The problem with NHS management is that no-one wants to do anything about the problem with NHS management. In John Major’s government in the 1990s, there was an ambitious Eurosceptic minister who refused to sign any direction that originated in Europe. Someone else had to do it. I wouldn’t mind betting that similar instincts of political distaste and fear of association stir in the mind of the average health minister when faced with decisions about management. So they tend to drag their feet before taking short-term, bitty decisions, driven primarily by the optics, avoiding — perhaps even unaware of — the need for a bigger, bolder strategic approach.

This wouldn’t matter much if NHS management played only a bit part in successfully delivering one of the public services most dear to the hearts of this country’s citizens. But the cosy myths on which policymakers fall back on to justify inaction — that NHS management is overpaid, overbearing and overpopulated, and that it doesn’t matter much — are the polar opposite of the truth. A more accurate description would be overstretched, over-regulated and overlooked.

We’ve failed too often to take the big view of NHS management, and now we see the consequences. As the challenges facing the NHS — waiting lists, ailing productivity and the staffing crisis — become unprecedented in size, experts across the spectrum are clamouring for the effective management function that we have been negligently undermining for decades.

Can this change? Yes, but we’re at crunch time. Lord Darzi has been lifting the floorboards on NHS performance. He is likely to say that many of our challenges are management ones and to recommend building management capacity. The Ten Year Plan expected in spring 2025 is a time-limited opportunity to respond to these findings by a big beast, and for the health secretary to be big and bold about NHS managers.

There’s an understanding that public service is a valuable vocation that should attract the best people It should be a matter of pride to be an NHS manager, not a source of embarrassment.

Can Wes Streeting swim against the tide of past political instinct and decisions? Here are three reasons why he should.

First, the recent slew of studies into the under-management of the NHS may not have reversed the tide, but they have made the debate non-tidal. During the general election campaign, for example, the health secretary himself refused to match management cuts proposed by the outgoing government, and the Tories were at pains to value the role of operational managers — both firsts.

Secondly, the new government wants a renaissance in public service. From the prime minister (a former director of public prosecutions) to the minister for the NHS (a former NHS manager), there is an understanding that public service is a valuable vocation that should attract the best graduates, the best apprentices, the best of our other staff and the best managers from other parts of the economy. It should be a matter of pride to be an NHS manager, not a source of embarrassment.

Thirdly, and most importantly, the government wants to rebuild the NHS in two terms. They will need managers to do it, as the last Labour government did, when it took the NHS to new heights of public satisfaction and achievement. Cheeky Simon Stevens liked to say that the Victorian public would have subscribed to statues for NHS managers. I don’t think the public will be much interested in memorialising NHS managers, but I do think that they will vote for anyone who sets managers to work restoring and rebuilding our NHS.

The Ten Year Plan is the place to lay lasting foundations for NHS management and turn our backs on the piecemeal, knee-jerk interventions of the past. With his eyes on the prize of a renewed NHS, Wes Streeting should demand from the plan an ambitious and achievable strategy for managers to deliver; the right management structures in the right places with the right number of managers; getting the right people and giving them decent talent and career development; system processes and technology that drive improvement and productivity; and incentives that change the culture and reward managers for doing the right thing. Managers won’t get an easy ride – few want one – but the health secretary will finally have broken with the past and given managers a chance to show what they can deliver for him. //