Keir Starmer has risked it all by abolishing NHS England and giving back the National Health Service (NHS) to ministers. By dismantling the arm’s-length setup introduced in the controversial 2012 reorganisation by Andrew Lansley, the move aims at enhancing accountability.
Starmer’s proposal aims to break the bureaucratic framework, make management more efficient, and shift funding to frontline health services. The move is anticipated to relieve the long waiting lists burden and enhance patient satisfaction, which had hit all-time lows after the 2012 overhaul. Health Secretary Wes Streeting welcomed the move as the “final nail in the coffin” of what he described as a catastrophic overhaul.
In his speech on restructuring the state, Starmer underlined that ending NHS England would free up financial resources for doctors, nurses, and core services, eventually speeding up improvement in the NHS. The government wants to deliver major reductions in waiting times before the next election.
NHS England had already been cut in half in size under Streeting’s leadership, and its chief executive, Amanda Pritchard, will resign by the end of the month. The role of NHS England will be merged into the Department of Health and Social Care (DHSC) and is expected to take two years.
Streeting, who had also been shown to be hesitant at the prospect of a full-scale top-down reorganisation of the NHS, lambasted the waste and duplication between the DHSC and NHS England. Insiders in Whitehall exposed No 10 and Streeting, led by Labour’s former health secretary Alan Milburn, becoming more and more fed up with the current set-up and deciding that ditching NHS England would best cut down on time and money.
While the government has promised that this step is not a shift towards austerity, unions have been concerned that savings through reorganisation and technology would further depress morale in the civil service. Starmer justified the move, stating that the public services are now in the shape they are due to decisions ten years ago and that the new strategy is a response to correcting those problems.
No challenge was made in the House of Commons by opposition to the abolition when Streeting outlined the strategy. The Liberal Democrats recognized an urgent need to make radical reforms to solve the NHS crisis, but they demanded greater emphasis upon reforming social care. In response, one party spokesperson commented, “We’ll never resolve the NHS until we resolve social care – and I’m worried the government is still not treating that seriously and urgently enough.”
But some ex-DHSC officials questioned the supposed savings and efficiencies. A former health minister maintained that the government already had the power to tell NHS England what to do and saw the changes as mainly symbolic. “It’s all about substance, [and] whether they utilize technology to transform how the NHS is coordinated and uses data, or else nothing will change,” he said.
Hugh Alderwick, policy director at the Health Foundation charity, described the move as a “watershed moment” but cautioned that reorganising NHS entities often leads to disruption without delivering the anticipated benefits. He warned that scrapping NHS England could divert the attention of senior leaders from patient care and consume ministerial time, especially given the potential need for new legislation. Also, anticipated reductions in local NHS management budgets could further destabilize the system and prevent government plans from being implemented.
NHS England interim chief executive James Mackey welcomed the simplicity this move brings while recognizing that it brings tension to staff. He emphasized that this transition could assist patients in maximizing their resources and shift from hospital-to-community care, from analog to digital, and from sickness to prevention.
While the government’s move to modernize the NHS and improve its efficiency is welcome, it will be challenging to balance patient care with reforms. The ability to effectively assimilate NHS operations under the DHSC and maintain staff morale and public confidence during the transition will be decisive in the success of the initiative.