The Conservatives claim Wes Streeting did not set out proper plans for NHS reform in his speech this morning. (See 11.39am.) In a response to the speech, Edward Argar, the shadow health secretary, said:

The prime minister said that there would be ‘no more money without reform’, yet all Labour has delivered is an extra £22bn for the NHS without any detail of how it will be used or productivity reforms in return.

We will support reforms that genuinely deliver better care for patients, better value for money for taxpayers, and that ensure our health and care systems are fit to meet the challenges of the future. But instead we see a government reheating old ideas, or announcing things that are already happening – what was needed was a plan; what we got from the health secretary was effectively a rehashed press release.

Liz Kendall has said she sees “no tension” in government over plans to make savings from restricting winter fuel payments to vulnerable pensioners and an increase in people securing pension credit, Aletha Adu reports.

Mel Stride, the shadow chancellor, has won a victory over the Treasury spin machine. He has managed to get officials to remove a post on X that claimed the budget did not increase national insurance contributions (NICs) – even though it did increase employers’ NICs by £25bn.

Stride complained about the advert in a letter to James Bowler, permanent secretary at the Treasury, describing it as “misleading”. He has now released the reply he’s received, in which Bowler said that the fact employers’ NICs went up in the budget was “well documented” and that the post referred to employees’ NICS. Bowler went on:

Nonetheless, for the avoidance of any doubt, the post has been taken down.

Stride says:

It is right that the Treasury have taken down their misleading post on the Chancellor’s National Insurance hike.

Given this response, I hope all Government ministers will now correct the record accordingly

Keir Starmer has been condemned by his predecessor as Labour leader, Jeremy Corbyn, and by the Palestine Solidarity Campaign for an answer he gave during PMQs about whether Israel’s policy in Gaza amounts to genocide. (See 12.26pm.)

In a post on social media, Corbyn said:

Today, my independent colleague @AyoubKhanMP asked the PM for his definition of genocide.

His response — which shows a blatant disregard for Palestinian suffering and international law — is disgraceful.

We will keep demanding: stop the genocide in Gaza.

And Ben Jamal, director of the Palestine Solidarity Campaign, said:

Keir Starmer prefers to deny that genocide is taking place rather than take any meaningful action to stop the mass slaughter of Palestinians in Gaza. For more than a year he has defended Israel’s well-documented war crimes, initially including the use of starvation as a weapon of war and cutting off fuel, water, and medical supplies.

The Genocide convention imposes duties on all states to act to prevent genocide whenever a risk exists. Right now, Israel is on trial for genocide at the International Court of Justice but Starmer, to his eternal shame, continues to allow the export of weapons used to carry out these atrocities. He has once again shown his despicable indifference to Palestinian life.

Ayoub Khan, who asked the question, is one of the five Independent Alliance MPs who were all elected in Labour-supporting constituencies after campaigning wholly or partly on a pro-Palestinian platform. He asked:

Article 2 of the United Nations genocide convention makes it explicit that genocide is not about numbers; it is about intent. The intent of the Israeli Government and the Israel Defence Forces has been explicit in words and actions over the past 400 days, with more than 45,000 innocent men, women and children killed.

On 28 October, the foreign secretary denied that a genocide was even taking place and suggested that the Israeli army had not yet killed enough Palestinians to constitute a genocide. Last week at Prime Minister’s Questions, the prime minister stated that he has never referred to the atrocities happening in Gaza as a genocide.

Will he share his definition of genocide with the house and state what further action he is prepared to take to save the lives of desperate and starving men, women and children, given that we now hold the presidency of the UN security council?

And Starmer replied:

It would be wise to start a question like that by a reference to what happened in October of last year. I am well aware of the definition of genocide, and that is why I have never described this or referred to it as genocide.

The Post Office is “far from perfect” and needs “significant cultural change” alongside work to address commercial challenges, a minister has said.

Gareth Thomas, a business minister, made the comment in the Commons during a statement on the Post Office’s plans to offload more than 100 of the crown post offices that it currently owns, seeking alternative businesses to take them over. He said doing nothing about the network was “simply not an option”.

Thomas told MPs:

We have to recognise that the Post Office is far from perfect.

We have seen this from evidence given at the [Post Office Horizon IT] inquiry. It’s clear there needs to be significant cultural change at the Post Office to ensure it genuinely prioritises the needs of postmasters and delivers customers’ needs far into the future.

