Keir Starmer to abolish NHS England – what it means and the way it may have an effect on you

NHS England – which oversees the running of the National Health Service in England – is to be abolished, the Prime Minister announced on Thursday.

In a major shake-up of the health service, Keir Starmer said the non-departmental public body will be brought into the Department for Health and Social Care (DHSC). He criticised that there is too much duplication going on between the DHSC and NHSE and said the previous Tory-Lib Dem government had been mistaken to make NHSE more independent from central government.

Speaking about duplication, he said: “If we strip that out, which is what we are doing today, that then allows us to free up that money to put it where it needs to be, which is the frontline.” The PM said any savings would go to doctors, nurses and patient services, and cut red tape to help speed up improvements in the health service, amid frustrations about the pace of change.

Health Secretary Wes Streeting told MPs the government was “abolishing the biggest quango in the world“. He confirmed there will be thousands of job cuts, with any taxpayer savings to be rediverted to improving patient care. Health experts have broadly welcomed the announcement but raised fears about staff cuts and about disruption to the NHS during the transition period.

Here’s everything you need to know about the announcement.

What has been announced?

Keir Starmer has announced he is abolishing NHS England to put the health service “back at the heart of government”. In a major speech, the Prime Minister said the move would bring the NHS “back into democratic control” in a huge reorganisation. It will now be brought under the DHSC.

Mr Starmer said the move will “cut bureaucracy” and allow ministers to focus on slashing record waiting lists and delivering for patients. He added: “I don’t see why decisions about £200billion of taxpayer money, on something as fundamental as the NHS, should be taken by an arms-length body. Today has got to be a line in the sand for all of us”.

The reforms will reverse the 2012 top-down reorganisation of the NHS which, ministers say, “created burdensome layers of bureaucracy without any clear lines of accountability”. Lord Darzi’s independent investigation into the state of the NHS last year found the 2012 structural reforms – led by the Tory-Lib Dem coalition government – were “disastrous”.

It comes after the departure of senior leaders at NHSE in recent weeks, including NHS chief executive Amanda Pritchard, chief financial officer Julian Kelly, chief operating officer Dame Emily Lawson, chief delivery officer Steve Russell and national medical director Professor Sir Stephen Powis.

What is NHS England and why is it being scrapped?

NHS England (NHSE) is a non-departmental public body of the DHSC which leads the National Health Service in England. It was created in 2012 by the Tory-Lib Dem Coalition to run the health service. It oversees the budget, planning, delivery and day-to-day operation of NHS trusts and wider organisations in England. It delivers services with taxpayers’ money.

NHSE directly commissions NHS GPs, dentists, opticians and some other specialist services. It is also responsible for putting arrangements in place so that drugs and appliances ordered on NHS prescriptions can be supplied to patients in pharmacies.

The government said it is abolishing NHSE as there is too much duplication between the Department of Health and Social Care (DHSC) and NHSE. Mr Streeting said the system is now too “fragmented”, adding: “We can’t justify such a complex bureaucracy with two organisations doing the same jobs.”

He said staff were “drowning in the micromanagement” in the NHS, which could be solved by scrapping NHSE. He referred to the Dame Patricia Hewitt’s 2023 review, which found a local service sent 250 reports and forms to NHSE and DHSC.

The review also revealed the challenges caused by duplication – citing “examples of tensions, wasted time and needless frictional costs generated by uncoordinated pursuit of organisational goals that do not take account of their wider effects”. Mr Streeting said: “That is time and energy that is not being spent delivering care for patients.”

What happens next and will jobs be lost?

The DHSC said work will begin immediately to return many of NHS England’s current functions to the Department, with Mr Streeting saying some work has already “to strip out the duplication between the two organisations”. A longer-term programme of work will deliver the changes to bring NHSE back into the department.

Mr Streeting said local NHS providers will be “set free” by the changes, adding: “By 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.”

