S Poddar
In a bold move, Keir Starmer has restored ministerial control of the National Health Service (NHS) by abolishing NHS England. The move is aimed at increasing accountability by doing away with the arm’s-length arrangement created under Andrew Lansley’s controversial 2012 shake-up.
Starmer’s agenda focuses on combating bureaucratic inefficacy, restructuring management, and diverting investment into frontline NHS care. Reducing waiting time and boosting the satisfaction level among patients had decreased significantly ever since the changes occurred in 2012. Wes Streeting, the Health Secretary, hailed the move as the “final nail in the coffin” for the ill-fated shakeup.
Starmer emphasized that dismantling NHS England would release funds for doctors and other necessary services, speeding up changes in the NHS. The government plans to substantially reduce waiting lists before the next election.
In the leadership of Streeting, NHS England had already halved its size, and its chief executive, Amanda Pritchard, will leave at the end of the month. The role of NHS England will be taken up by the Department of Health and Social Care (DHSC) and is supposed to be undertaken in two years.
Earlier reluctant to sanction a wholesale NHS reorganisation, Streeting deplored the overlap of work between NHS England and the DHSC. Whitehall sources leaked that No 10 and Streeting, advised by former Labour health secretary Alan Milburn, grew frustrated with the waste and turned to abolition as a means of saving time and money.
This move would not be a veering back into austerity measures, but unions feel that cutting corners through reorganisation and technology could cut down on morale within the civil service all the more. Starmer intervened, saying the reason for the strategy was public service issues, resulting from actions nearly a decade ago, which the new proposal aims to address.
The opposition did not challenge the abolition when Streeting laid the plan before the House of Commons. The Liberal Democrats agreed with the necessity of radical changes to treat the NHS crisis but called for greater urgency and attention to reforming social care. A party spokesperson said, “We’ll never cure the NHS unless we cure social care – and I’m afraid the government still isn’t taking that seriously or urgently enough.”
But former DHSC officials were also doubtful about the efficiencies and savings promised. One former health minister argued that the government already had the power to instruct NHS England and saw the reforms as symbolic. “All that counts is substance, [and] whether they use technology to fundamentally transform how the NHS is coordinated and makes use of data, because without that, nothing will change,” he said.
Hugh Alderwick, director of policy at the Health Foundation charity, described the move as a “watershed moment” but said that reorganisation of NHS organisations tends to cause disruption without bringing the promised benefits. He warned that abolishing NHS England might take the attention of senior leaders away from patient care and occupy ministerial time, particularly in the probable requirement for new laws. Reductions in the budgets of local NHS management may further destabilize the system and prevent the implementation of government policy.
James Mackey, the interim chief executive of NHS England, recognized the uncertainty for staff but embraced the clarity the move brings. He emphasized that this change could enable maximizing resources for patients and enable changes from analogue to digital, from sickness to prevention, and from hospital-based to community-based care.
Though the government is interested in overhauling the NHS and improving efficiency, the success of the program is subject to implementing the functions of the NHS into the DHSC smoothly and sustaining staff morale and public confidence throughout the process.