It’s also clear more needs to be done to rebuild trust within the business and with the public who depend on their services.

It’s no secret too that the business is facing commercial challenges – nearly half of its branches are not profitable or only make a small profit from the Post Office business.

Postmaster pay hasn’t increased materially for a decade. The company has a high cost base and needs to transform its IT system.”

Referring to the proposals from Nigel Railton, the chair of the Post Office, Thomas said no final decisions had been taken yet.

The Post Office will continue to deliver on the 11,500 minimum branches requirement set by government. We have made clear to the Post Office that we expect them to consult with postmasters, trade unions and other stakeholders before any individual decisions are taken.

Aspects of the plan are also subject to government funding and outcomes of the upcoming spending review.

He said the government would publish a green paper on the future of the Post Office. And he added:

Doing nothing at the Post Office is simply not an option. There is more work to be done but there has to be change.

During the UQ on the Chagos Islands, Priti Patel said the Conservative party was opposed to the deal transferring sovereignty to Mauritius.

In her first Commons outing as shadow foreign secretary, Patel said:

The world is a more dangerous place than ever before in our lifetimes, and this government has agreed to give away a key strategic asset in the Indian Ocean ending more than 200 years of British sovereignty.

It is a wrong decision, and we stand by that completely.

A month is now gone since the government’s announcement, but we’re still in the dark about exactly what the government has agreed and this is simply not acceptable. We have no treaty and vital questions remain unanswered.

That is unacceptable, and the minister needs to put that right today. We cannot afford for our military base on Diego Garcia to be compromised in this way.

Lord Ashcroft, the billionaire former Tory deputy chairman who has become a much more enthusiastic supporter of the party again since Kemi Badenoch became leader, has offered to fund a legal challenge against the decision. He posted this on social media.

I am on to financially support any legal action to reverse the shameful giveaway of the Chagos Islands. I have been there and understand why UK sovereignty is imperative…

Speaking at the Agricultural Industries Confederation conference this morning, Daniel Zeichner, the farming minister, said the government will not change the plan to subject some farms to inheritance tax.

Thousands of people plan to descend on Westminster next week in a protest against the changes which they say will cause family farms to be sold off to pay inheritance tax bills. Amazon Prime star Jeremy Clarkson is due to speak at the event as are some political figures yet to be confirmed.

“We are not going to see any change to the budget,” Zeichner said.

But he also said the government was looking into why the Treasury’s figures say only 28% of farms will be affected by the new rules, while figures from the Department for Environment, Food and Rural Affairs imply 66% could be.

On Bexit and the trade with the EU, Zeichner also played down suggestions that the UK could reduce trade friction by aligning with EU standards. He explained:

This government has said that we want to renegotiate or improve our relationship with our near neighbours, the European Union.

But quite a lot of the regulatory systems we have inherited are now beginning to diverge and just not through choice, but just because time is passing. And I very much appreciate the fact that for exporters that poses potential challenges.

Now, without going over the debate from the past, we are where we are, but I am charged by Keir Starmer with working with others to try and negotiate an improved veterinary agreement, and we will be trying to achieve that.

We must also respect the choice of British people made the referendum. It wasn’t my choice but that choice was made, and there are advantages, as we’ve seen, in terms of the fact that we’ve been able to move much more quickly on precision breeding.

These are from Theo Bertram, a former Labour adviser in No 10 under Tony Blair and Gordon Brown, on social media on Kemi Badenoch’s performance at PMQs.

Badenoch is still learning at PMQs. I am sure she will get better. There was one small rookie error and one major strategic blunder.

The small, rookie error: on the third question, she spoke before she stood up so her first words were missed by the mic. Stand first. Slow down.

The strategic mistake: Starmer wants to paint her as opposing the difficult choices to do the popular things. He baited her twice on this & the second time, she took it.

Starmer: if she’s against those things she should say so

Badenoch: I’m not against any of those things

It’s hard to earn credibility in opposition. It’s reasonable for the Tories to take time to figure out how they will balance the books but in the meantime Badenoch needs a better line when challenged on spending commitments & to resist being baited.

The Labour party is also criticising Badenoch for saying she supports all the budget measures, but not the employers’ national insurance contributions (NICs) rise that funds them. The party issued this statement after PMQs from Ellie Reeves, the Labour chair.

