When Andy Burnham's team let it be known, in the fortnight before his coronation as Prime Minister, that Andy Haldane, Lord Jim O'Neill and Richard Hughes had all lent their counsel, the effect on the bond market was immediate and calming. Gilt yields, which had been drifting upward on fears of a more expansionist and interventionist premiership, settled. Investors took the presence of three of Britain's most credible economic minds as a signal that whatever Burnham's instincts on public ownership and the bond market, someone with real fiscal discipline would be in the room. A month into government, none of the three has taken up a formal role. What City figures were sold as ballast has turned out to be decoration.

This matters well beyond the Square Mile, and it matters specifically to a health service that is about to find out what kind of Chancellor John Healey intends to be. Healey delivers his first Budget on 28 October, and he does so at a moment when the National Institute of Economic and Social Research has already warned of a shortfall in the tens of billions across public services, driven by inflation eating into spending plans that were fixed in cash terms. Hospitals and schools were named specifically. For an NHS still absorbing the consequences of the last funding settlement, still working through the implications of Yvette Cooper's arrival as Health Secretary after two changes of leadership within a year, the question of who is actually shaping fiscal policy in Downing Street is not academic. It determines whether October's Budget treats health spending as a protected priority or as one claim among many on a Treasury with, by most independent accounts, almost no room left to borrow.

What Burnham has assembled instead of a recognisable economic operation is a "National Economic Council" made up of mayors and ministers rather than economists, and a scattering of generalist advisers whose expertise lies in party management rather than public finance. Some of that team is inherited and genuinely capable. Torsten Bell and Dan Tomlinson bring Resolution Foundation rigour to the pensions and growth briefs. Varun Chandra retains business relationships built over years. But the pattern that emerges from the departures, particularly the unresolved status of Minouche Shafik as chief economic adviser and the lapsing of the economists who served the previous Chancellor, is of a government more comfortable with political operators than with people willing to tell it things it does not want to hear.

For health leaders watching from NHS England's dwindling remnants or from newly consolidated integrated care boards, that distinction has practical consequences. A Chancellor advised chiefly by figures skilled at reading the parliamentary party is one more likely to prioritise measures with immediate political payoff, the freezing of business rates, headline energy tax changes, over the less glamorous work of protecting real-terms NHS capital budgets against inflation. Burnham has been explicit that he wants to run a "cost of living government" and to be more hands-on with the Treasury than Keir Starmer ever was. That instinct may serve patients well if it means genuine pressure to protect frontline funding. It may equally mean health spending decisions made through the lens of what plays well in the next by-election rather than what a multi-year capital programme or a stretched workforce actually requires.

James Murray's own trajectory, from chief secretary to the Treasury, to a brief stint as Health Secretary, and back to the Treasury as financial secretary, is a small but useful illustration of how few people in this government move comfortably between fiscal discipline and health policy. Healey has said his Budget will be built on fiscal rules and will meet them. NHS leaders have no reason to doubt his intent. They have every reason to ask who, precisely, is doing the sums behind him, and whether the answer offers any more certainty than a handful of names that turned out not to matter.