NHS England will be scrapped with responsibility for the health service in England being resumed directly by government ministers, reversing the controversial overhaul by then-Conservative health secretary Andrew Lansley in 2012.
The Labour government’s move has been cautiously welcomed by think tanks and trade bodies, but there have also been warnings that such major reorganisations can be “hugely distracting and rarely delivers the benefits politicians expect”.
Prime minister Kier Starmer set out the reforms with NHS England being subsumed back into the Department of Health and Social Care (DHSC).
Starmer said it would bring an end to “the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients”.
Work will begin immediately to returning many of NHS England’s current functions to DHSC.
A longer-term programme of work will deliver the changes to bring NHS England back into the department, likely to be around two years.
Not positive experiences
The British Medical Association (BMA) called it a “high stakes move” and highlighted that the systematic fragmentation and incremental cuts to the NHS have made it too complex and unclear to frontline staff, patients and doctors who is responsible.
BMA council chairman Prof Phil Banfield said: “Any reorganisation must see that the government retains the expertise needed in the coming battle to mend the NHS.
“This is a high stakes move from government. Without NHSE acting as a buffer between himself and delivery of healthcare to patients, the buck will now well and truly stop with the health secretary.
“Doctors’ experiences of reorganisations of the NHS have not been positive. This must not become a distraction from the crucial task that lies ahead: dealing with a historic workforce crisis, bringing down waiting lists and restoring the family doctor.”
‘Hugely distracting’
The Health Foundation also sounded a note of caution and emphasised that abolishing NHS England was a watershed moment in how the English NHS is governed and managed, and ended a 12-year experiment with trying to manage the NHS more independently from ministers.
Director of policy Hugh Alderwick said: “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.
“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.
“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.”
‘New ways of working’
In a statement to Parliament, health and social care secretary Wes Streeting (pictured) said: “Over the next two years, NHS England will be brought into the department entirely.
“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, 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.”
