It has become a given in Westminster circles that Keir Starmer’s tenure as prime minister could be nearing its end. This is because, fairly or unfairly, the UK public have made up their minds – and they do not like him.

Labour MPs know this all too well, having seen the level of animosity on the doorstep during recent election campaigns in England, Wales and Scotland. They just didn’t immediately know what to do about it. But then Wes Streeting quit as health secretary, criticising Starmer in his resignation letter for what he said was a “vacuum” where political vision was required.

Recent UK history is full of precedents when prime ministers found their position untenable. For the Conservatives, Theresa May, Boris Johnson and Liz Truss were all removed eventually. But such a course of action comes with costs: to party unity, to market sentiment, and in terms of how the voters view political shenanigans.

This is why, until now, the more thoughtful voices in the Labour party either kept their counsel or argued for caution. But a significant number of Labour MPs believe that a change at the top is now inevitable.

Streeting, Rayner or Burnham

From the right of the party, Streeting, the combative former health secretary, is the key figure to challenge Starmer. But he still requires the backing of at least 81 fellow Labour MPs.

A Streeting bid for the leadership would be supported by much of the media, but what many regard as his lukewarm re-tread of old Blairite orthodoxies would limit his appeal with the party membership. And members play a significant role in leadership contests.

By contrast, a likely candidate of the so-called “soft left”, former deputy prime minister Angela Rayner, has now cleared up her tax affairs and is more popular with the party rank-and-file. But she would alienate much of the London commentariat.

What neither Streeting nor Rayner possess is genuine cut-through with the wider British public. And this is where the current mayor of Greater Manchester, Andy Burnham, comes in. Burnham does not have a parliamentary seat and, although he intends to contest the Makerfield constituency made vacant by Josh Simons’ decision to step aside, it is not guaranteed that he will win. Given Labour’s current unpopularity, the party cannot assume it would win a by-election anywhere.

And even if Burnham did scale that hurdle, there is a real danger that his replacement as the Labour candidate for the mayoralty would lose to Reform UK. This would allow party opponents to portray Burnham’s move as an indulgence at the expense of the party.

Nevertheless, if the political stars were to align and Burnham navigates his passage back to Westminster in time for a leadership challenge, he would be a formidable opponent. Burnham not only outpolls his main rivals among Labour members, he also enjoys rare net approval ratings with the public (+6, compared with -12 for Rayner and -20 for Streeting). Labour MPs will be paying particular attention to those numbers.

There is strong reason to believe that Rayner will have a crucial role in how this plays out. This could either be by standing for leader herself or through working with Burnham. Either way, she is in an incredibly influential position.

And what would Labour and the country look like under new leadership? The revolving door at the top partly reflects the extent of the challenges (economic, political, cultural) that the country faces. Voters have not seen rises in their real living standards for two decades, are truly angry and deeply polarised.

The UK is divided on how to go forward, and so is the Labour Party. That is why potential challengers to Starmer really should be careful what they wish for. Much of the political instability of recent years is down to the collective obsession with politics as a short-term and personality-based kind of show business.

But this ignores the more worrying long-term developments in financial markets that indicate that there is no faith in the UK’s ability to tackle its structural problems any time soon. The eventual winner of Labour’s leadership drama may inherit the throne just as money markets’ patience with the UK runs out.

Charles Lees does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

It has become a given in Westminster circles that Keir Starmer’s tenure as prime minister could be nearing its end. This is because, fairly or unfairly, the UK public have made up their minds – and they do not like him.

Labour MPs know this all too well, having seen the level of animosity on the doorstep during recent election campaigns in England, Wales and Scotland. They just didn’t immediately know what to do about it. But then Wes Streeting quit as health secretary, criticising Starmer in his resignation letter for what he said was a “vacuum” where political vision was required.

Recent UK history is full of precedents when prime ministers found their position untenable. For the Conservatives, Theresa May, Boris Johnson and Liz Truss were all removed eventually. But such a course of action comes with costs: to party unity, to market sentiment, and in terms of how the voters view political shenanigans.

This is why, until now, the more thoughtful voices in the Labour party either kept their counsel or argued for caution. But a significant number of Labour MPs believe that a change at the top is now inevitable.

Streeting, Rayner or Burnham

From the right of the party, Streeting, the combative former health secretary, is the key figure to challenge Starmer. But he still requires the backing of at least 81 fellow Labour MPs.

A Streeting bid for the leadership would be supported by much of the media, but what many regard as his lukewarm re-tread of old Blairite orthodoxies would limit his appeal with the party membership. And members play a significant role in leadership contests.

By contrast, a likely candidate of the so-called “soft left”, former deputy prime minister Angela Rayner, has now cleared up her tax affairs and is more popular with the party rank-and-file. But she would alienate much of the London commentariat.

What neither Streeting nor Rayner possess is genuine cut-through with the wider British public. And this is where the current mayor of Greater Manchester, Andy Burnham, comes in. Burnham does not have a parliamentary seat and, although he intends to contest the Makerfield constituency made vacant by Josh Simons’ decision to step aside, it is not guaranteed that he will win. Given Labour’s current unpopularity, the party cannot assume it would win a by-election anywhere.