Kemi Badenoch is trying to have her cake and eat it. Labour’s budget is fixing the foundations to deliver on the promise of change.

The Tories want all of the benefits of the budget, yet they voted against it and they have no plan to pay for it.

It’s the same old Tories, they haven’t listened, and they’ve learned nothing. It’s time they told the public where they would find the money to pay for more investment in schools and the NHS.

For the record, this is what Keir Starmer asked Badenoch during PMQs.

We produced a budget which does not increase tax on working people, nothing in the payslip, investing in our NHS, investing in our schools, so every child could go as far as their talent will take them, investing in the houses of the future. If she is against those things, she should say so.

And this is Badenoch’s reply.

I’m not against any of those things, of course not, none of us are against any of those things.

Stephen Doughty, a Foreign Office minister, was replying to Nigel Farage about the Chagos Islands. He said that, if the UK had not negotiated an agreement with Mauritius, “a legally binding decision against the UK [on sovereignty] seemed inevitable”. He said:

I fundamentally disagree with what [Farage] has had to say.

Let me be absolutely clear, this government inherited a situation where the long-term secure operation of this crucial military base [Diego Garcia] was under threat

International courts were reaching judgments. International organizations were taking steps not to undermine Mauritian sovereignty, and this threatened the secure and effective operation of the base.

And, in the absence of a negotiated solution, a legally binding decision against the UK seemed inevitable. This would have threatened the secure and effective operation of the base and that was not sustainable.

He also said that he looked forward to working with the incoming Trump administration and that he was confident that, when they were briefed on the details, they would realise it was not a threat to security.

We’re looking very forward to working with [the incoming Trump administration], and I’m sure that they will be being briefed on the full detail of this deal. And I am confident that the details of this arrangement will allay any concerns.

Here are the main lines from Nigel Farage’s UQ speech on the Chagos Islands.

• Farage, the Reform UK leader, said there was “outright hostility” in the incoming Trump administration to the UK’s deal with Mauritius handing over sovereignty of the Chagos Islands. He explained:

And if you say to me, ‘Well, yes, it’s OK, the United States are fully in favour [of the sovereignty deal],’ really?

I can tell you that the incoming national security adviser, Mike Waltz, has form on this, right back to when [James Cleverly, the then foreign secretary] was doing his best to give away the sovereignty of the Chagos islands. Indeed, he wrote to Secretary of State Blinken at the time. [See 11.51am.]

There is, I can assure you, having been in America last week, knowing also the incoming defense secretary [Pete Hegseth] very well, there is outright hostility to this deal.

Whatever is said about a lease agreement, as we saw with Hong Kong, these agreements can very, very easily be broken.

Diego Garcia was described to me by a senior Trump adviser as the most important island on the planet as far as America was concerned.

So you’re going to outright hostility [to the deal from the Trump administration] …

There is no basis for this agreement to continue what it is, and if you do, you will be at conflict with a country without which we would be defenseless.

• He claimed there was “no legal reason” why the UK had to give sovereignty of the Chagos Islands to Mauritius. He said Mauritius did not have a historical claim to the islands, which are 1,300 miles away, and he said the Internationl Court of Justice’s ruling saying Mauritius should have sovereignty was only advisory.

• He said the Chagossian people were also opposed to the deal.

And by the way, when it comes to the Chagossian people, yes, of course, what happened to them was truly awful. They do not wish to live – they’re unanimous in this – they do not wish to live under Mauritian rule. They want to live under British rule because they actually trust us.

That was a good PMQs for Keir Starmer. He easily saw off the rightwing opposition leader – or, rather, both of them.

The hit on Nigel Farage was the neatest, and the funniest. The Reform UK leader, who on the basis of today’s interventions also doubles up as MP for Mar-a-Lago, not MP for Clacton, asked a perfectly reasonable question about proscribing the IRRG, but Starmer shot him down with a joke. (See 12.30pm.) It was slighly hypocritical, given that Starmer is fast approaching the point where an MP at PMQs is going to welcome the fact that he’s making a rare visit to the UK (a gag told about Tony Blair, when his globetrotting went too far). But the putdown was genuinely funny, and so that did not matter.

In the past Starmer has sometimes seemed a bit wary of treating Farage with disdain in the chamber. But maybe he has decided it is safe to hit him hard after all.

