Prime Minister, Kier Starmer, has today revealed plans to scrap NHS England (NHSE) as part of wide-reaching proposals to avoid duplication and free up resources to tackle ongoing pressures on frontline services.

Speaking in Hull, Starmer said the state is ‘overstretched’ and ‘unfocused’ adding that abolishing the governing body would ‘cut bureaucracy’ and bring the health service ‘back into democratic control’.

According to the announcement, NHS England will be absorbed into the Department of Health and Social Care (DHSC), ending the duplication currently experienced across both organisations.

When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline

However, critics have voiced concern the move will impact staff and patients at a time when services are at breaking point.

Thea Stein, chief executive of the Nuffield Trust health think tank said of the move: “NHS England was set up to take the politics out of the NHS, but today politics has taken out NHS England.”

Stripping it back

In its announcement the Government said: “By stripping back layers of red tape and bureaucracy, more resources will be put back into the frontline rather than being spent on unnecessary admin.”

The move comes 12 years after then-Health Secretary, Andrew Lansley, formed NHS England as an arms-length body as part of a health service reorganisation.

“The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability,” the announcement said.

We need to bring NHS England and DHSC together so we can deliver the biggest bang for our buck for patients, as we look to implement the three big shifts – analogue to digital, sickness to prevention, and hospital to community – and build an NHS fit for the future

“As Lord Darzi’s independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system.”
Current Health Secretary, Wes Streeting, said: “This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most-expensive NHS in history.

“When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.

“NHS staff are working flat out, but the current system sets them up to fail.

Value for money

“These changes will support the huge number of capable, innovative and committed people across the NHS to deliver for patients and taxpayers.

“Just because reform is difficult doesn’t mean it shouldn’t be done.

“This government will never duck the hard work of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for you when you need it.”

Responding to the news, Sir James Mackey, who has been named transition chief executive of NHS England, said: “We know that while unsettling for our staff, today’s announcement will bring welcome clarity as we focus on tackling the significant challenges ahead and delivering on the Government’s priorities for patients.

NHS England was set up to provide arms-length operational independence for the NHS from government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery

“From managing the COVID pandemic, the biggest and most-successful vaccine campaign which got the country back on its feet, to introducing the latest most-innovative new treatments for patients, NHS England has played a vital role in improving the nation’s health.

“I have always been exceptionally proud to work for the NHS – and our staff in NHS England have much to be proud of.

“But we now need to bring NHS England and DHSC together so we can deliver the biggest bang for our buck for patients, as we look to implement the three big shifts – analogue to digital, sickness to prevention, and hospital to community – and build an NHS fit for the future.”

Reducing duplication

And incoming NHS England chairman, Dr Penny Dash, added: ‘I am committed to working with Jim, the board, and wider colleagues at NHS England to ensure we start 25/26 in the strongest-possible position to support the wider NHS to deliver consistently high-quality care for patients and value for money for taxpayers.

“I will also be working closely with Alan Milburn to lead the work to bring together NHSE and DHSC to reduce duplication and streamline functions.”

A joint statement from Matthew Taylor, chief executive of the NHS Confederation; and Daniel Elkeles, incoming chief executive of NHS Providers, reveals concerns the move will create further disruption at a time when the service is struggling.

It states: “This is the end of an era for the NHS and marks the biggest reshaping of its national architecture in a decade.

Transforming services

“Our members will understand the dynamics at play here, but it comes at an extremely-challenging time, with rising demand for care, constrained funding and the need to transform services.

“History tells us this will cause disruption while the transition is taking place.

It is not immediately clear that rearranging the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the Government

“Much of trust and ICS leaders’ focus will need to go on stabilising the NHS in the short term as they prioritise patient care, but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming 10-year plan.

“Our members will want to see strong voices maintained for the health service in future policy making and the major decisions that affect leaders and their staff.

“NHS England was set up to provide arms-length operational independence for the NHS from government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery.

“The NHS Confederation and NHS Providers and our diverse memberships will work with the Government to help this transition go smoothly and to ensure the 10-year plan helps the Government to meet its ambitions.

“Local NHS organisations and other bodies will need to be involved in this transformation as the immediate next steps become clearer, so that an optimum operating model can be created.”

Stein has also commented to Healthcare Property in the last few minutes, voicing concern for staff and patients.

She said: “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.

The Government should be careful this doesn’t lead to even more top-down micro-management of local services from Whitehall, which has been the bane of the health service

“With public finances under extraordinary pressure it does, however, make sense to remove the duplication and bureaucracy that exists currently – and patients and the public are probably not going to shed many tears over the shifting of power from an arm’s-length body into central government.

“But profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists and how to invest in care closer to home with the NHS’s wider finances already underwater and social care reform in the long grass.

“It is not immediately clear that rearranging the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the Government.

“Furthermore, the Government should be careful this doesn’t lead to even more top-down micro-management of local services from Whitehall, which has been the bane of the health service.

“NHS England was set up to take the politics out of the NHS, but today politics has taken out NHS England.”