I found myself at a ministerial press event this week with about 48 hours’ notice. I assume I’m on some kind of 'expert-adjacent, available at short notice' list. For once, I had a gap and thought — why not?

As ever with these things, the details arrived late. I suspect for security, though it always feels faintly cloak-and-dagger. I was informed it would cover the 'Government’s role in modernising the NHS, highlighting key achievements to date and setting out plans to accelerate progress in making the NHS fit for the future'. So naturally I was curious.

The venue, to my delight, turned out to be the University of East London in Stratford — conveniently close to Westfield and a very respectable M&S. Small wins.

When health secretary Wes Streeting walks into a room, it feels like there should be smoke, lighting, and a soundtrack. Depending on your political persuasion, that’s either something imperial and ominous or something grand and orchestral. Either way, he has presence.

He walked in carrying a large red embossed book — the kind that looks important simply by existing — and didn’t open it once. He didn’t need to.

He opened with twenty minutes on what Labour has done for the NHS. There is always a slight cognitive dissonance in these moments — the gap between the narrative you’re hearing and the system you’re working in — but I nodded along and followed him down the rabbit hole.

To be fair, he is a very good speaker. No notes, no reliance on the prop in front of him, just clear, confident delivery. It’s almost soothing. It reminded me of being read to as a child — calm, assured, slightly hypnotic.

And that’s the thing. It’s so easy to be carried along that you almost miss the sleight of hand. We are told we will empower neighbourhoods. Care closer to home. Integration. Prevention. But not the funding. Not the mechanisms. Not the ability to take risk. And certainly not the permission to fail safely while learning.

At the same time, the system must hit its four-hour targets, deliver referral to treatment (RTT) recovery, control spending, and avoid any clinical misstep.

Somewhere between all of that, I began to feel like I was sitting in a live-action version of Alice in Wonderland — a world where everything sounds coherent until you try to make it real.

Then came questions. This, I thought, is where it gets interesting. It didn’t.

Questions from the media focused on meningitis, social care headlines, and staff satisfaction — less about solving problems and more about scoring points. Watching it, you realise the political class is only as effective as the questions it is asked. If no one asks how the system actually works, no one has to answer.

Meanwhile, those of us in the room — the people expected to deliver all of this — sat quietly, waiting for the conversation we actually needed.

It came, briefly, in the final minutes. Why can’t nurses and midwives get jobs in a system that clearly needs them? How are we supposed to innovate when there is no meaningful financial framework to support it? These are not abstract questions. They are operational reality.

I had half a mind to stand up and ask the obvious one: if neighbourhood health is the future, why are we still designing a system that makes it almost impossible to deliver?

Instead, we were told that Greater Manchester Mayor Andy Burnham might have the answer — he’s getting a sort of deputy Mayor in charge of health because the politicisation of healthcare has always gone so well I can’t imagine why there would be any concerns about this course of action.

Immediately afterwards, I found myself in a local meeting on Integrated Neighbourhood Teams for children and young people.

And there I was — explaining how it could work. Talking about primary care as the golden thread. About sharing risk. About aligning incentives so the right clinical decision is also the right financial one.

I realised, mid-sentence, how absurd that was. Not because the ideas are wrong — but because they are not widely understood.

I only know this because I have spent years in the weeds: conferences, strategy groups, building models, testing ideas. The teams now being asked to deliver this are being handed the vaguest of instructions and told to 'get on with it'.

That is not empowerment. That is abdication.

So here’s a thought.

If neighbourhood health is genuinely the future, then we need to stop talking about it as an aspiration and start explaining how it actually works — in operational, financial, real-world terms.

And to those asking the questions: Next time, ask the right ones.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.