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I think it was Napoleon who said he didn’t care too much about the qualifications of his generals… he just wanted them to be lucky.
Luck or talent? What do we want? It’s a close call.
The news that junior doctors are to go on strike this November, when we were led to believe Streeting was negotiating with them, bringing an end to their industrial dispute, begs the question…
Is he unlucky? For sure, there’s no sign of talent.
On his watch we have:
- an unfunded, unplanned ten-year-plan, with no impact analysis, or implementation plan;
- the chaos of an unheralded closure and merger of NHSE and DH+;
- swingeing workforce cuts and unfunded redundancies;
- no parliamentary time to introduce the legislation needed to close NHSE and legislate for the successor organisation;
- a bewildered duopoly of committees and boards trying to run what is essentially a single organisation;
- waiting lists, at best static;
- morale through the floor;
- social care hanging by a thread;
- Covid numbers skyrocketing and cuts to vaccinations;
- productivity grinding to a halt;
- primary care close to rioting;
- rows about physician associates and workforce planning;
- a looming barney with the pharmaceutical industry;
- and an unpaid bill of about £300m from the last round of strikes…
… it’s hard to think this is all as bad luck.
It’s a man-made mess, made by a very silly-boy.
The strike represents a direct challenge to Streeting’s authority over pay, workforce policy and industrial relations.
A walkout casts doubt on his ability to manage one of the service’s most critical workforce groups, without provoking them.
Already, during earlier strike rounds, Streeting has framed the dispute as a confrontation… he warned that doctors would ‘lose a war with this government.’ Really...
These unwanted and crippling November strikes escalate that confrontation.
Streeting will be judged on how well he handles his self induced crisis…
... both on optics; can services continue, are patients protected…
... and substance; can he strike a deal without destabilising finances or alienating other NHS staff?
Any missteps will be magnified, especially given rising public anxiety over NHS waiting lists and access to services.
Streeting has said there is ‘no more room for manoeuvre’ on pay. He has offered non-pay concessions on conditions and training reforms… but even with that leverage he has achieved nothing.
His combative nature will push him into trying to mobilise public opinion and prevail on the non-striking NHS to once more bust-a-gut to keep services flowing.
I imagine a lot will think carefully about donating their discretionary effort, to dig Streeting out of a hole he’s dug for himself.
There is also the no little-matter of the potential reputational damage within the Labour Party.
The NHS is a core issue for Labour. Many supporters will expect Streeting to defend and strengthen it...
... actually, he's attacked it with his 'broken' message and weakened it with chaotic reforms.
If strikes are viewed as symptomatic of Labour's mis-management or failure to deliver, that could erode support or provide fodder to critics.
Streeting has already warned that extended strikes could become 'a gift to Nigel Farage’.
Given his temperament I wouldn't be surprised if Streeting's considering legal, regulatory or contractual levers to limit or constrain strikes.
This would be politically fraught and might escalate confrontation, union backlash, court challenges, or political backlash.
Public opinion? It’s unlikely the doctors will carry public support…
... but they know that and they don’t care. These doctors aren't from the Dr Findlay era.
They calculate, given the unpopularity of HMG and recent missteps, it’s likely attention will turn on the competence of the government.
Can Streeting project a government in control, credible, responsive. I doubt it. It looks to me reactive and cornered.
The narrative will be critical.
Talking tough is stupid. Talking-up improvements in conditions, demonstrating they’re in place and being clear about reasons for resisting further pay demands…
... would demand a maturity we don’t see in Streeting.
During the last action NHSE tried to downplay strikes and project a ‘business as usual’ image. Bushing off the impact. I’m not sure that will hold as winter draws-in.
Streeting’s leadership, judgment and ability to finesse industrial, financial and public pressures will all be under the microscope.
For the NHS, it’s another escalation in a destructive cycle brought about by an inexperienced health secretary, advised by people who want us to make the same mistakes they made 20 years ago.
It’s time for a change.
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