The aspiration for a ‘mission driven' approach is important, but it is far from clear the Government is sufficiently enthusiastic especially when it comes to health. Rather than waiting for change from Whitehall, it's up to those outside – notably in the NHS and local government – to show how better joining up can and should make a difference.  

I am not a young man, but I have never felt as disoriented and worried about the world as I do now. 

A senior member of the US administration, Elon Musk, has issued threats to members of the UK Government. Newly inaugurated US President Donald Trump has abandoned the Paris Climate Accord, promised to leave the World Health Organisation and banned diversity initiatives. 

When it comes to the public vilification of minorities and migrants, there seems to be a new and dangerous normal. Reflecting a tendency that started with Brexit, parts of the mainstream right of centre media flirt with conspiracy theories and calls for insurrection. Growing market scepticism about public finances here and elsewhere has driven up borrowing rates and could force our already unpopular Government into further tax rises or spending cuts. 

The public sector is fraying at every edge and in the health service we are battling through a very tough winter reflected in daily media stories of patient harm and staff despair.  

Given my past political affiliations, it's not surprising that I would want our Government to succeed. But this runs deeper. The UK is a lonely beacon of centrism in a world shifting sharply to the authoritarian right. If Starmer fails, Britain could go the same way. 

The challenges facing this country, including the NHS, are unlikely to be met by the old ways of running Government. This was one of the insights that lay behind Labour's commitment to its five missions and the methodology behind them. 

Yet, almost as soon as the election passed, it became clear that views in Government about the usefulness of missions are mixed, enthusiasm thinly spread and with little account of how to go about doing things differently. 

Health policy reflects this mixed picture. The health mission board is largely focused on prevention, but while there has been progress in areas like tobacco and junk food advertising there is little sign of more comprehensive and braver commitment to tackle harms ranging from gambling to child poverty. 

The DWP and DHSC have worked with the Treasury to develop policy and release some modest funding focused on reducing health based economic inactivity. This is welcome and the NHS Confederation is working with ICSs to enable systems to be effective partners across organisational divides. But the scope for more strategic local action on work, health and skills is 

hampered by multiple small pots of money and tangled upward reporting lines. 

In many other areas, including other parts of the health service, homelessness and mental health in schools, there is obvious scope for joining up to produce better outcomes and use investment more wisely but little sign of a new approach. 

Mission government should involve three things. 

First, clear national priorities which drive policy across Whitehall. For example, the vital goal of improving healthy life expectancy should be recognised and acted on across all service departments not just the DHSC. Second, new forms of accountability and measurement that underpin and enable joining up. This would, for example, make it easier to win the case for investment in one department even if the benefits are felt some time later in another. Third, the processes around mission working should enable greater agility, so that when department-spanning problems occur teams of ministers and officials can move swiftly into task and finish mode. 

For some time, the NHS Confederation has sought to reach out across Whitehall. When we do, we often find ministers and officials beyond DHSC keen to engage with health leaders but unsure of how to go about it. We have spent over a year pushing for the implementation of Dame Patricia Hewitt's recommendation to establish an ICS Forum through which system leaders can engage across Whitehall. 

There are at last signs of progress on the Forum but, it has at times felt like a lonely struggle. A joined-up mission approach is critical to the success of Keir Starmer's Government and to building an NHS fit for the 21st century and beyond. If the idea falls away, we outside Government will be as culpable as those sitting around the Cabinet table.