political centre that has chosen disruption over understanding, rhetoric over grip and movement over meaning.
The NHS has not failed this year... but, it was failed.
There are five clear lesson from 2025.
1. You Cannot Re-organise Your Way Out of Operational Failure
The year’s defining act… abolishing NHS England. Presented as decisive leadership. In practice, it was disruption without diagnosis and 'done because we can'.
At precisely the moment the system needed continuity, focus and memory, it was given uncertainty, vacancies and months of organisational paralysis.
At the top, confusion, distraction, decisions deferred. Locally, managers left to interpret shifting lines of accountability.
Reorganisations are not reform. They are what happens when the centre runs out of operational answers.
The front-line struggled on, not because the change helped, but because it was smart enough to find workarounds.
2. Long-Term Plans Are Irrelevant When the Short Term Is Unsafe
Tossed into this instability came a Ten Year Health Plan. Expansive language, thin on realism.
It spoke confidently about neighbourhood services, integration and prevention while the actual service struggled; winter demand, unsafe bed occupancy and chronic workforce shortages.
The contradiction went largely unremarked.
A long-term plan that doesn’t begin with today’s risks is not strategic. It is escapist.
3. Maternity, a Case Study in Knowing Everything and Doing Nothing
Nowhere is the failure of political leadership clearer than in maternity services.
The causes of repeated maternity failures are exhaustively documented;
- understaffing,
- weak clinical leadership,
- poor supervision,
- defensive cultures,
- ignored warnings and…
… the inability to act on data already in hand.
The political reflex? Commission another review. Criminal dissembling.
Reviews are not a substitute for action. Once again, grieving families will be asked to re-live their loss to fuel institutional delay.
There is no lack of knowledge. There is lack of grip, accountability, courage, will, maturity and a grown-up in the room.
4. You Can’t Fix a Workforce Crisis by Misunderstanding the Workforce
The handling of the resident doctors’ dispute was emblematic of the year’s failures.
The doctors, now, have an increasing sense of being managed by people who do not understand the job.
Instead of insight, the response was escalation. Instead of negotiation, rhetoric.
Now we are stuck… prolonged disruption and entrenched positions.
5. The NHS Runs on Informal Trust… the Centre Is Burning It
What keeps the NHS functioning is not structure or slogans. It is informal trust from the front door of A&E, to the back door of the boiler room.
This is the year that trust was repeatedly tested.
Cack-handed announcements about redundancy and the possibility that some NHSE people won't 'qualify' to become DH+ civil servants.
Managers bullied into cutting and transforming simultaneously. GPs were publicly blamed for system failure while delivering record numbers.
Gradually trust was drained from the system.
All this chaos has an author.
The instability and disruption were not accidental. They were the consequence of decisions taken and the tone set, by the Secretary of State.
From the opening declaration… ‘the NHS is broken’ to his latest…
... Jenga towers ready to collapse.
The abuse of resident doctors (accusing them of dousing the NHS in petrol)...
... attacks on GPs (who are expressing perfectly reasonable concerns about appointments without triage)...
... his narrative has been one of demolition and confrontation.
Inexperience is not a sin. Pretending it does not matter is.
The NHS is the largest organisation in Europe. It cannot be abused into improvement. Those who have led large systems know, instinctively… first stabilise, then change.
This year did the opposite.
How different this year would have looked...
... if the NHS were to have been stabilised before restructuring....
... if industrial relations had been based partnership not provocation.
The NHS survived this year because its staff absorbed the consequences of decisions they did not make and chaos they did not create.
The blunt message from this year is the NHS is led by someone who isn’t clever enough, experienced enough and is too cocky by half.
Potentially, the NHS slip-sliding into failure creates an incentive for Streeting to launch a leadership bid in 2026... so that his political legacy does not amount to several years of catastrophe at the NHS.
As much as we can’t have another year of him in the NHS... we can't have him anywhere near Downing Street.
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Have the best Xmas you can. Thank you for this year of friendship, fellowship and a bit of fun. For the hundreds of emails tipping me off and ticking me off. If you are up for doing it all again next year… so am I. Merry Christmas to you and yours.
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