| Even in the UK the appointment to the US government of Elon Musk, the world's richest man, is a popcorn moment amongst the already eyeball-popping appointments rolling out of Donald Trump's transition team. Every single one of the spluttering "But how is it going to work?" questions you may have is brilliantly answered in this Bloomberg Businessweek long read from our resident Musk experts. For me, the essence of it is the tactic he deploys in the running of all his firms, as detailed in the must-read biography of him by Walter Isaacson. Musk calls engineers into his office at anti-social moments of the day or night and asks if they know the cost of a bit of kit; then he asks if they know how much it would cost to buy the raw materials for said piece of kit. The price differential is what he calls the Idiot Index. Well, the Idiot Index is now coming to the US government. Could the Idiot Index come to the UK? Today one of this government's most reform-minded and impressive figures, Health Secretary Wes Streeting, is having a go — in his own way. Unveiling new "tough love" measures, he says the government will: publish a "football-style" league table of best and worst performing hospitals in England based on A&E waiting times, sack persistently failing managers, and send "turnaround teams" into failing NHS trusts. He might not quite yet be asking NHS managers if they know the price of a rocket widget – but it's the same pursuit of productivity.  Wes Streeting pictured last month Photographer: Hollie Adams/Bloomberg And it is needed. Both Musk and Streeting are trying to solve the same problem: public sector productivity, which has stalled for the last two decades. When I was in government during the pandemic, I suggested a league table approach to boost vaccine uptake in NHS trusts, thinking it might focus minds and create healthy competition. It triggered lots of eye rolls and tut-tutting from the officials in the room and was dead within seconds. You can see the same attitude on display today in the criticism of the health secretary's suggested regime, but at least he is protected by being a Labour politician. Had a Conservative suggested it, there would have been endless accusations that they wanted to privatize the NHS. The problem, even for Streeting, will be that the public instinctively trusts doctors and nurses more than politicians. But at least he is trying. In the budget a fortnight ago the NHS was one of the main beneficiaries of an increase in expenditure. But no-one expects this injection of cash to lead to real improvements in the NHS patient experience. Plus, the funding runs out in two years, meaning the health service will likely need to come back to the Treasury asking for more. In short, Streeting needs to start to get more for his money. For all the sound and fury around Musk's conflicts of interest, the collapse in X's value, his pronouncements on the UK, child-rearing and the rest – let alone his alleged dialogue with Putin — Streeting may be watching the work of DOGE pretty closely. Want this in your inbox each weekday? You can sign up here. | 
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