Those who blame Britain’s governing lethargy on an anonymous, anti-dynamic “blob” can hardly claim to be disappointed. In a wide-ranging speech on reforming the “overstretched” and “weak” state, the Prime Minister’s most headline grabbing announcement was the scrapping of NHS England – the world’s largest quango. The Health Secretary, Wes Streeting, will now take charge, as it becomes subsumed by the Department of Health and Social Care (DHSC) over the next two years.
NHS England (NHSE) was established in 2013 as part of Andrew Lansley’s health service reforms. The aim was to take the NHS “out of politics”, the NHSE always being separate to the NHS itself. The body was tasked with overseeing the day-to-day running of the health service: its budget for 2024-25 was £179bn. But Lansley’s changes have been widely seen as a failure. Instead, they resulted in two enormous health empires – NHS England and the Department of Health – who were often (according to the government’s official release) “doing the same job”, but neither of whom were accountable to the public or NHS staff. Just who was responsible when things went wrong?
The government’s bold move was kept a guarded secret, purposely left out of various pre-speech briefings. But NHSE’s future had been looking increasingly precarious over recent weeks. Its chief executive Amanda Pritchard resigned her position on 25 February, and it was understood that Streeting was keen to move some NHSE functions “in-house”. A string of other senior figures have stepped down in the intervening weeks, while on Monday (10 March) it was revealed that up to 6,500 job cuts among NHSE staff were being planned.
There are several reasons behind the axing of NHSE, among them, “duplication”, the Prime Minister told journalists. “We’ve got a communications team in NHS England, communications team in the health department of government. Got a strategy team in NHS England, a strategy team in the government department… If we strip that out, which is what we’re doing today, that then allows us to free up that money to put it where it needs to be, which is the front line.”
Setting out further details in the Commons, Wes Streeting said that there are currently 15,300 staff at NHS England, and 3,300 in the Department of Health and Social Care. The overall headcount will be reduced by 50 per cent, he said, resulting in “hundreds of millions of pounds worth of savings”. Money saved from two layers of bureaucracy “could and should be spent on nurses, doctors, operations, GP appointments”, the Health Secretary pledged.
The integration between NHSE and the DHSC will start immediately; the government hopes to complete it in within two years. Parliament will need to pass legislation to abolish NHS England formally, the Health Secretary confirmed, but much of the change could be delivered beforehand. The Labour health secretary under Tony Blair, Alan Milburn, will be central in overseeing the return of NHSE’s functions to the department.
More than money, this is about accountability – and power. It brings the health service “back into democratic control”, the Prime Minister argued. While the idea behind the creation of NHSE was to allow ministers to set the wider health strategy but not interfere on a daily basis, the result was to create a vacuum in responsibility. For too long, Starmer said, successive governments – of all political persuasions – had “swept democratic accountability under the carpet”. The government can only make the NHS work again, reduce waiting lists and cut unnecessary bureaucracy if it is directly responsible for it.
The approach is not risk-free. The Health Foundation think tank pointed out that while this is a “watershed moment” in NHS governance, scrapping NHSE will (inevitably) “cause disruption and divert the time and energy of senior leaders at a time when attention should be focused on improving care for patients”. Therein lies the issue for Streeting and the government. With great power, comes great opportunity. Labour knows that if it can deliver tangible improvements to the NHS and people’s everyday interactions with it, it stands a decent chance of securing a second term. But if it fails, today’s changes ensure that the government will have no one to blame but itself.
[See also: The Do No Harm dilemma]
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