Cliff Notes
- Sir Keir Starmer’s decision to abolish NHS England aims to eliminate bureaucratic duplication and restore direct democratic control over NHS management, with a focus on streamlining operations.
- The government’s reform intends to save £100 million and enhance frontline services, with plans to transition NHS England back under the Department of Health and Social Care (DHSC) over a two-year period.
- Leading figures from NHS England are resigning in light of these changes, with the government asserting that new leadership will foster greater autonomy for local systems and improve patient care.
What is NHS England – and what does abolishing it mean?
Sir Keir Starmer has confirmed plans to abolish the “arms-length body” NHS England. But what is the quango – and why is the prime minister scrapping it?
What is NHS England and how does it work?
NHS England was established in 2013 by former Tory health secretary Andrew Lansley to give the NHS greater independence and autonomy – with an intention for it to operate at arm’s length from the government.
It was set up as a quango – an organisation that is funded by taxpayers, but not controlled directly by central government – and is responsible for delivering high-quality care, supporting staff, and ensuring value for money.
Its website states that it has a “wide range of statutory functions, responsibilities and regulatory powers”, which include working with the government to agree funding and priorities for the NHS and overseeing the delivery of safe and effective NHS services.
NHS England currently employs about 13,000 people, however it is unknown how many jobs will be affected by the incoming changes.As health is a devolved matter, the equivalent bodies for Scotland, Wales, and Northern Ireland cannot be abolished by the prime minister.
Why has it been scrapped?
The prime minister has said abolishing the body will bring management of the NHS “back into democratic control”. This move will put the NHS “back at the heart of government where it belongs,” he said during a speech in east Yorkshire on Thursday, “freeing it to focus on patients, less bureaucracy, with more money for nurses”. He added that the NHS will “refocus” on cutting waiting times at “your hospital”.
PM to abolish NHS England
When asked how the decision would improve NHS services, Labour Prime Minister Sir Keir Starmer said on Thursday: “Amongst the reasons we are abolishing it is because of the duplication.
“So, if you can believe it, we’ve got a communications team in NHS England, we’ve got a communications team in the health department of government; we’ve got a strategy team in NHS England, a strategy team in the government department. We are duplicating things that could be done once.”
He said by stripping out duplication, it allows the government to “free up that money to put it where it needs to be, which is the front line”.
The 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. 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.”
What will happen now?
NHS England will be brought back into the Department of Health and Social Care (DHSC), it was announced.It is expected to take two years for NHS England to be brought fully into the DHSC and will generate £100m in savings, Mr Streeting said. A new leadership team has been brought in to help implement the changes. It comes after NHS England said three leading board members were stepping down at the end of the month.
Chief Financial Officer Julian Kelly, NHS Chief Operating Officer Emily Lawson and Chief Delivery Officer and National Director for Vaccination and Screening Steve Russell will leave their roles in the coming weeks.
At the time, NHS chief executive Amanda Pritchard – who is also stepping down – said the board members made their decision based on the upcoming changes to the size and function of the centre. Sir James Mackey, who will be taking over as transition chief executive of NHS England, said while he knows the announcement will “unsettle staff” it will also bring “welcome clarity” as the NHS focuses on “tackling the significant challenges ahead”.
Incoming NHS chair, Dr Penny Dash, added she will be working to “bring together NHSE and DHSC to reduce duplication and streamline functions”.
The changes will also “give more power and autonomy to local leaders and systems – instead of weighing them down in increasing mountains of red tape”, the government said.
“Too much centralisation and over-supervision has led to a tangled bureaucracy, which focuses on compliance and box-ticking, rather than patient care, value for money, and innovation.”
Dr Penny Dash