And even if Burnham did scale that hurdle, there is a real danger that his replacement as the Labour candidate for the mayoralty would lose to Reform UK. This would allow party opponents to portray Burnham’s move as an indulgence at the expense of the party.

Nevertheless, if the political stars were to align and Burnham navigates his passage back to Westminster in time for a leadership challenge, he would be a formidable opponent. Burnham not only outpolls his main rivals among Labour members, he also enjoys rare net approval ratings with the public (+6, compared with -12 for Rayner and -20 for Streeting). Labour MPs will be paying particular attention to those numbers.

There is strong reason to believe that Rayner will have a crucial role in how this plays out. This could either be by standing for leader herself or through working with Burnham. Either way, she is in an incredibly influential position.

And what would Labour and the country look like under new leadership? The revolving door at the top partly reflects the extent of the challenges (economic, political, cultural) that the country faces. Voters have not seen rises in their real living standards for two decades, are truly angry and deeply polarised.

The UK is divided on how to go forward, and so is the Labour Party. That is why potential challengers to Starmer really should be careful what they wish for. Much of the political instability of recent years is down to the collective obsession with politics as a short-term and personality-based kind of show business.

But this ignores the more worrying long-term developments in financial markets that indicate that there is no faith in the UK’s ability to tackle its structural problems any time soon. The eventual winner of Labour’s leadership drama may inherit the throne just as money markets’ patience with the UK runs out.

Charles Lees does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

This year’s budget allocation for health echoes most past budgets. It implies there is significant investment and earmarks some specific areas that will receive additional support. But in reality, this is a cutback budget signalling continued austerity.

The government is right that health receives the largest share of investment among categories, some NZ$34.2 billion, up from $31 billion in 2025. This represents an increase of about 10% and makes a good sales pitch.

Yet much of this expenditure, as always, is spread over several years. This means the compound annual growth rate of budget funding for health through to 2029–30 is 3.49% per year, basically matching the inflation rate.

In healthcare, the inflation rate tends to exceed what is happening in the general economy. As noted in the budget document itself, the funding will simply “maintain current health settings”.

This is not good enough. New Zealand’s health system is in dire need of help and already comparatively underfunded.

The argument that health is a backbone of a strong economy and good society is supported by multiple studies.

In this context, building a highly productive, high-quality and accessible health system is fundamental. But this requires significant investment as well as long-term planning.

In an adversarial political system such as New Zealand, focused largely on the short term, it also requires politicians to work across party lines in the best interest of the public – for the current population needing to access high-quality services regardless of income or ability to pay as well as for future generations.

Health requires a growth mindset

Health is unlike any other area of public service in that it requires strong government intervention and support for public services to deliver for people. It requires a development and growth mindset as well as understanding that underinvestment is a losing strategy.

Budget allocations could have been made in key areas, and the health workforce should have been front and centre.

Staff shortages, along with the general working environment, are increasingly challenging in the public hospital system. This includes facilities and a generally negative ethos, driven by successive governments failing to grasp the fundamental need for long-range workforce planning.

Unmet need for specialist assessments in the public hospital system is worsening, highlighted again recently. The budget makes no mention of how maintaining current settings would do anything other than worsen the workforce and service access crises.

Primary care is another area requiring investment and attention. Growing unmet need places mounting pressure on already busy general practitioners (GPs).

For patients referred back to their GP, unable to access a public hospital specialist, this is stressful and unproductive. Improving the ability of GPs to manage unmet need – including through covering patient fees – would have been an important signal.

The budget allocates $80 million for the building of a third medical school, but this will not help, at least not until 2035.

New investments

Some of the earmarked “new spending” initiatives are important and should add value.

Digital and cyber security gets $152 million over five years ($35 million to $39 million per year). This is a small investment in an area where New Zealand once led the world. The recent high-profile data breaches have been an indictment on lazy government policy and poor private provider attention to security basics.

Investments in ambulance services ($35 million over five years), paediatric palliative care (a new site in the South Island in addition to the existing Auckland Starship hospital; $15.5 million over five years) and the national bowel screening program ($12.4 million over five years) to lower eligibility from 58 to 56 years are all important and welcome.

There are also investments in hospitals including additions to Whangārei Hospital and some additional funding for the new Dunedin Hospital construction.

In an election year, a bold government could have laid down a pathway for long-term planning. It could have stated an intention to build genuine all-party consensus on healthcare and acknowledge that an adversarial system is not serving people.

It is also important to consider the cost of ongoing health sector reform. The previous government initiated reforms in 2022 but the coalition government disestablished new agencies (such as the Māori Health Authority) and repealed new policies and laws (such as legislation that would have created a smoke-free generation). The cost of these repeated reforms, as well as ongoing structural changes, is likely to be in the hundreds of millions.

The public deserves better. Rather than restructuring, this money should have been invested by all politicians in services and future generations.

The government could also have announced a commission to review healthcare funding as New Zealand’s public health system is weakening, with increasing provision by the private sector. In summary, budget 2026 is a short-term plan for continued austerity for the health sector.

Robin Gauld has received funding from the NZ Health Research Council, NZ Ministry of Health, Health Quality and Safety Commission and General Practice NZ.