The UK is onto its eighth health secretary in the past five years. So far, all have promised reforms while asking an overstretched NHS to do more with less: fewer staff, tighter budgets, fragmented services, and growing demand.
The question now is not simply who is James Murray, who has taken over from Wes Streeting as the latest in post, but what kind of politics should shape the future of healthcare in England?
One thing is certain: Murray cannot continue the same cycle of crisis management, outsourcing, and superficial reform of his predecessors.
Instead, he needs to take a health justice approach: one that treats healthcare as a political right, values workers as the foundation of public care, and rebuilds democratic accountability and public trust in the NHS.
The politics of health justice
The NHS was launched by the first health minister, Aneurin Bevan, in 1948 on three simple but radical principles:
- It should be comprehensive, meeting the needs of everyone
- It should be universal, with GP consultations and hospital treatments free to all at the point of delivery
- It should be based on clinical need, not ability to pay.
Bevan’s political vision understood health not as a privilege for those who could afford it, but as a collective social good. Decades later, despite mounting pressures, the NHS remains one of the most valued public institutions in the UK and is often regarded as one of the best health systems in the world.
The health secretary plays a far more powerful role than public debate often acknowledges. Beyond media appearances and crisis announcements, the position shapes the strategic direction of the NHS itself.
The health secretary oversees funding settlements, workforce planning, public health priorities, and relations with NHS England, which is set to be abolished and its functions moved to the Department of Health and Social Care. They influence pay negotiations, social care coordination, procurement decisions, and the extent to which private companies are allowed to profit from public healthcare infrastructure.
These choices are political. They determine whether healthcare operates primarily as a public service or increasingly as a for-profit ‘industrial-complex’.
A health justice understanding begins from the idea that health is shaped by far more than hospitals alone. Housing insecurity, poverty, racism, disability access, pollution, and labour conditions all profoundly affect who becomes ill and who receives care. NHS policy cannot be separated from wider social policy.
A good health secretary should therefore be judged not only on waiting times or hospital targets in isolation, but on whether healthcare becomes more equitable, democratic, and humane.
End corporate capture and build public digital infrastructure
Murray must confront the growing role of private corporations within NHS infrastructure, particularly in digital healthcare and data systems. Here, there is no greater foe than Palantir.
That the US data analytics and spytech firm has a contract to run NHS England’s Federated Data Platform symbolises a dangerous direction of travel: one in which sensitive public health systems become increasingly dependent on private firms with little democratic accountability, particularly one that has both feet in the Gaza genocide.
Defenders of this contract often frame it as modernisation, while ignoring ethics and the fabrication of success. In reality, they risk deepening corporate influence over public healthcare. Outsourcing critical infrastructure creates long-term vendor lock-in, fragments accountability, and shifts public resources into corporate profit rather than patient care.
Murray should prioritise terminating Palantir’s contract by the end of the year, following in the footsteps of London mayor Sadiq Khan, whose office has just prevented the Metropolitan Police from extending its contract with the company. He has an opportunity to show strong leadership as Palantir’s presence in the public sector continues to be scrutinised by constituents.
The health secretary must also commission a review of the procurement failures that enabled Palantir to secure the contract in the first place – this is not simply a problem with one company, but with a procurement culture that has repeatedly privileged expensive and incapable private contracts over sustainable public investment.
At the same time, Murray should invest in building a strong in-house technological capacity within the NHS. That means working directly with NHS tech workers, digital teams, trade unions, and researchers to develop secure, open-source, transparent, and publicly accountable data systems designed to be patient-centred, rather than catering to corporate interests.
Rebuilding democratic control over NHS technology infrastructure would help ensure that no future government can so easily hand core public systems to private firms again and that no private company can abuse our data.
Treat health as a wider social justice issue
Healthcare policy alone cannot solve the health crisis facing England. The NHS is continually forced to absorb the consequences of political choices made elsewhere: austerity, weakened social care, low wages, precarious work, polluted environments, and inaccessible housing.
If Murray is serious about relieving pressure on the health system and reducing the waiting times, he must look at why so many people are sick in the first place. Public health cannot be reduced to hospital management while government policy deepens the poverty that contributes to chronic illness. The health secretary must work across government departments to support people to live and work in healthy conditions.
Take housing, for example. Housing insecurity and homelessness have been intensified across England by the growing shortage of affordable housing. More people are being forced to move frequently, live in overcrowded conditions, or face constant anxiety about eviction and rising rents. By last summer, over 132,000 households in England were living in temporary accommodation.
Behind these figures lies a profound public health crisis. Poor-quality, unaffordable, and insecure housing is linked to worse mental and physical health outcomes, including chronic stress, respiratory illness, and higher levels of inflammation in the body. Housing insecurity actively produces illness.
A health justice approach, therefore, requires Murray to work with his equivalent in housing, Steve Reed, to deliver major investment in social housing and rent controls. Similar interventions should be made in welfare, employment, and the environment.
The NHS is built and fought for from below
Changing ministers alone will not save the NHS. Structural transformation will require sustained political pressure from health workers, trade unions, patient advocacy groups, tenants’ organisations, and the wider public.
The NHS itself was created through collective struggle and political demand; its future will depend on similar forms of democratic pressure. Without organised resistance, governments will continue to pursue short-term crisis management, outsourcing, and policies that treat health primarily as a personal problem rather than a political right.
Murray faces a clear choice. He can continue with privatisation and reactive policymaking, or he can begin rebuilding the NHS around equitable access and democratic control.
Although how the NHS is managed will remain an important political issue in all upcoming elections, its future will not be decided solely in Westminster, but through the collective pressure of the workers and communities who rely on it every day.
Nina Radulović is an ex-NHS health worker and communications lead at Medact, a health justice campaigning organisation.
