Hot topic: Why Labour axed NHS England

On Thursday UK Prime Minister Sir Keir Starmer abolished NHS England, the organisation that’s been responsible for running the health service’s day-to-day operations for the last 13 years. 

This was unexpected, and a radical move. Nobody in Westminster, or the NHS, saw it coming. 

Why did he do it? Who will run the NHS in England now? And – importantly – what will be the impact?  

To answer these questions, let’s rewind to 2012, when former (Conservative) Health Secretary Andrew Lansley unveiled a huge reorganisation of the NHS.  It was so big that the NHS’s top boss at the time memorably quipped it could be “seen from space”. 

Two main aims of the ‘Lansley reforms’ were to give doctors a greater say over how the NHS was run and stop political meddling in its day-to-day affairs.  

NHS England was created to satisfy the second of those aims, moving operational control of the NHS away from the Department of Health, which is headed by ministers.  

NHS England’s role was to direct and oversee the health service in England, which now has around 1.5 million staff and a staggering budget of close to £200 billion. 

But the unintended consequence was to create two parallel bureaucracies. The Department of Health – known as “DH” – was meant to deal with long-term policy, and NHS England with the more immediate stuff. But where does one area end and the other start? This was never clear and, inevitably, a turf war began. 

NHS England appeared to emerge as the winner, swelling its numbers while the DH payroll shrank.  

Successive Conservative health secretaries, preoccupied with firefighting on A&E waiting times, full hospitals, strikes, and Covid, ignored the issue of duplication for years. They probably felt squeamish about throttling the child of a Tory predecessor, even if it was a ‘quango’ (a quasi-autonomous non-governmental organisation). Ironically, quangos are often in the firing line of those on the political right – for being unaccountable. 

The current health secretary, Labour’s Wes Streeting, who’s set out his store as a disruptor, felt no such qualms.  

We knew something was up when NHS England boss Amanda Pritchard abruptly resigned on February 25, followed by a slew of senior figures. Then came the bombshell news that half of NHS England’s 13,000 workforce – half! – were for the chop. 

But Starmer and Streeting were just getting started. At a press conference on Thursday (March 13), Starmer said NHS England itself was to go. Interestingly, the announcement was not trailed beforehand in the media – giving an idea of just what a big deal it was. 

Starmer boasted that he was “abolishing the biggest quango in the world” and putting the NHS back under “democratic control”.  

Part of the reason is purely financial: Whitehall civil servants are expensive. In total, as many as 10,000 jobs could go; DH and NHS England collectively employ about 19,000 staff. The rationalisation could save as much as £500 million. 

But optics play a major role too. Starmer wants to be seen as doing everything he can to help NHS patients, especially given its parlous state, even if that means difficult decisions.  

He told reporters: “I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy. That money could and should be spent on nurses, doctors, operations, GP appointments.” 

More widely, it sends a message that Labour is not afraid of taking an axe to parts of the state.  

It also gave Labour the chance to give the Tories a little kicking, with Streeting saying NHS England’s abolition was “the final nail in the coffin of the Conservatives’ disastrous top-down [re]organisation” of the NHS. 

So, who will run the NHS now?  

Those who keep their jobs will transfer to the Department of Health. It should also not be forgotten that there is a vast bureaucracy outside these central management units: each NHS trust in England (and there are 220 of them) employs managers.  

And what about the impact? 

The government clearly believes there was so much duplication that the impact on operational delivery will be minimal. 

There are serious questions, though, about whether NHS England’s abolition will create real problems.  

Will the right posts be eliminated? When cuts are so swingeing, they can be indiscriminate. Will Starmer and Streeting be forced to re-hire staff, just as has happened at the Food and Drugs Administration (FDA) in the US after Elon Musk’s ‘DOGE’ cuts? 

Hugh Alderwick, of the Health Foundation, a charity and think tank with close links to top NHS managers, said: “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.” 

Abolishing NHS England will cause disruption. But Starmer and Streeting clearly think it’s worth it.