Amanda Pritchard’s resignation is a moment of opportunity for Wes Streeting

Few would envy Amanda Pritchard’s in-tray when she took over NHS England (NHSE) in August 2021. The frailties that had built up in the health system over the previous 11 years had been accelerated by the Covid pandemic, and recovery – particularly in hospitals – was sluggish. Arguably, the decline in hospital productivity and NHSE’s attempts to reverse came to define her tenure.

Pritchard’s record on NHS performance has been mixed. The elective waiting list grew to record levels, but also not as high as many forecasted. Emergency performance has been particularly bad since she took over, with millions of people waiting more than 12 hours in A&Es since then – a relatively rare occurrence before the pandemic. However, the recent drop in the waiting list has been a result of programmes such as elective surgical hubs, community diagnostic centres and the expansion of advice and guidance – all launched or expanded under Pritchard’s watch. General practice is delivering more appointments than ever. But the partner workforce – the lifeblood of the service – has continued its steady decline. 

Prickly select committee appearances stoked the pressure on Pritchard

While rumblings that Pritchard would leave started almost as soon Labour won the general election, it was arguably pressure from Pritchard’s recent select committee evidence sessions that made her position untenable. In its report on her appearance, the Public Accounts Committee (PAC) claimed that “senior officials [including Pritchard] do not seem to have ideas, or the drive, to match the level of change required [in the NHS]”.  ¹⁰ https://committees.parliament.uk/publications/46303/documents/233234/default/ , p.1

While strongly worded, there is some merit to PAC’s view. Both Pritchard and Chris Wormald’s (then permanent secretary of DHSC) evidence painted a picture of a health service that would struggle to deliver health secretary Wes Streeting’s reform plans over the coming years. That should be worrying for a government that pins much of its hopes of re-election on turning around NHS performance.

NHSE’s reply to that critique exposed an unwillingness to engage in external criticism, dismissing PAC’s report as containing “basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work”. ¹¹ https://www.england.nhs.uk/2025/01/nhs-england-response-to-flawed-pac-report/  Despite this prickly defence, by springing her resignation on the NHS, it appears that Pritchard jumped before she was pushed. 

Streeting is using the upheaval as a chance to take back control

Almost immediately, there were reports that Streeting plans to slim down NHSE ¹² https://www.theguardian.com/society/2025/feb/25/wes-streeting-to-axe-thousands-of-jobs-at-nhs-england-after-ousting-of-chief-executive  – with the goal of reducing duplication of work with his health department.

Streeting’s view of an inefficient centre is one shared by many in the health policy world. NHSE is supposed to be responsible for the operational management of the NHS, while DHSC is supposed to take a wider, maybe more strategic view of health and social care spending and policy. But in reality, the lines between the two organisations are blurred, and frequently overlap. That can lead to duplication of work, disputes between the organisations that slow policy making, and confusing lines of accountability for those on the frontline.

Streeting may also have been frustrated to find that he had few levers to influence NHS performance, despite much of the accountability resting with him. Bringing more responsibility back into DHSC could empower the secretary of state to move more quickly on his plans for reform. 

Streeting is likely to pull powers back into his department over time but has also committed to not abolishing NHSE. There is still the possibility of substantial reorganisation, but these reforms should be focused on where they will make a real difference to delivery. Otherwise, they risk being just another distraction – and Streeting will be disappointed if the most substantial change in the NHS by the next election is a reduction in headcount in NHSE. 

Streeting has an opportunity to pick his health policy champions

Pritchard’s resignation means that three of the most senior positions in the health system – permanent secretary of DHSC, CEO of NHSE, and chair of NHSE – are either vacant or have been recently filled.

Streeting has already chosen Dr Penny Dash as the new chair of NHSE and, at least rhetorically, Dash is aligned with Streeting’s reform programme. 

The appointment of the next NHSE CEO and DHSC permanent secretary will have an outsized influence on the success of Labour’s NHS reform plans. The health secretary can influence both those appointments, and Streeting will no doubt be thinking carefully about who is best suited to those roles. The PAC report may provide some inspiration for the type of candidates he should consider: people who understand the NHS but are also willing to think creatively about what it would take to reform the service in line with the government’s vision.