Starmer also won quite comfortably against Kemi Badenoch, although that probably was more to do with her performance, rather than his. PMQs is not easy, and the new Tory leader seems a long way off working out how to use it to embarrass or unsettle the PM. Labour MPs were heckling her at one point for using a script, but there is nothing wrong with having questions written down. What is important, though, it to work out how to use a question, to either lure the PM into a response that will open them up to criticism, or to make their refusal to engage look weak and weasly. Badenoch did not really manage this with any of her questions, and so all we were left with was a broad-brush shouting match. Starmer did best because his payoff line was the more persuasive partly, again, because humour was involved. (See 12.14pm.) Other opposition leaders have used wit to great effect at PMQs, but humour doesn’t seem to be one of Badenoch’s strong points.

Otherwise, PMQs was interesting – or depressing – because it provided fresh evidence that this intake of government backbenchers is worse than previous ones when it comes to asking soft, planted questions. Here is my colleague Peter Walker making this point.

Two thoughts on #PMQs. Felt like another win for Starmer. It takes time to get the hang of it & Badenoch still felt a bit unfocused (& slightly patronising). Also, while planting obsequious questions with governing party backbenchers isn’t new, under Labour they are *ubiquitous*.

Kate McCann from Times Radio noticed this too.

One of the worst PMQs sessions I’ve been to in some time. Lots of planted questions, no real answers… MPs also voting with their feet and leaving early. Definitely less packed than in recent weeks.

As an MP, if you had the opportunity to ask the PM a question why would you read out something handed to you by whips? (A planted question). There must be hundreds of issues and awful cases raised by constituents - have always thought it’s such a waste.

In the Commons Stephen Doughty, a Foreign Office minister, is now responding to the urgent question on the Chagos Islands. It was tabled by Nigel Farage, the Reform UK leader, and he said that from his time in the US last week, talking to Donald Trump’s team, he says they regard the deal with Mauritius, giving it sovereignty of the Chagos Islands, with “outright hostility”.

He says Diego Garcia, the main island in the Chagos Island and the home of a UK/US military base, was described to him as “the most important island on the planet” for US security. He claimed the deal would pose a threat to its future.

I will post more from the UQ after my PMQs snap verdict.

Alec Shelbrooke (Con) says the assisted dying bill will be one of the most consequential pieces of legislation considered by MPs. He is worried about the short period of time set aside for the debate. Will the PM commit to giving the Commons two days to debate the bill on the floor of the house at report stage – “16 hours of protected time'” - so the issues can be considered in full.

He says, without that assurance, “people like myself may decline a second reading over fear that we may not get to debate these issues in full”.

Starmer says it will be a free vote. Every MP needs to decide how they will vote. He says he thinks “sufficient time” has been allocated to the bill.

And that is the end of PMQs.

Nigel Farage (Reform UK) says the PM will want to congratulate Donald Trump on his victory last week.

(Starmer did – last week)

Farage goes on. Will the UK proscribe the Islamic Revolutionary Guard Corps, which would mend fences with the Trump administration “given that the whole of his cabinet have been so rude about him over the last few year”.

Starmer starts with a joke.

I’m glad to see the honorable member making a rare appearance back here. He’s spent so much time in America recently I was half expecting to see all the immigration statistics.

He goes on to say Farage has made a serious point about Iran.

Kemi Badenoch says at Cop29 the PM made unilateral commitments that would make life more expensive for everyone. Will the PM confirm that he will keep the cap on council tax?

Starmer says he is proud of the fact that he is restoring leadership on the climate.

And on Monday he announced an order into blades for offshore wind for Hull.

On council tax, he says MPs “will know what the arrangements are”.

Here is the list of MPs down to ask a question at PMQs. Nigel Farage is on the list, so the Commons will be hearing from him twice this afternoon.

Wes Streeting has now delivered his speech to the NHS Providers conference in Liverpool, and it is being described as a potential turning point in his time as health secretary. Here is a verdict from Shaun Lintern, the Sunday Times’ health editor.

Bullish, specific. Streeting is beginning to move from era of “reviews” to actual starting to direct the NHS on what Govt wants

And this is from Dave West from the Health Service Journal.

Wes Streeting at @NHSProviders conference gives a clear message and mission for ICBs and ICB leaders - you are a strategic commissioner and will lead the transformation to neighbourhood care Very good news to have a clear mission

As mentioned earlier, this was a speech that had been very well trailed in advance, both in news releases and in Streeting’s interviews. Here are some new, or newish, lines from what he said.

