Wes Streeting has ordered a “high-stakes” reorganisation of the NHS that will scrap 10,000 jobs in an attempt to free up cash for frontline care.
Experts warned that the move to abolish NHS England and fold it into the Department of Health and Social Care (DHSC) could distract ministers from the urgent job of ending long waits for treatment, while trade unions expressed concern about the “shambolic” announcement of job cuts for public servants.
However, the health secretary said the move to abolish the “world’s largest quango” would put ministers back in charge of the health service while saving hundreds of millions of pounds that could be better spent on doctors, nurses and improving frontline care.
“I tell people now who resist this reform out of love for the NHS, do not kill it with kindness,” Streeting said.
The decision to scrap NHS England, announced by the prime minister on Thursday, is a dramatic reversal of the unpopular NHS changes brought in by the Conservative-Lib Dem coalition government more than a decade ago.
One former health minister, James Bethell, said he wished the Conservatives had “had the guts to do this”, while Jeremy Hunt, the former health secretary, praised the “boldness” of the proposals.
Unveiling the plans, Keir Starmer said the move would “cut bureaucracy” and bring management of the health service “back into democratic control”, while Streeting said it was 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”.
Whitehall sources said Streeting had made the decision that NHS England should be scrapped earlier this year amid frustration about the duplication that exists with the DHSC, and that Starmer had been fully on board with the idea.
The aim is for ministers to take back responsibility, but put an end to micromanaging by an arm’s-length central authority and empower hospitals and local health authorities to make their own decisions about how to improve.
Privately, Streeting had become deeply frustrated with the NHS’s apparent inability to improve waiting times, make hospitals run better and stop overspending, and also to make strategic changes to the way it operates, such as ramping up community-based care to reduce demand on A&E, despite its budget and workforce having increased substantially in recent years.
“By slashing through the layers of red tape and ending the infantilisation of frontline NHS leaders, we will set local NHS providers free to innovate, develop new, productive ways of working and focus on what matters most: delivering better care for patients,” he told the House of Commons.
Those close to Streeting said he holds a view also shared by other recent health secretaries that while NHS England has many different teams specialising in different areas of care, it lacked an overall strategy for rescuing the NHS from the “permacrisis” it has been stuck in for years.
Streeting had come to see NHS England as an organisation that “is in charge of everything but didn’t seem to be able to deliver on the things that matter most to politicians”, one insider said.
The reforms are expected to take two years, save up to £500m and lead to a halving in the size of the merged DHSC and NHS England, which collectively have 19,000 employees.
However, there were warnings that the attempted reforms could risk tying up the health service in a costly and time-consuming bureaucracy, while Unison, a leading trade union among health staff, said the announcement had “left NHS England staff reeling”.
“Just days ago they learned their numbers were to be slashed by half, now they discover their employer will cease to exist,” said Unison’s general secretary, Christina McAnea. “The way the news of the axing has been handled is nothing short of shambolic. It could surely have been managed in a more sympathetic way. Thousands of expert staff will be left wondering what their future holds.”
after newsletter promotion
The BMA, the trade union for doctors, said it was a “high-stakes move from government: without NHSE acting as a buffer between himself and delivery of healthcare to patients, the buck will now well and truly stop with the health secretary”.
Prof Phil Banfield, chair of BMA council, said: “Doctors’ experiences of reorganisations of the NHS have not been positive. This must not become a distraction from the crucial task that lies ahead: dealing with a historic workforce crisis, bringing down waiting lists and restoring the family doctor.”
Three health thinktanks, the King’s Fund, the Health Foundation and the Nuffield Trust also had reservations about the resources and energy that the changes would take up.
Thea Stein, the chief executive of the Nuffield Trust, said removing duplication made sense but “profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists, and how to invest in care closer to home with the NHS’s wider finances already underwater and social care reform in the long grass”.
“It is not immediately clear that rearranging the locus of the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the government,” she said.
However, sources said Sir Jim Mackey, Amanda Pritchard’s successor as “transitional” NHS England’s chief executive, is expected to be much tougher in demanding that the service improves its performance visibly and quickly.
In the Commons, Streeting praised Mackey for his “outstanding track record of turning around NHS organisations, balancing the books, driving up productivity and driving down waiting times”.
The health secretary cited Prof Ara Darzi’s verdict in his review of the NHS last autumn that the creation of NHS England in 2012 by Andrew Lansley, then the health secretary, as part of a massive reorganisation under the Tory/Lib Dem coalition, had been “disastrous … a calamity without international precedent”.
-
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
