NHS England, the body responsible for overseeing the National Health Service in England, is set to be abolished, Prime Minister Keir Starmer revealed on Thursday.
In a sweeping reform of the nation's healthcare system, Mr Starmer declared the non-departmental public body will be integrated into the Department for Health and Social Care (DHSC). The Prime Minister criticised the excessive overlap between the DHSC and NHSE. He argued the move to make NHSE more autonomous from central government.
Addressing concerns over inefficiency, he said: "If we strip that out, which is what we are doing today, that then allows us to free up that money to put it where it needs to be, which is the frontline."
He assured that any financial savings would enhance services for patients and bolster the ranks of doctors and nurses, simultaneously trimming bureaucracy to expedite improvements throughout the health service, amid discontent with the slow rate of progress, reports the Mirror.
Health Secretary Wes Streeting reported to Parliament that the government is "abolishing the biggest quango in the world". He confirmed forthcoming job cuts in the thousands, pledging that savings made at the taxpayers' expense would be funnelled directly towards patient care enhancements.
While health professionals have largely supported the announcement, there are prevailing concerns about potential staff reductions and disruptions to NHS operations during the transition phase.
Here's everything you need to know about the announcement.
What has been announced?
Keir Starmer has declared his intention to dismantle NHS England, aiming to place the health service "back at the heart of government". In a significant address, the Prime Minister outlined this overhaul would restore the NHS to "back into democratic control".
The healthcare system will be integrated into the Department of Health and Social Care (DHSC).
Mr Starmer explained this reorganisation is set to "cut bureaucracy" and enable government officials to concentrate on reducing the unprecedented waiting lists and improving patient care. He stated: "I don't see why decisions about £200billion of taxpayer money, on something as fundamental as the NHS, should be taken by an arms-length body. Today has got to be a line in the sand for all of us".
The proposed changes are intended to undo the 2012 comprehensive restructuring of the NHS which, according to government officials, "created burdensome layers of bureaucracy without any clear lines of accountability". An independent review by Lord Darzi last year concluded that the structural changes implemented by the Tory-Lib Dem coalition government in 2012 were "disastrous".
This announcement follows the recent resignation of top executives at NHSE, including NHS chief executive Amanda Pritchard, chief financial officer Julian Kelly, chief operating officer Dame Emily Lawson, chief delivery officer Steve Russell, and national medical director Professor Sir Stephen Powis.
What is NHS England and why is it being scrapped?
NHS England (NHSE), a non-departmental public body of the Department of Health and Social Care (DHSC) that oversees the National Health Service in England, was established in 2012 by the Tory-Lib Dem Coalition to manage the health service. It is responsible for the budget, planning, delivery and daily operation of NHS trusts and wider organisations in England, using taxpayers' money.
NHSE directly commissions NHS GPs, dentists, opticians and some other specialist services. It also ensures that drugs and appliances ordered on NHS prescriptions can be supplied to patients in pharmacies.
The government has announced plans to abolish NHSE due to perceived duplication between the DHSC and NHSE. Mr Streeting criticised the current system as being too "fragmented", stating: "We can't justify such a complex bureaucracy with two organisations doing the same jobs."
He suggested that staff were "drowning in the micromanagement" within the NHS, a problem he believes could be resolved by scrapping NHSE. He referred to Dame Patricia Hewitt's 2023 review, which highlighted a local service that sent 250 reports and forms to NHSE and DHSC.
The review also exposed the challenges caused by duplication, citing "examples of tensions, wasted time and needless frictional costs generated by uncoordinated pursuit of organisational goals that do not take account of their wider effects". Mr Streeting concluded: "That is time and energy that is not being spent delivering care for patients."
The Department of Health and Social Care (DHSC) has confirmed that the process to integrate many of NHS England's functions back into the department will commence promptly, with Mr Streeting indicating that efforts have already begun "to strip out the duplication between the two organisations". A comprehensive long-term plan will execute the reintegration of NHSE within the department.
Mr Streeting believes that local NHS services will thrive under the new reforms, remarking: "By slashing through the layers of red tape and ending the infantilisation of frontline NHS leaders, we will set local NHS providers free to innovate, develop new, productive ways of working and focus on what matters most, delivering better care for patients."
What happens next and will jobs be lost?
During a session with MPs, the Health Secretary expressed his aim to finalise these changes "complete within two years". In a significant move that will impact staffing levels, he affirmed his target to cut NHSE's "overall headcount by 50%" - a reduction that will result in substant]ial job losses.
