Just over a year after Keir Starmer entered Downing Street, his political survival already looks uncertain. Perennially indecisive, unpopular with the public and unable to pass major legislation without rebellions, the prime minister has reportedly been put “on notice” by senior figures within his party. Speculation about a potential successor is mounting.

What would Labour’s dominant faction – the neo-Blairite right – look for in a candidate? Their best bet would be an effective operator who doesn’t carry too much political baggage, a decent communicator, free of Starmer’s stumbling reticence, and a committed partisan of their cause: namely the free market and a strong state. They need someone who will go on the offensive for these values, rather than offering the bland apologetics that we have seen from the incumbent.

Few fit the bill better than the health secretary, Wes Streeting, who has made no secret of his ambition to lead the country and appears to have spent years laying the groundwork with media rounds, donor events and backroom conversations. When Starmer’s leadership of the Labour party was on the brink during the Beergate scandal, Peter Mandelson is said to have canvassed the Labour frontbench to anoint Streeting. “In the longer term,” briefed one party source, “Wes is their guy, not Keir.”

Born into a working-class east London family in 1983, Streeting has been fairly consistent in both his political style and outlook since he was in his early 20s. A pugnacious advocate of private enterprise, and an effective behind-the-scenes operator, his deft handling of the press allows him to stride into the limelight at crucial moments, with memorable one-liners that seem crafted to enrage his opponents. As president of the National Union of Students (NUS) in the twilight of the New Labour era, he inveighed against lecturers’ strikes, remarking that “students need industrial action by university staff like a hole in the head”. He also broke with dominant student opinion by supporting tuition fees and criticising Palestine solidarity protests.

From the NUS it was only a small step to parliament, where Streeting landed in 2015. The words “future leader” were immediately “appended to his name like a Homeric epithet”, according to one insider account. He vigorously opposed the leadership of Jeremy Corbyn, repeatedly excoriating him in parliamentary meetings and working with the People’s Vote campaign to chip away at his resistance to a second Brexit referendum. This earned him a place in Starmer’s shadow cabinet once the right had regained control five years later. There, he made no bones about accepting hundreds of thousands of pounds from donors linked to the private healthcare industry. He insisted that the party needed to get tough on “law and order” along with “defence and national security”; and he signalled a clear shift from the foreign policy of the Corbyn era by visiting Israel and meeting with ministers in its government.

Now that Streeting is at the helm of the NHS, we are beginning to see how his hypothetical prime ministership might play out. Shortly after the last general election, he sketched out his vision for the health service in the pages of the Sun, writing that “major surgery” was needed to make it “fit for the future”: moving treatment out of hospitals, so as to focus on local care and prevention. This could not be achieved through public spending, Streeting warned, because “the money isn’t there”. It could only be done through hard-knuckled “reform”.

True to his word, Streeting has helped to normalise the state of perma-austerity at the health department, which will receive only an extra 2.8% annually in real terms over the coming years: less than the long-term historical norm of 3.7%, and far below the average increase of 6.8% under New Labour. This is nowhere near enough to solve the perpetual crisis in the sector, let alone make any real improvements in the quality of care.

Without meaningful investment, the levers that Streeting can pull to realise his goals are limited. There is reorganisation through measures such as the summary abolition of NHS England and mass job cuts. There is techno-optimism, allowing AI companies such as Palantir to run parts of the ailing service. And, most importantly, there is privatisation.

Streeting has been working hard to ensure that “more treatments can be delivered through the independent sector”, as an official briefing put it. Under his watch, an even greater portion of the NHS – including, potentially, sensitive patient data – is being handed over to profit-making companies. His plan to set up 300 “neighbourhood health hubs” is powered by corporate finance, in what is shaping up to be a frame-by-frame replay of the disastrous PFI initiatives of the 2000s. Research shows that the effect of these policies is to worsen health inequality. But this does not seem to concern the minister.

Bullish as ever, Streeting has said he is “up for the fight” that his plan will provoke. And that is what he now has. In recent weeks, resident doctors rejected his notion that “reform” alone will magically resolve the service’s deep-rooted problems of under-resourcing and understaffing. They refused to accept a pay deal that would amount to a 21% reduction in their salaries since 2008, and instead made a principled case for wage restoration. Streeting was intransigent. During the resulting five-day strike he launched a series of broadsides against the workers, insisting that they must feel the “pain” of the walkouts and vowing that they would “lose a war with this government”. Much like his “bullet in the head” rhetoric, the remarks showed that Streeting’s main interest is in positioning himself as a crusader on behalf of the establishment rather than fixing the service he oversees. He is also keenly aware of the populist appeal of his rhetoric at a time when support for the doctors’ struggle is in decline.

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The other front on which Streeting has been fighting is the culture war. He has imposed a permanent ban on puberty blockers for trans children – despite a wealth of dissenting expert opinion including that of the British Medical Association, which disputes the scientific basis of the prohibition – and he has also barred those under 18 from changing gender markers on their NHS records, potentially making it more difficult for them to access vital services.

The irony, of course, is that while Streeting styles himself as the man to beat Nigel Farage, his politics is one of deference to big business, clampdowns on trans rights and incendiary rhetoric to provoke the left. These features are more typically associated with reactionary populism than with social democracy. Streeting’s ascent reflects the fact that, in today’s Labour party, the former is cannibalising the latter.

Oliver Eagleton is an associate editor at the New Left Review and author of The Starmer Project: A Journey to the Right