‘Glaziers and Window Breakers: Former health secretaries in their own words‘ is a report by the Health Foundation, published in October 2020, in which former Secretaries of State for Health reflect on how their roles oscillated between being ‘window breakers’ – driven to disrupt and reform – and ‘glaziers,’ who mend, steady and consolidate once change is underway. Through interviews with eleven ministers, the book explores the perennial tension between ministerial politics and operational management within the NHS.
Providing insights into the tensions between the NHS and the UK Government, it is a fascinating read to help us understand how policy and delivery of UK healthcare is impacted – and can be shaped to improve the health outcomes for communities across the UK. There are interesting insights to be learned whether your focus is primary healthcare, community healthcare, or anything from local mental health support services to local physical health and disability support services.
About Glaziers and window breakers
Glaziers and window breakers begins with historical and analytical perspectives, tracing the evolution of the health secretary’s role from the heavily managed NHS of the mid‑20th century to a more devolved, market-influenced system. While there is broad agreement among interviewees that day‑to‑day operations should largely be entrusted to NHS professionals, they acknowledge that political pressures and public expectations inevitably draw ministers into the operational fray.
Crucially, the timing of intervention matters. Ministers emphasise the need to ‘buy time’ at the outset of their tenure and to think strategically/build understanding before taking significant action. Alan Milburn suggests publishing a ten‑year plan; Alan Johnson advises holding off speeches for at least a month, to gain a clearer picture; Frank Dobson reminds successors that thoughtful reflection remains invaluable.
Drawing on vivid testimony – from Virginia Bottomley’s metaphor of needing both healers and breakers of glass, to Ken Clarke’s reflection on the immense scale and complexity of NHS management – the report presents a mosaic of perspectives. In turbulent times such as financial crises, pandemic threats, and scandals like Mid Staffordshire – secretaries have repeatedly swung between reform and stewardship, using their powers more assertively in times of crisis.
Glaziers and Window Breakers offers a compelling, insider’s chronicle of the enduring dilemma facing health secretaries: how to steward an £140 billion public service thoughtfully. There are lessons about knowing when to intervene, and when to stand aside and let the system work; lessons that are transferable to anyone working in a leadership role within the charity sector. The real value of the book lies in the unfiltered recollections of those who’ve held the office: from the pragmatic wisdom of caution and calm, to the decisive urgency that only window-smashing sometimes offers.
Lessons from Glaziers and Window Breakers
he Health Foundation’s Glaziers and Window Breakers offers a set of considered, often hard-won insights for future Secretaries of State for Health—drawn directly from those who have occupied the post. Though political circumstances shift and the NHS evolves, several recurring themes emerge as enduring advice.
Take time to understand before acting.
Almost all contributors stress the importance of resisting the impulse to rush in. The first weeks in office should be used to observe, listen and build relationships—not to announce grand reforms. Alan Johnson, for instance, warns against giving a major speech in the first month. Frank Dobson suggests that wise ministers “don’t do very much at all to begin with.” The clear message is: patience isn’t weakness—it’s strategic discipline.
Balance reform with realism.
The metaphor of glaziers and window breakers is more than poetic and reflects the real duality of the role. Change is necessary, but so is consolidation. Good secretaries must know which windows need breaking, and which are best left intact or carefully repaired. Political legacy is seductive, but maintaining continuity where it matters most often benefits patients more than radical overhauls.
Respect the operational distance of the NHS.
Several former secretaries warn of the temptation to micromanage or intervene too often in the daily running of the health service. Political instincts tend to pull ministers toward the action, but they argue that successful leadership lies in supporting the system, not controlling it. Hewitt, Burnham and Hunt all stress the importance of trusting NHS professionals, and of creating space for long-term planning rather than short-term firefighting.
Build strong relationships—especially with the Treasury.
The ability to influence outcomes often hinges less on vision than on relationships. Ministers repeatedly mention the importance of working closely with the Chancellor and civil service colleagues. Without a shared financial and strategic understanding, ambitions will be throttled by bureaucracy or budgetary constraint.
Communicate carefully and publicly show confidence.
Words matter. Ministers need to reassure a weary public and an often beleaguered workforce. The language of crisis may be honest, but overuse damages morale. The public-facing nature of the role requires a steady, visible presence—not least when the NHS is under pressure. Calmness and credibility can often achieve more than policy.
Accept the limits of the role.
Despite its seniority, the Secretary of State for Health is not all-powerful. The NHS is vast, culturally diverse, and only partially within the minister’s grasp. As Ken Clarke puts it, the health secretary must be a ‘minister for health and illness and everything else in between’, but not everything can or should be changed by one individual. Recognising the role’s constraints is a mark of maturity, not timidity.
Leave the system better than you found it.
Amid the politics, the media briefings and the budget negotiations, a quiet ethical thread runs through the interviews: the desire to leave behind something of value. Whether it’s a long-term workforce plan, a more integrated care model, or simply a healthier culture of leadership, the most effective secretaries seem guided by legacy—not headlines.
The key takeaway from Glaziers and window breakers
The advice is subtle but resolute: observe first, act thoughtfully, and resist the political theatre of constant reform. Understand the machinery before you try to rewire it. And always, always remember that this isn’t about you. It’s about the millions whose lives depend on the NHS being steady, responsive, and humane.
Read the full report here.