• Streeting said the NHS was too hierarchical. As the Telegraph reports, he said:

The NHS in 2024 is more hierarchical than almost any other organisation that I can think of. Even our armed forces … are less locked and centralised into command and control.

• Streeting said that he wanted to give local managers more freedom but that he would take back power if they were underperforming.

If performance dips I reserve the right to take those freedoms away and for those judged to be persistently failing, we will act, going from zero consequences for failure to zero tolerance.

• He said that he wanted a culture of honesty in the NHS, and that a culture that that “stifles inconvenient truths … ultimately puts patient safety at risk”.

• He criticised the health thintanks that have complained about the settlement for health in the budget.

• He said the NHS had been living on borrowed time.

The NHS is already living on borrowed time and if a Labour government can’t improve the NHS then it simply won’t survive.

But if we get this right we can look back on our time with pride and say we were the generation that took the NHS from the worst crisis in its history, got it back on its feet and made it fit for the future.

• He said the 10-year plan for the NHS would be published in May.

Wes Streeting has been urged to provide “urgent clarity” on whether the hospice sector who have been hit by the rise in national insurance will receive extra funding.

The health secretary vowed to make an announcement before Christmas on whether the sector will recieve more money, and noted he “recognised the pressures” they were facing.

It comes after the Guardian reported on Sunday the government could offer a financial lifeline to the hospice sector amid fears end-of-life care providers are at risk of closure due to the double blow of the employers’ national insurance rise and higher wage bills.

Officials were said to have been looking at the options for providing more funding to hospices and other end-of-life care through the NHS partly to offset the impact of the national insurance rise, which the sector believes could cost it £30m a year.

Streeting told the BBC Radio 4’s Today:

One of the reasons that I haven’t yet announced the allocation for hospices is I’m looking very carefully at what we can do through the hospice grant to recognise that pressure.

We’ll make an announcement on the hospice grant before Christmas because I recognise that people need to be able to make decisions about the next financial year, but the hospice grant will continue.

Sources in the end of life care sector said they were hopeful after Streeting’s comments but still worried about whether the help extended would cover the whole extent of the national insurance rise and other pressing financial pressures.

Liberal Democrats health spokesperson Helen Morgan said:

We need urgent clarity on what extra funding hospices will receive and whether it will fully cover the cost of the national insurance tax hike.

Many hospices are already on the brink and this tax hike risks pushing them over the edge. The simplest thing would be for the government to listen to hospices and exempt them from this tax rise.

David Blunkett has warned the UK could “end up with Nigel Farage as prime minister” unless the government improves people’s lives in a way that matters to them.

The Labour peer and former cabinet minister said the lesson of Donald Trump’s victory and Joe Biden’s loss in the US was that “tinkering” was not enough and that “small change isn’t enough”.

Blunkett, who served as home secretary, education secretary and work and pensions secretary, said:

We’ve got to start thinking differently. We’ve got to be able to talk with people about the things that matter to them while you’re doing the big macro stuff. It’s not one or the other. You’ve got to do both.

But if you don’t do the little things, you’ll end up with Farage as prime minister. It’s not beyond the bounds of possibility. Reform came second to Labour in 89 seats. Nevermind the ones they were close to in terms of Conservative seats. We’ve got to get real, basically. We’ve got time but not a lot of time to readjust to a different world.

Blunkett told an Institute for Government event yesterday that No 10 and departments had about six months to embark on reforms or the government may “run out of momentum”.

I think they’ve probably got six months. I heard somebody rather stupidly in the spring … from a policy angle brief that Labour’s policies were all ready, they’d all been signed off. It was a load of baloney. They had signed off generalities and macro but not the details of what was going to happen.

Bringing people in very quickly which Wes [Streeting] has been doing, the review of curriculum … those are important early moves that will have to lead to very rapid change because otherwise the government will run out of momentum. It just happens.

Wes Streeting, the health secretary, has said that passing a bill to allow assisted dying would limit the ability of the NHS to provide other services.

In comments that mark a significant escalation of his opposition to the bill, the health secretary told Times Radio this morning:

[Assisted dying] would be a big change. There would be resource implications for doing it. And those choices would come at the expense of other choices.

