NHS England will be abolished to “cut bureaucracy” and to bring management of the health service “back into democratic control”, Keir Starmer has said. We take a look at what this means for the health service and its patients.
What has the government announced?
NHS England, the body that has run the NHS in England since 2013, is being abolished. It is being merged with the Department of Health and Social Care (DHSC), which is run by Wes Streeting, the health secretary.
Starmer announced the shock – and very significant – move on Thursday in his speech on reforming the state.
“Today we are abolishing the biggest quango in the world,” Streeting later said, in reference to NHS England, which has 15,000 staff. The NHS as a whole employs about 1.5 million people, mainly through 220 health trusts, and is one of the world’s biggest organisations.
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. “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,” the prime minister said.
“And I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy [NHS England and the Department of Health and Social Care]. That money could and should be spent on nurses, doctors, operations, GP appointments.”
What did Starmer mean by ‘two layers of bureaucracy’?
In October 2011, the NHS Commissioning Board was created. Its key role was to commission clinical commissioning groups – local NHS bodies, which replaced primary care trusts – to provide the range of clinical services needed in their areas, such as GP care.
Its name changed to NHS England in spring 2013, by which time Jeremy Hunt had replaced Andrew Lansley as health secretary. Since then, it and the DHSC have contained many teams of officials who each do roughly or exactly the same thing. For example, each has a dedicated team covering different areas of care such as GP services, mental health and urgent and emergency care (A&E and ambulance services).
In his speech, Starmer cited these examples of duplication in the course of justifying his shake-up of the NHS: “Is it a good idea for the frontline of the NHS to get rid of two sets of comms teams, two sets of strategy teams, two sets of policy teams, where people are basically doing the same thing? Yes, it is.”
What does NHS England do?
It directs, manages and oversees the whole of the health service in England, including its 1.5 million staff and its budget, which from next month is due to be close to £200bn. It is responsible for ensuring that the NHS’s key waiting times, such as the supposed maximum four-hour wait for A&E care and 18-week wait for hospital treatment, are delivered.
This document explains things in more detail.
What will happen to NHS England’s 13,000 staff?
Some will be made redundant, while the others will start working for the DHSC. Both organisations have large offices in London: the DHSC’s HQ is in Westminster while NHS England’s premises is in nearby Waterloo. Both also have offices in other parts of the country, including Leeds, where NHS England is headquartered.
Amanda Pritchard, NHS England’s outgoing chief executive, told staff in an email on Monday that as a direct result of the DHSC’s decision to change its relationship with the NHS, the size of “the centre” – the NHS England/DHSC axis in London – “could … decrease by around half”. People working for the 42 NHS integrated care boards – regional bodies that oversee NHS trusts in their area – were told that half of them would be losing their jobs.
What changes are being made to the leadership of NHS England?
Pritchard announced on 25 February that she would be leaving at the end of this month.
Most of the organisation’s most senior executives have since said they too will be standing down at the same time, including the medical director, Prof Steve Powis, on 6 March, and the deputy chief executive and chief finance officer, Julian Kelly, on 10 March.
Pritchard is being replaced by Sir Jim Mackey, and the outgoing chair, Richard Meddings, by Dr Penny Dash, a doctor and former McKinsey executive who chairs the NHS’s integrated care board in north-west London.
Had Starmer or Streeting dropped any hints they were considering taking the dramatic step of abolishing NHS England?
No. Both the prime minister and health secretary have spoken a lot about their plans to enact bold reform of the NHS in England. Starmer had promised that his government would execute the most radical reform of the service since its creation in 1948.
But neither had given any clue that the abolition of NHS England, and its merger with the DHSC, was on the cards.
In fact, Streeting had specifically ruled out a merger in the course of an interview with the Health Service Journal (HSJ) as recently as 31 January.
• Join Wes Streeting in conversation with Pippa Crerar discussing England’s health and social care system and how Labour plans to turn it around. On Tuesday 25 March 2025, 7pm-8.15pm (GMT). Book tickets here or at guardianlive.com
• This article was amended on 14 March 2025. NHS England’s predecessor, the NHS Commissioning Board, was set up in October 2011, not 2013 as an earlier version said, owing to an editing error. Also, staff at integrated care boards are not employed by NHS England; and the headquarters of NHS England is in Leeds, not London.
