PM to scrap NHS England and bring health service back under democratic control

Sir Keir Starmer says the body will be abolished to

NHS England, dubbed the “world’s largest quango”, will be abolished to “cut bureaucracy” and bring management of the health service “back into democratic control”, Sir Keir Starmer has said.

The Prime Minister said decisions about billions of pounds of taxpayer money should not be taken by an “arms-length” body, as he promised sweeping reforms which the Government says will deliver better care for patients.

Sir Keir said the previous Tory government had been mistaken to make NHS England more independent from central government, as hesaid the state was “weaker than ever”.

“Overstretched, unfocused, trying to do too much, doing it badly,” the Prime Minister said.

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.

NHS England is a public body delivering services with taxpayers’ money, which was set up to support and oversee NHS trusts and wider organisations to deliver healthcare.

It has worked with the Government to set priorities and agree funding for the NHS.

The latest news comes after the announcement of the departure of senior leaders at NHS England in recent weeks, including NHS chief executive Amanda Pritchard, chief financial officer Julian Kelly, chief operating officer Dame Emily Lawson, chief delivery officer Steve Russell and national medical director Professor Sir Stephen Powis.

Health Secretary Wes Streeting told the Commons on Thursday he wanted the transition of moving NHS England into the Department of Health to be completed in two years.

“Today we’re abolishing the biggest quango in the world,” Mr Streeting told MPs.

On staff reduction, he said: “The size of NHS England, there are 15,300 staff; in the Department of Health and Social Care 3,300, and across both we’re looking to reduce the overall headcount by 50%.

“That will deliver hundreds of millions of pounds worth of savings, and the exact figures will be determined by the precise configuration of staff.”

The changes will reverse the 2012 shake-up of the NHS under the Conservative-Liberal Democrat coalition, which the Government says created “burdensome” layers of bureaucracy without any clear lines of accountability.

Speaking on a visit to Hull, Sir Keir said: “I can’t in all honesty explain to the British people why they should spend their money on two layers of bureaucracy.

“So today I can announce we’re going to cut bureaucracy, focus Government on the priorities of working people, shift money to the front line.

“So I’m bringing management of the NHS back into democratic control by abolishing the arms-length body NHS England.”

Answering a question from a cancer patient on how the decision would improve NHS services, Sir Keir said: “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.

“If we strip that out, which is what we are doing today, that then allows us to free up that money to put it where it needs to be, which is the frontline.”

He added that the Government wanted to push power to frontline workers “and away from the bureaucracy which often holds them up”.

In a wide-ranging speech, the Prime Minister said that “strength abroad” demands “security back at home”, and the Government must go “further and faster” in delivering reform.

He said: “Given what’s happening globally, given the insecurity in our country, now is the time, in my belief, for greater urgency and to go further and faster on what we need to do on security and renewal.

“So every pound that we spend, every regulation, every decision must deliver for working people. And I don’t just mean efficiency, although doing what you’re doing, you’ll know how important efficiency is.

“I mean something else which is allowing the state, the Government, to operate what I call maximum power.

“So, reforming it so it’s closer to its communities, tearing down the walls of Westminster, inviting the British people in as partners in the business of change.”

The Government said work would begin “immediately” to return many of NHS England’s functions to the Department of Health and Social Care, “to put an end to the duplication resulting from two organisations doing the same job”.

A new leadership team, Sir Jim Mackey and Dr Penny Dash, will oversee this transition, while “reasserting financial discipline and continuing to deliver on the Government’s priority of cutting waiting times,” it said.

Mr Streeting said in a statement: “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.

“NHS staff are working flat out but the current system sets them up to fail.

“These changes will support the huge number of capable, innovative and committed people across the NHS to deliver for patients and taxpayers.

“Just because reform is difficult doesn’t mean it shouldn’t be done. This Government will never duck the hard work of reform.

“We will take on vested interests and change the status quo, so the NHS can once again be there for you when you need it.”

In a letter to NHS England staff, seen by the PA news agency, Ms Pritchard and Sir Jim said a briefing would be held with workers on Monday.

It added: “We recognise this is very difficult news, particularly as it comes on the back of multiple announcements over the last couple of months…

“Understandably this is going to be unsettling.”

A letter to staff from Mr Streeting also said: “I know that this will be unsettling and you will all have views about the process. This is a change process and change is unsettling.”

Hugh Alderwick, director of policy at the Health Foundation, said there was some logic in bringing the workings of NHS England and the Government more closely together.

He added: “But history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect. Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients.

“It will also eat up the time of ministers, with new legislation likely needed.”

Nuffield Trust chief executive, Thea Stein, said that “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.”

She added: “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.”

Published: 13/03/2025 by Radio NewsHub