The Health Secretary told MPs he is hoping the changes will be “complete within two years”. He confirmed he is aiming to reduce NHSE’s “overall headcount by 50%” – meaning thousands of people are set to lose their jobs. Mr Streeting said: “The size of NHS England, there are 15,300 staff; in the Department of Health and Social Care 3,300, and across both we’re looking to reduce the overall headcount by 50%.”

While health experts broadly welcomed the announced, they raised concerns about the impact on staff. Nuffield Trust chief executive Thea Stein said: “Today’s news will be devastating for staff at all levels of NHS England, and we must remain mindful of the human cost of this decision.” Sir James Mackey, who will be taking over as Transition chief executive of NHSE, admitted the news would be “unsettling” for staff.

What does it mean for you?

In the Commons, Mr Streeting emphasised that cutting down duplication will save money for taxpayers. He said job cuts in NHSE with save the taxpayer “hundreds of millions of pounds” and that, more generally, improving efficiency will be better value for the taxpayer.

And he said any savings – which will be ringfenced – will “flow down” to the front line to better improve patient care. “Over the next two years, NHS England will be brought into the department entirely,” he said. “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.”

Ministers also hope that bringing NHSE under government-control will free up more time to focus on things like improving technology to the NHS. Mr Streeting said: “NHS England will have a much clearer focus over this transformation period, it will be in charge of holding local providers to account for providing the outcomes that really matter, cutting waiting times and managing their finances responsibly.

“And it is tasked with realising the untapped potential of our National Health Service as a single payer public service, getting a better deal for taxpayers through central procurement, being a better customer to medical technology innovators to get the latest cutting-edge tech into the hands of staff and patients much faster, and being a better partner to the life sciences sector to develop the medicines of the future.”

What have health experts said?

In a joint statement, Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, branded the announced “the end of an era for the NHS” and said it “marks the biggest reshaping of its national architecture in a decade”.

But they warned the announcement comes at an “extremely challenging time” and raised fears about “disruption” during the transition period. The pair, who represent NHS trusts, services and organisations, said: “Our members will understand the dynamics at play here, but it comes at an extremely challenging time, with rising demand for care, constrained funding and the need to transform services. History tells us this will cause disruption while the transition is taking place.” They added that it is important “we get the right balance between recovery and reform” as it looked ahead to the upcoming 10-year plan.

Sarah Woolnough, Chief Executive of The King’s Fund, said: “Today’s announcement lands on the same day that NHS stats show people continue to wait days in A&E and many patients remain stuck in hospital beds despite being well enough to leave. The most important question is how will the abolition of NHS England make it easier for people to get a GP appointment, shorten waits for planned care, and improve people’s health. That hasn’t yet been set out – ministers will need to explain how the prize will be worth the price.

‘It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role. It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions, and therefore staff, than it was originally designed to do.”

Hugh Alderwick, Director of Policy at the Health Foundation, said: “Abolishing NHS England is a watershed moment in how the English NHS is governed and managed – and ends a 12 year experiment with trying to manage the NHS more independently from ministers. 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. And – in reality – it is impossible to take politics out of the NHS.

“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.”

Nuffield Trust chief executive Thea Stein acknowledged the “devastating” news for staff but said: “With the public finances under extraordinary pressure it does, however, make sense to remove the duplication and bureaucracy that exists currently – and patients and the public are probably not going to shed many tears over the shifting of power from an arm’s-length body into central government.

“But profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists and how to invest in care closer to home with the NHS’s wider finances already underwater and social care reform in the long grass. It is not immediately clear that rearranging the locus of the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the Government.”

She added: “Furthermore, the Government should be careful that this doesn’t lead to even more top-down micro-management of local services from Whitehall, which has been the bane of the health service. NHS England was set up to take the politics out of the NHS, but today politics has taken out NHS England.”

Dr Hannbeck, CEO of the Independent Pharmacies Association, said: “Any reforms that reduce bureaucracy and streamline administration in the healthcare system are welcome. However, the test for these reforms will be whether cost savings can be channelled back into frontline patient care. The focus of this Government must be investing in the ‘front door’ of healthcare and primary care services such as pharmacies, doctors and dentists. A reorganisation of the NHS should prioritise this aim, not distract from it.”