It was announced today – 13th March, 2025 – NHS England will be abolished to “cut bureaucracy” and to bring management of the health service “back into democratic control”, Keir Starmer has said.
What is NHS England?
NHS England is an arm’s-length body (‘quango’) that oversees the budget, planning, delivery and day-to-day operation of the health service in England.
It employs more than 15,000 staff and was set up in 2013 by then-Conservative health secretary Andrew Lansley MP to give the NHS greater autonomy.
The NHS is devolved in the UK. So there are separate organisations that run the NHS in Scotland, Wales and Northern Ireland.
What has the government announced?
NHS England (NHSE) is being abolished. It is being merged with the Department of Health and Social Care (DHSC), which is run by health secretary Wes Streeting MP.
‘Beneath’ NHSE, there are 7 NHSE regions and 42 NHSE Integrated Care Boards (ICBs). It is not clear whether these are to be abolished as well as the highest level of administration.
Nonetheless Starmer said “Today we are abolishing the biggest quango in the world.”
The NHS as a whole employs about 1.5 million people, mainly through 220 health trusts (hospital groups), and is thought to be the 5th biggest organisation in the world.
The total budget for NHS England was £3.2 billion in the 2023/4 budget, around 2% of the total NHS budget.
By absorbing NHS England into DHSC, the government hopes to save £100s millions a year.
What did the prime minister say?
Starmer portrayed the move as a cost-saving and bureaucracy-slashing exercise that would put ministers back in charge and benefit patients. He said,
I don’t see why decisions about £200bn of taxpayer money on something as fundamental to our security as the NHS should be taken by an arm’s length body, NHS England.”
What are the pros and cons of this major decision?
5 Pros
- Control (positive). Wes Streeting and the DHSC will regain direct control of the NHS. They should find it easier to manage (see next point), and not waste time fighting a bureaucracy created to run it for them. There is no such layer of management between government and other important functions of the state (defence, judiciary, police, education etc). Furthermore NHSE diminishes the influence and experience of the civil service, who should work ‘for’ the minister and government
- Less distance to frontline. Without a vast duplicated bureaucracy between DHSC and local hospital, mental health and GP leadership groups, coalface problems should be sorted quicker
- Save money and be simpler. NHS England has become a huge bloated quango, that does not necessarily carry out the will of the current government. Its independence was one reason why it was created; i.e. a. to reduce the influence of constantly changing governments and ministers that last a year or less (‘messing up’ longterm plans); and b. to allow the ‘experts’ (doctors, NHS managers and senior nurses) to run the NHS better. But under their leadership most things have got worse. They have had their chance. Its abolition will save £100s millions a year (eventually, see Con 2 below) and create something simpler
- Performance. A DHSC-led NHS will have more power (and probably money) to take over large parts of private hospitals, and build surgical hubs (perhaps as PFI projects). Both should have significant effects on waiting lists, which is the governments primary target by end of this term – i.e. to hit the 18 week target (currently some people wait 18 months for treatment)
- Major change in the future. This will be good preparation for further major change in the NHS in a possible second term of the current government.
5 Cons
- Control/responsibility (negative). If this does not work, or not enough, there will be no one else to blame and the Labour Party are likely to be voted out in 2029. The stakes are high
- Two years of stasis, union fightback and cost
- The handover of power will take two years at least. There is a danger in this period of stasis, the ‘old’ and ‘new’ regimes will be so busy fighting for influence, that no reform happens at all. People will wait till the ‘new bosses’ are in place, before trying to change anything
- Many unions will oppose this (and fight it), as they always oppose change that leads to loss of jobs
- It will also be very expensive. 15,000 ‘golden handshakes’ (some to highly paid NHS doctors/managers) will be very expensive, as well as the employment tribunals that will be needed if the handshakes are not sufficient
- Acts of Parliament. To dissolve NHSE will probably take 2 or more Acts of Parliament. These may get snarled up in political infighting, the House of Lords, and the run up to the next election. They need to be brought forward soon to have any chance
- Next (Conservative? Reform??) government. With full control of the NHS, they could go further than Labour and dismantle it completely; leaving us with an American-style private healthcare system
- Similar people. In the past when senior doctors/managers lose their jobs (as they will soon), they re-emerge in other NHS organisations (or DHSC) and favour their poor policies that got us into this mess. The DHSC need to be wary of leaving the same people ‘in charge’.
What does MyHSN think?
MyHSN agrees with this fundamental change of responsibility for healthcare in England. The performance of the NHS is so poor that almost any different method of running it should be tried. It cannot get any worse.
We would, however, like the DHSC to go further and abolish the 7 NHS Regions and 42 ICBs, and replace them with 10 or more health/social insurance organisations – like the best performing health services in Europe (e.g. Netherlands and Switzerland).
Such countries: a. pay a similar amount for healthcare and have virtually no waiting lists; and b. have a social care system that works without you having to sell your house at the later stages of life. It is possible.
In summary, we applaud the new Government’s determination to rebuild the NHS and make it work.
We also need to be more adventurous, take some risks and try new things; as a return to good simple healthcare is vital to our less than healthy country.
Other resources
Short history of NHS
History of NHS 1948-60
NHS history timeline
NHS: 5 Pros and 5 Cons