When it was put to him that, if the assisted dying bill passes, the NHS would have to “find the money from somewhere else”, Streeting replied:

Yep. To govern is to choose. If parliament chooses to go ahead with assisted dying, it is making a choice that this is an area to prioritise for investment. And we’d have to work through those implications.

At a press conference yesterday Kim Leadbeater, the Labour MP promoting the private member’s bill that would allow assisted dying, said she expected only a few hundred people a year to use the legislation if it passes.

In the past Streeting said he was torn over whether or not to support assisted dying, saying that he could see compelling arguments both for and against. But last month he told a meeting of the parliamentary Labour party that he had decided to oppose the bill because he did not believe palliative care services in the NHS were good enough to justify assisted dying being made legal as an alternative.

But arguing that the bill would also impose unreasonable costs on the NHS (a proposition for which there is little or no evidence) shows Streeting is ramping up his attack on the proposals.

MPs are unsure what will happen when the Commons debates the plans, with a free vote, on Friday 29 November. But, given what Streeting has said in public about the plan, it would be awkward for him as health secretary if the legislation were to pass and he may be increasingly keen to kill it off.

In the past Keir Starmer has been in favour of an assisted dying law, with safeguards. But in comments this week he has refused to commit himself to voting in favour of the bill – perhaps because he does not want to be associated with the side that will lose.

The Labour MP Diane Abbott has suggested that Wes Streeting’s attacks on NHS managers are a pretext for further privatisation. She posted these on social media this morning.

Wes Streeting’s cascade of abuse of NHS managers and medics is a pretext for further and faster privatisation.

Just yesterday NHS chiefs told Streeting they have not been given sufficient resources to meet his waiting list targets. They are right - they have not.

Demanding unreachable targets when funds are inadequate will just deepen the crisis in the NHS.

Here is more on the criticism of the hospital league table plan from Adrian Boyle, president of the Royal College of Emergency Medicine. Boyle was interviewed on the Today programme this morning and his arguments were put to Wes Streeting. (See 8.52am.) Boyle raised three objections to the plan.

• Boyle said trying to compare the performance of NHS trusts in league tables was “surprisingly complicated”. He explained:

League tables is an interesting idea. Measuring good and bad performance is actually surprisingly complicated, especially since we’ve merged so many hospitals.

Back in 2001 each individual hospital had its own performance, and that could be publicly reported.

We’re now in a very different situation where lots of hospitals have merged into what we call multi-site trusts, and this makes it really complicated to try and decide who’s performing. So, for example, you might have a trust which runs three emergency departments, one with long waits, one with short waits, one with waits that are in the middle.

• He said league tables could incentivise “short-term target chasing”, leading to less attention being paid to long-term reforms that are needed, such as integrating health and social care.

• He said league tables could demoralise staff and harm recruitment.

There’s good and bad managers right across the NHS. It is good to have some form of accountability, because accountability is something which everybody within the NHS struggles to try and measure. So I think the right to try and do that.

There’s a difference between the intent and the way they do it. And there is a risk that this will demoralise stuff, and you will see that in poorly performing areas, recruitment and retention of staff, and that will go right down to clinical staff, will become even harder.

In an interview with LBC Wes Streeting claimed there were “lots” of poor managers in the NHS. Asked about opposition to his plans, he said”

Look, I know it’s not going to be popular with everyone in the system. I think people would rather sometimes that I got everyone around the campfire to sing Kumbaya and hailed the great religion of the National Health Service and how wonderful it is. But when it’s going through the worst crisis in its history, I think we need to drive serious change.

That does mean more support for leaders, and today I’m not only talking about more freedoms and autonomy for our best performing leaders, but investment in leadership, development and training.

But it does also have to come with accountability. It is not entirely surprising to me that people who represent leaders in the NHS are a bit nervous about that.

But to be honest, I think that there are lots of people in leadership roles in the NHS at all levels, from middle management to senior management, who are … giving the rest of the profession a bad name.

Asked if he was worried that league tables could lead to an Ofsted-type tragedy, Streeting replied:

I’m not interested in humiliating individuals. What I am interested in is performance, managing poor leaders on and out of the NHS. I don’t think that’s an unreasonable thing when the average very senior managers play is £145,000 a year. The level of responsibility they carry is enormous. They’re responsible for a vital public service, and if they’re not up to it in a very professional way, we need to manage people onto another future.

Guardian readers with long memories will notice something familiar about Wes Streeting’s announcement this morning about league tables for hospitals. Here is a story we ran a while back.

