Abolishing NHS England: what you need to know

Background

On the morning of Thursday 13 March, the Prime Minister delivered a speech in Yorkshire that was trailed by government to be about the ‘bonfire of the quangos’. He opened his speech by reiterating the Labour Party’s election pledge to facilitate change in the country. As was a cornerstone of the party’s election rhetoric, the Prime Minister said “working people do not feel like the state and public services are working for them”, and that every pound of government money spent must deliver for the British people. 

The Prime Minister cited NHS England as an example of over-regulation and duplication of bureaucracy, before announcing it would be abolished, and spoke of it being "brought back into democratic control" within the Department for Health and Social Care (DHSC). He stressed that he was not criticising civil servants themselves, but rather the system which has evolved to work in an overly bureaucratic way. Later in the morning, the Secretary of State made a statement to the House of Commons on the changes, confirming that the expectation would be for the abolition (requiring primary legislation) to be completed within two years. 

At the same time, NHS Confederation members, notably integrated care boards (ICBs) and provider trusts, have been told to make further cuts, with ICBs asked to make 50 per cent reductions in their running costs by Q3 2025/26 and trusts being told to cut their “corporate services” budgets back to pre-pandemic levels. 

Wes Streeting’s statement to the House of Commons

• The Secretary of State opened by saying he cannot say the current setup is getting the best out of the NHS. “I’m sure members have heard their local NHS leaders complain about the top-down way the NHS is run – it’s something I’ve heard for years. I agree with these complaints.”
• He went on to say that frontline NHS staff are “drowning in the micromanagement they are subject to by the centre.”
• He cited the Hewitt review, which reported that one local service was required to send 250 reports and forms to NHSE and DHSC in a single month – “that is time not spent delivering care for patients.”
• The Secretary of State went on to say NHSE staff have been set up to fail by a fragmented system and that “this is not a reflection of them.” He said that many NHSE functions will be brought into DHSC.
• He said a key aim of change is also to help the NHS be a better partner to life sciences.
• He also said that the NHS needs “fewer checkers and more doers.”
• In closing, Secretary of State said “change is hard – there will always be cautious voices. However, broken the status quo is, there will always be people who are resistant to change.”
• He also said, “we will take on vested interests and change the status quo.”
• The Secretary of State referred to Darzi review having been critical of the Lansley reforms, including the impact of a growth in the number of staff across NHS England, DHSC and other national bodies with regulatory or policy influence on the system, which can then confuse accountability and lead to local leaders spending significant time on internal management activities.
• Finally, Secretary of State pointed out that the Prime Minister has set an incredibly ambitious target for the NHS – “it will require government to go further and faster than even the last Labour government, but it’s nothing less than patients deserve.”

Key exchanges between MPs and health and social care secretary

Full transcript will be available on the Parliament UK website (from approximately 4pm on 13 March) but below are exchanges most relevant to members. 

Layla Moran (Lib Dem, Chair of Health and Social Care Selection Committee, Oxford West and Abingdon)

• ICBs need to cut running costs by 50 per cent. My concern is the first thing to be cut is place-based teams. Will he send a signal to ICBs that this is not the right thing to do?
• Response: We will make it clear this does need to be done in a way that builds an NHS fit for the future. When we ask frontline leaders to change ways of working, it does sometimes require reconfiguration. The public can get anxious about this. It’s really important that we support and engage with local NHS leaders and give them the support they need to do what they’re asking them to do. I will only use my powers to intervene in the most extreme circumstances. 

Jeremy Hunt (Conservative, Godalming and Ash)

• Can I commend the radical nature of this reform. But it cannot be replacing bureaucratic central oversight with political central oversight. Are we going to get rid of central targets that make it impossible for managers to deliver real change on the ground? Will he also confirm a role for the reformed CQC?
• Response: Democratic accountability matters for both patient outcomes and value for taxpayer money. The role of the SoS is to be the champion for patients and taxpayers to ensure the system as a whole serves both. I have ruffled feathers – both within the NHS and more so with charities who think NHSE and the SoS should just bark out orders to an ever more complex system. Of course, we set strategic priorities on behalf of the public and ensure transparency, but overcentralisation has to stop. National health service should enable systems, we’re embarking on biggest decentralisation of power in the NHS history. If we get this right, it will be truly the end of the world. More targets from the centre is not the answer. Sir Julian Hartley has our full support in reforming the CQC. 

Danny Beales (Labour, Uxbridge and South Ruislip)

• How long until the integration of digital tools by NHSE? Bonfire of bureaucracy will not stop effective local management of trusts and primary care – locally the NHS is poorly managed, with clinical staff having to backfill admin (From tone, I took poorly managed to mean enough management capacity, not that the management was bad.)
• Response: We have to give local frontline leaders the tools to do the job. NHS leaders are some of the best people I have met in my time in this role and when I was shadowing it. I want to liberate them to make decisions in the best interests of patients. I’ve given them an undertaking that I will have their backs. 

Adrian Ramsey (Green, Waveney Valley)

• Can I guarantee that when I meet my ICB chief exec next week, they won’t have to tell me they’re cutting frontline services due to government funding?
• Response: The reports relate to the deficits that have been sent in to NHSE ahead of the 2025-26 financial year and those re the financial plans that are being revised as we speak. I am asking frontline leaders to improve services and reform ways of working – they have my support in doing that. We announced £26 billion of funding for the NHS at the Autumn Budget. 

Things we still do not know

• When relevant legislation will come – there were a couple of questions in the statement session, but SoS did not confirm.
• Where job losses will come from – and which roles/teams will be absorbed into DHSC. 
• Guidance on where the 50 per cent cuts ICBs are being asked to make should come from, and what the specifics on trust cuts that have been referenced will be. 
• What the interim arrangements will be to support more joint working between both organisations ahead of legislation.

Our reaction

In recognition of this considerable reform, we issued a joint response with NHS Providers.

Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, said:

“This is the end of an era for the NHS and marks the biggest reshaping of its national architecture in a decade.

“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. 

“Much of trust and ICS leaders’ focus will need to go on stabilising the NHS in the short term as they prioritise patient care but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming ten-year plan.

“Our members will want to see strong voices maintained for the health service in future policy making and the major decisions that affect leaders and their staff. NHS England was set up to provide arms-length operational independence for the NHS from government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery.    

“The NHS Confederation and NHS Providers and our diverse memberships will work with the government to help this transition go smoothly and to ensure the ten-year plan helps the government to meet its ambitions. Local NHS organisations and other bodies will need to be involved in this transformation as the immediate next steps become clearer, so that an optimum operating model can be created.”

You can also check our Bluesky account (@nhsconfed.org) for clips of the main interviews we have taken part in across broadcast media.