Over the next two years, the prime minister is to abolish NHS England and bring the NHS back under the control of the government.
Prime minister Keir Starmer has announced plans to abolish NHS England and bring the health service back under the direct control of government and back into the Department of Health and Social Care (DHSC) over the next two years.
“I can’t in all honesty explain to British people why we should spend their money on two layers of bureaucracy,” he said in a speech in Hull. “That money could and should be spent on nurses, doctors, operations and GP appointments.”
Starmer’s move is a desire to move the management of the NHS away from NHS England – what he dubbed an “arms-length body” – back into “democratic control”.
“The biggest reshaping of its national architecture in a decade.”
More pithily, health secretary Wes Streeting told the House of Commons that the government was now “abolishing the biggest quango in the world”.
As chief executive of NHS England, James Mackey will lead the transformation team alongside Penny Dash as the incoming chair.
The move is the final nail in the coffin for NHS reforms under the Conservative-Liberal Democrat coalition which followed the 2010 general election. In 2013, then Conservative health minister Andrew Lansley established NHS England to give the health service greater independence and autonomy. It was a deliberate attempt to allow it to operate at arm’s length from the government.
Not mourned
The government announcement is, so far, short on detail other than Streeting’s claim that the plans would deliver “hundreds of millions of pounds in savings” by stripping out the duplication between the two organisations and bringing many of NHS England’s functions into the DHSC.
Few within the sector mourn the demise of NHS England. “It has been increasingly clear that NHS England no longer has a grip on the health service, its staffing or the future of the NHS,” said Phil Banfield, chair of BMA council while Ajay Verma, consultant gastroenterologist at Kettering General Hospital NHS Foundation Trust, described it as “a failing organisation that has undermined doctors and patient safety”. Nonetheless, the initial reaction was one of shock.
Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, which represent NHS leaders around the country, described the abolishment of NHS England as “the end of an era for the NHS” and that it marked “the biggest reshaping of its national architecture in a decade” while Thomas Reynolds, director of policy and communications at not-for-profit medical defence organisation the Medical Defence Union (MDU) said that it had the potential to be “a landmark moment in the NHS’s story”.
As news of the move broke more widely, it was cautiously welcomed.
Ryan Shorthouse, founder and chair of the think tank Bright Blue, called the government’s plans “sensible” and highlighted NHS England’s “too many layers of governance”.
“To be fair, I can see the logic,” agreed Hina Choksy Evans, co-founder of healthcare consultancy Colligo Labs. “NHS England and the Department of Health and Social Care have been tripping over each other for years, duplicating roles, forming separate strategies, and spending money on two different sets of comms teams who, ironically, might have struggled to communicate,” she said.
“Cutting back on administrative waste could mean more resources for patient care, fewer delays, and a more coordinated approach to health policy,” she continued.
“This is not just a restructuring on a spreadsheet. Thousands of NHS England staff are losing their jobs.”
The human cost
The immediate attention of the government plans will be on the human cost of the changes. NHS England currently employs around 15,300 people, while the DHSC employs 3,300. Streeting said that work has already begun “to strip out the duplication between the two organisations” and his aim is to cut headcount across both in half.
Nuffield Trust chief executive Thea Stein said that “today’s news will be devastating for staff at all levels of NHS England, and we must remain mindful of the human cost of this decision”.
“This is not just a restructuring on a spreadsheet. Thousands of NHS England staff are losing their jobs. Many of them have worked tirelessly to keep the system running through endless pressures, only to now be told their roles are redundant. If the goal is to improve efficiency, will we also lose the expertise that makes those efficiencies possible?” asked Colligo Labs’ Evans.
The step beyond this will be to see whether anything has really changed.
“This will have major implications for healthcare policy and delivery in the UK – this centralisation makes proactive government affairs and parliamentary engagement more important than ever to bring effective change to patients,” said Brussels-based public affairs consultancy RPP Group in a statement on LinkedIn.
No wonder then that the BMA’s Banfield calls the reform “a high stakes move” from government. “Without NHS England acting as a buffer between himself and delivery of healthcare to patients, the buck will now well and truly stop with the health secretary,” he said.
The prime minister has said that the reforms will mean shorter waiting times, less bureaucracy and more money for nurses. The devil as is so often said, will be in the details.