Mr Streeting elaborated on the scale of the cuts, noting: "The size of NHS England, there are 15,300 staff; in the Department of Health and Social Care 3,300, and across both we're looking to reduce the overall headcount by 50%."
Health experts, while generally supportive of the announcement, have voiced concerns over the potential impact on NHS staff. Nuffield Trust's CEO Thea Stein expressed the sentiment: "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 incoming Transition chief executive of NHSE, Sir James Mackey, acknowledged that the update might be "unsettling" for the workforce.
What does it mean for you?
For the taxpayer, there could be financial relief in sight, according to discussions held in the Commons. Mr. Streeting pinpointed the reduction of duplication as a means to save money.
He underlined that job cuts within NHSE are projected to conserve "hundreds of millions of pounds" for taxpayers and highlighted the broader aim to bolster efficiency, ensuring better value for taxpayer money.
Intriguingly, he noted that any realised savings, which will be protected, are set to "flow down" and directly benefit frontline services to enhance patient care. Detailing the plan further, Mr. Streeting revealed: "Over the next two years, NHS England will be brought into the department entirely", promising: "These reforms will deliver a much leaner top of the NHS, making significant savings of hundreds of millions of pounds a year. That money will flow down to the front line, to cut waiting times faster, and deliver our plan for change."
These funds, he pledges, will descend to the frontline, aiming to accelerate the reduction of waiting times and advance the agenda for change.
Ministers plan to retake control of NHS England, with hopes of boosting areas such as tech innovation within the health service. Mr Streeting said: "NHS England will have a much clearer focus over this transformation period, it will be in charge of holding local providers to account for providing the outcomes that really matter, cutting waiting times and managing their finances responsibly.
"And it is tasked with realising the untapped potential of our National Health Service as a single payer public service, getting a better deal for taxpayers through central procurement, being a better customer to medical technology innovators to get the latest cutting-edge tech into the hands of staff and patients much faster, and being a better partner to the life sciences sector to develop the medicines of the future."
What have health experts said?
Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, issued a joint statement calling this move "the end of an era for the NHS" and described it as "marks the biggest reshaping of its national architecture in a decade".
However, they cautioned that the announcement comes at an "extremely challenging time" and expressed concerns about potential "disruption" during the transition period. The duo, representing NHS trusts, services and organisations, stated: "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."
They emphasised the importance of striking "we get the right balance between recovery and reform" as they looked forward to the forthcoming 10-year plan.
Sarah Woolnough, Chief Executive of The King's Fund, commented: "Today's announcement lands on the same day that NHS stats show people continue to wait days in AandE and many patients remain stuck in hospital beds despite being well enough to leave.
"The most important question is how will the abolition of NHS England make it easier for people to get a GP appointment, shorten waits for planned care, and improve people's health. That hasn't yet been set out ministers will need to explain how the prize will be worth the price.'
It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role.
"It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions, and therefore staff, than it was originally designed to do.
'It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role.
"It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions, and therefore staff, than it was originally designed to do."
Hugh Alderwick, Director of Policy at the Health Foundation, said: "Abolishing NHS England is a watershed moment in how the English NHS is governed and managed and ends a 12 year experiment with trying to manage the NHS more independently from ministers.
"There is some logic in bringing the workings of NHS England and the government more closely together for example, to help provide clarity to the health service on priorities for improvement. And in reality it is impossible to take politics out of the NHS.
"But history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect. Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients. It will also eat up the time of ministers, with new legislation likely needed."
Thea Stein, chief executive of Nuffield Trust, recognised the "devastating" impact on staff but remarked: "With the 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."
She continued by highlighting the enduring challenges: "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 locus of 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."
Stein also cautioned: "Furthermore, the Government should be careful that 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."
Dr Hannbeck, CEO of the Independent Pharmacies Association, commented: "Any reforms that reduce bureaucracy and streamline administration in the healthcare system are welcome. However, the test for these reforms will be whether cost savings can be channelled back into frontline patient care. The focus of this Government must be investing in the 'front door' of healthcare and primary care services such as pharmacies, doctors and dentists. A reorganisation of the NHS should prioritise this aim, not distract from it."
Get all the latest and breaking news in Yorkshire by signing up to our newsletter here.
Get all the latest and breaking news in Leeds by signing up to our newsletter here.
