Cliff Notes
- Keir Starmer has abolished NHS England to return oversight of the health service to ministers, aiming for greater accountability and reduced bureaucracy.
- The move is seen as a response to the contentious 2012 NHS reorganisation under Andrew Lansley, with plans to speed up service improvements and reduce waiting lists.
- Concerns arise regarding potential disruption and efficacy, with experts warning that reorganisations may detract from patient care improvements while unions express worry over staff morale and potential job cuts.
Keir Starmer scraps NHS England
Keir Starmer has brought the health service back under the control of ministers by abolishing NHS England.The prime minister said the NHS should be overseen by politicians rather than an arm’s-length body, as it would bring greater accountability. Starmer’s move reverses the unpopular shake-up of the NHS carried out by the former health secretary Andrew Lansley in the first years of the Conservative-Liberal Democrat coalition.
The health secretary, Wes Streeting, said it was 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”. In a speech about reshaping the state, Starmer said NHS England would be abolished to “cut bureaucracy” and bring management of the health service “back into democratic control”.
Free up cash for doctors
He said the move would free up cash for doctors, nurses and frontline services, and speed up improvements in the NHS, with the government aiming to slash waiting lists by the next election. Wes Streeting has already presided over plans to reduce the size of NHS England by half, and its chief executive, Amanda Pritchard, is leaving at the end of the month.
Streeting said on Thursday that the government was “abolishing the biggest quango in the world” by getting rid of NHS England. Its functions would be taken into the Department of Health and Social Care (DHSC), with the merger taking about two years.
He had said before the election he did not want to be distracted by a massive top-down reorganisation of the NHS. However, he had also criticised the duplication of work between the DHSC and NHS England.
Whitehall sources said
Whitehall sources said No 10 and Streeting, advised by the former Labour health secretary Alan Milburn, had quickly become frustrated with the inefficiency of the structure and concluded the best way of saving time and money was a straightforward abolition.
However, unions are concerned that Starmer’s drive to save money in the civil service through reorganisations and technology may undermine morale further.Pressed on whether the move to cut jobs in NHS England and other public bodies was a return to austerity, Starmer said this was not the case.
“Part of the problem we’ve got with our public services is what was done to them a decade or so ago, so we’re not going down that route. None of our plans are going down that route,” he said.
The Conservatives did not oppose the abolition of NHS England when Streeting addressed the House of Commons on Thursday. The Lib Dems said there was “no doubt we need big changes like this to fix the NHS after the Conservatives left it on its knees” but called for a greater focus on overhauling social care.
A party spokesperson said: “We’ll never fix the NHS unless we fix social care – and I’m afraid the government still isn’t treating that seriously or urgently enough.”However, some senior former department of health figures said they were sceptical that Starmer and Streeting’s changes would bring the savings and efficiencies promised.
One former health minister said the government already had the powers to direct NHS England and the changes were little more than a headline. “All that matters is substance, whether they use technology to radically improve how the NHS is coordinated and uses data, as without that, nothing will change,” he said.
Watershed moment
Hugh Alderwick, the director of policy at the Health Foundation charity, said it was a “watershed moment” but added: “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. Expected cuts to local NHS management budgets will add to the disruption, and may undermine the NHS’s ability to implement the government’s plans for improving the NHS. Reforming NHS bureaucracy is not the same as reforming patient care – and government must be careful that these changes don’t get in the way.”
James Mackey, who is the transitional chief executive of NHS England, said the news would be unsettling for staff but bring a “welcome clarity” and mean the department could “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”.