Welcome to the Streeting Doctrine: punish the poor performers, reward the miracle workers, and let the system rot beneath them. If you were wondering whether the NHS would be spared the logic of late capitalism. Targets, competition, cuts masked as innovation. The answer is now clear. The future of English healthcare management lies not in collaboration or care, but in the braying language of the corporate boardroom: carrots, sticks, and six-figure bonuses.
Wes Streeting’s announcement that NHS chief executives will have their pay rise withheld if they “overspend” or “fail to hit targets” amounts to a managerialist fantasy masquerading as reform. It imagines the NHS as a failing firm that just needs the right spreadsheet metrics, some incentivised CEOs, and a bit of performance-based discipline. But hospitals are not fast-food franchises. Waiting lists are not marketing funnels. And patients are not missed KPIs.
Let’s not forget what is actually happening in our hospitals. Last year, over 14,000 people died after waiting more than 12 hours in A&E. That’s not a performance issue. That’s a system in collapse. Ambulance and Corridor care is the new normal. To suggest that financial punishments for individual managers will somehow resolve this is either deluded or dishonest.
This isn’t just bad policy. It’s ideological rot. The belief that a single chief executive can turn around an under-resourced, short-staffed trust through the magic of personal ambition is fantasy. It treats structural crisis as managerial failure and rewards obedience to austerity with cash bonuses. If a hospital is struggling because staff are quitting, wards are closing, or beds are being cut—Streeting’s plan demands the blame be laid at the feet of whoever is unlucky enough to be in charge.
And what does success look like under this new regime? Not better outcomes. Not public satisfaction. But shorter waiting lists and tighter spending. Never mind if that’s achieved through cuts, outsourcing, or creative accounting. Never mind if it results in rationing of care or unsafe staffing levels. The bonus cheque only cares that the trust met its financial target. You want a £30k payout? Just get patients off the list. Dead or discharged, it’s all the same.
It is galling that Streeting dresses this up in the language of “learning from business”. Business is why we’re in this mess. Private Finance Initiatives hollowed out the NHS. Agency staffing turned care into gig work. Consultants are used like temp workers, junior doctors are being driven out, and the NHS spends billions every year patching up the damage of privatisation. Bringing in the logic of the boardroom hasn’t saved the health service. It has bled it dry.
The NHS doesn’t need more carrots and sticks. It needs more beds, more staff, and the funding to match rising demand. It needs to be run for patients, not targets. And it needs leaders who are trusted to advocate for their hospitals. Not treated as fall guys for government failure.
Streeting’s plan is a desperate attempt to look tough on inefficiency while avoiding the real truth: that NHS trusts are being asked to do the impossible. You cannot cut your way to shorter waiting lists. You cannot fire your way to patient safety. And you cannot run a health system like a hedge fund.
We should be ashamed this is even on the table. A functioning health system is not one where executives earn bonuses while patients die in corridors. It is one where no one has to wait 12 hours for a bed. Where A&E isn’t a bottleneck of suffering. Where dignity is not a casualty of accounting.
If this is how Labour plans to run our hospitals, we should be very afraid. Because what’s coming isn’t a reset. It’s a managed decline. And it won’t be the executives who suffer the most. It will be the patients. It always is.
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