And it starts like this:

The government has revealed the performance ratings of every major hospital in England, naming and shaming a dozen trusts as the worst performers in the NHS.

All 170 acute trusts in the country have been ranked on indicators such as waiting times, staff vacancy rates, patient satisfaction and cleanliness, producing the first ever NHS performance league table.

Amol Rajan quoted this on the Today programme this morning. He pointed out that it was from 2001, when Labour was last in power.

Alan Miliburn was health secretary at the time. But he left two years later; Gordon Brown fought his plans for NHS reform aggressively, and the league table plan was dropped. But Miliburn is now back. At the weekend it was announced that he has been appointed as the lead non-executive member on the board of the Department of Health and Social Care. Welcoming the appointment, Wes Streeting, the current health secretary, said:

As secretary of state, Alan made the reforms which helped deliver the shortest waiting times and highest patient satisfaction in the history of the NHS … His unique expertise and experience will be invaluable and he has an outstanding track record of delivering better care for patients.

Good morning. Wes Streeting, the health secretary (for England), is giving his first major speech on NHS reform, and there has been almost as much advance pitch-rolling for what he is going to say as you get for a budget. The Department of Health and Social Care has already press released three stories about what Streeting will say, starting on Monday.

• “Trusts could be banned from using agencies to cover gaps in entry level positions, and agencies could be banned from re-introducing NHS workers that leave permanent jobs,” the DHSC said on Monday, in its first announcement about the reform package.

• Pay arrangements for NHS trust chief executives will be changed so they are linked to performance, with “no more rewards for failure”, Streeting said in another press release about his plans.

• “NHS league tables will be introduced to help tackle the NHS crisis”, the DHSC said last night, in a briefing ahead of the speech today.

Denis Campbell has written this up for the Guardian overnight. As he reports, the plan for a league table of best and worst-performing hospitals has already provoked a backlash from NHS leaders.

Streeting has been doing an interview round this morning and he has been defending his plans. On the Today programme he was asked about Adrian Boyle, President of the Royal College of Emergency Medicine, who told the programme in an early interview that league tables could “demoralise staff”. Asked to respond to these comments, Streeting replied:

There’s nothing more demoralising than going to work, busting a gut for your patients, and knowing that despite your best efforts you’re letting them down because you’re not given the tools to do the job, and you’re working in a context where … you’ve got poor leadership.

On urgent and emergency care, for example, there is a wide variation across NHS performance, ranging from 83% of people in one trust being seen within four hours in type 1 A&Es right down to 38.2%. That’s over 44 percentage points difference.

And what we need to understand, in those poorest performing areas, is that because of wider contextual challenges, wider system challenges? And if so, let’s provide the national support in to fix those fundamental problems in the system, so we don’t keep on in that doom loop of underperformance.

But where we have poorly performing senior managers, I’ll make no apology for managing those people out. Because people know – and this is the guilty secret of the NHS – there are very senior managers, who are paid on average £145,000 pounds a year, who are managed out, given a payoff in one trust and then reincarnate in another NHS trust.

And those might be the rotten apples – and I want to recognise that there are some outstanding leaders right across the NHS – but those rotten apples are unacceptable and give the rest of the profession a bad name, so we’ve got to manage those out.

I will post more from Streeting’s interview round soon.

Here is the agenda for the day.

9.15am: Louise Haigh, the transport secretary, gives evidence to the Commons transport committee about the work of her department.

9.30am: Liz Kendall, the work and pensions secretary, gives evidence to the Commons transport committee about the work of her department.

10.25am: Wes Streeting, the health secretary, gives a speech to the NHS Providers conference in Liverpool.

Noon: Keir Starmer faces Kemi Badenoch at PMQs.

If you want to contact me, please post a message below the line or message me on social media. I can’t read all the messages BTL, but if you put “Andrew” in a message aimed at me, I am more likely to see it because I search for posts containing that word.

If you want to flag something up urgently, it is best to use social media. I’m still using X and I’ll see something addressed to @AndrewSparrow very quickly. I’m also trying Bluesky (@andrewsparrowgdn) and Threads (@andrewsparrowtheguardian).

I find it very helpful when readers point out mistakes, even minor typos. No error is too small to correct. And I find your questions very interesting too. I can’t promise to reply to them all, but I will try to reply to as many as I can, either BTL or sometimes in the blog.