Sir Keir Starmer has announced the abolition of NHS England in a move he said would slash bureaucracy, save money and bring management of the health system “back into democratic control”.
The shake-up brings the service in England back under the direct control of the health department, reversing a major top-down reorganisation ushered in by David Cameron, then Conservative prime minister, in 2012.
The UK prime minister said the abolition of the body — which employs more than 15,000 staff — would put the NHS “back at the heart of government” and free it up to “focus on patients” and cut waiting lists.
He cited strategy and communications teams in both NHS England and in the Department of Health and Social Care as examples of duplication and waste.
“We’re duplicating things that could be done once. If we stripped 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,” Starmer said.
Ministers are aiming to cut around half the jobs at the agency, which they estimate will save “hundreds of millions of pounds”, health secretary Wes Streeting said.
NHS England is responsible for the overall management and direction of the health service in the country, allocating £134bn to local NHS systems.
Health leaders described the move on Thursday as the “biggest reshaping” of NHS “national architecture in a decade” and warned it would lead to “disruption”.
In a joint statement, Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, 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.”
The British Medical Association, which represents doctors, called the move “high stakes”, but welcomed the decision. “It has been increasingly clear that NHS England no longer has a grip on the health service, its staffing or the future of the NHS,” said BMA council chair, Prof Phil Banfield.
“If removing a layer from the NHS brings the immediate priority of staff retention closer to ministers’ noses, then all the better.”
But Hugh Alderwick, policy director at the Health Foundation, warned the move would “divert time and energy of senior leaders at a time when attention should be focused on improving care for patients”.
He added: “History tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect.”
Starmer’s intervention follows the resignation of the body’s chief executive Amanda Pritchard last month, as Streeting outlined plans for tighter Whitehall control of the NHS.
Streeting told the Commons on Thursday that frontline NHS staff were “drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy” under the current system.
He told MPs that work would start immediately to bring teams together and that the full “integration” of NHS England into the department would be “complete within two years”.
Streeting had demanded a “new relationship” between the government and the NHS. The scrapping of NHS England reverses the operational independence granted to the service under controversial reforms introduced in 2012 by Andrew Lansley, then Conservative health secretary.
“This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history,” Streeting said.
“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.”
On Monday, staff working in central operations at NHS England were warned of job cuts of up to 50 per cent and announced the resignation of several of the most senior officials running the organisation.
NHS waiting lists have now fallen for five months in a row, Starmer said, arguing that it was a striking achievement during the winter.
He said technology and AI could play a “brilliant part” in improving the NHS, as he turned to wider questions of Whitehall reform, claiming that digitisation could help achieve savings of £45bn across the public sector.
The Conservatives threw their support behind the move, but warned that ministers must be accountable for the health service’s performance in future.
“We support measures to streamline NHS management and the principle of taking direct control,” said Alex Burghart, Tory shadow Cabinet Office minister. “Labour ministers now have nowhere to hide or anyone else to blame on NHS performance,” he added.
