Sir Keir Starmer has confirmed plans to abolish the “arms-length body” NHS England.
But what is the quango – and why is the prime minister scrapping it?
What is NHS England and how does it work?
NHS England was established in 2013 by former Conservative health secretary Andrew Lansley to give the NHS greater independence and autonomy – with an intention for it to operate at arm’s length from the government.
It was set up as a quango – an organisation that is funded by taxpayers, but not controlled directly by central government – and is responsible for delivering high-quality care, supporting staff, and ensuring value for money.
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Its website states that it has a “wide range of statutory functions, responsibilities and regulatory powers”, which include working with the government to agree funding and priorities for the NHS and overseeing the delivery of safe and effective NHS services.
NHS England currently employs about 15,300 people, while the Department for Health and Social care (DHSC) employs 3,300.
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PM to abolish NHS England
Health Secretary Wes Streeting said on Thursday the government wants to slash those totals by 50% to “deliver hundreds of millions of pounds worth of savings”.
But when questioned precisely how many jobs would be lost, the prime minister’s official spokesperson said he was “not going to get into figures at this stage”.
As health is a devolved matter, the equivalent bodies for Scotland, Wales, and Northern Ireland cannot be abolished.
Why has it been scrapped?
The prime minister has said abolishing the body will bring management of the NHS “back into democratic control”.
He said the move would free up money for doctors, nurses and frontline services, and cut red tape to help speed up improvements in the health service, amid frustrations about the pace of change.
Sir Keir added that the NHS will “refocus” on cutting waiting times at “your hospital”.
When asked how the decision would improve NHS services, Sir Keir said on Thursday: “Amongst the reasons we are abolishing it is because of the duplication.
“So, if you can believe it, we’ve got a communications team in NHS England, we’ve got a communications team in the health department of government; we’ve got a strategy team in NHS England, a strategy team in the government department. We are duplicating things that could be done once.”
He said by stripping out duplication, it allows the government to “free up that money to put it where it needs to be, which is the front line”.
Image: Health Secretary Wes Streeting said the government wants to slash total headcount by 50%
Mr Streeting added: “When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs.
“We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.”
What will happen now?
NHS England will be brought back into the DHSC – the ministerial department which is responsible for developing and implementing policies and legislation on health and social care in England.
It is expected to take two years for the quango to be brought fully into the DHSC and will generate £100m in savings, Mr Streeting said.
The implementation of artificial intelligence and digitalisations will work to free up £45bn of savings, the prime minister’s spokesperson said.
A new leadership team has also been brought in to help oversee the transition.
It comes after NHS England said three leading board members were stepping down at the end of the month.
Chief financial officer Julian Kelly, chief operating officer Emily Lawson and national medical director Sir Stephen Powis will leave their roles in the coming weeks.
At the time, NHS chief executive Amanda Pritchard – who is also stepping down – said the board members made their decision based on the upcoming changes to the size and function of the centre.
Sir James Mackey, who will be taking over as transition chief executive of NHS England, said while he knows the announcement will “unsettle staff” it will also bring “welcome clarity” as the NHS focuses on “tackling the significant challenges ahead”.
Incoming NHS chair, Dr Penny Dash, added she will be working to “bring together NHSE and DHSC to reduce duplication and streamline functions”.
‘Devastating for staff’
The prime minister’s announcement has been met with mixed reaction.
Thea Stein, head of the Nuffield Trust – a charitable trust which aims to improve health care in the UK – said the announcement will be “devastating for staff at all levels of NHS England”.
She added that it “makes sense to remove the duplication and bureaucracy that exists currently” but warned: “We must remain mindful of the human cost of this decision.”
Think tank The Health Foundation added that it was a “watershed moment” in how the NHS is governed and managed, and there is “logic” in the decision to bring the NHS and government closer together.
However, it added that scrapping NHS England will “cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients”.
The think tank said: “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.”
What happened during the last NHS shake up?
Under the Conservative-Liberal Democrat coalition government in 2012 the Health and Social Care Act was implemented.
This worked to significantly reform the NHS by establishing clinical commissioning groups, abolishing primary care trusts and strategic health authorities, and creating Public Health England.
The move has been criticised by the current government, who said the move created “burdensome” layers of bureaucracy without any clear lines of accountability.
Mr Streeting claimed that the “disastrous” reorganisation “led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history”.
