Prime Minister Keir Starmer has announced plans to abolish NHS England, bringing the National Health Service (NHS) back under direct government oversight.
“I’m restoring NHS management to democratic control by dissolving the arms-length body, NHS England,” Starmer stated. In his speech, he highlighted the need to streamline government operations, reduce bureaucracy, and redirect resources to frontline care.
“We’re eliminating duplication—right now, both NHS England and the Department of Health have separate communications and strategy teams. By consolidating these functions, we can free up funds to be used where they’re needed most: patient care.”
Starmer argued that the NHS should be directly overseen by elected officials rather than an independent body. He described the move as a crucial step in bringing the NHS back to the centre of government decision-making, adding that “tough choices” will continue.
Under these reforms, NHS England will now operate within the Department of Health and Social Care. Health Secretary Wes Streeting defended the decision, calling NHS England the “world’s largest quango” and emphasising that the move would restore ministerial oversight while saving hundreds of millions of pounds—funds that could be better allocated to doctors, nurses, and improving frontline care.
“To those who resist this reform out of love for the NHS, I say: do not kill it with kindness,” Streeting urged. An insider revealed that Streeting viewed NHS England as an organisation that was “responsible for everything yet struggled to deliver on the priorities that matter most to politicians.”
The reforms are expected to take two years, save up to £500 million, and significantly reduce the combined workforce of the Department of Health and Social Care (DHSC) and NHS England, which currently employ 19,000 people.
Criticism and concerns
Critics warn that these changes could entangle the health service in costly and time-consuming bureaucracy. But according to Dr Joydeep Grover, lead for Clinical Governance and Patient Safety for the Emergency Department, NHS England is already highly bureaucratic.
“This has led to a valid question: Is this the best way to run an organisation?” he said.
He further added, “The duplication between the Department of Health and Social Care and NHS England has likely reduced political control over the NHS. While it was designed to be independent, politicians are still blamed when things go wrong. Some politicians are now saying, ‘If NHS England makes mistakes and we get voted out, we might as well take direct control and be accountable for our actions instead of relying on an intermediary.’ I understand where they’re coming from.
“The risk, of course, is that the NHS becomes politicised. But in my 25 years of observing the NHS, it has always been a political tool. It might be better for politicians to take direct credit or blame rather than operate through an intermediary.”
When asked about the likelihood of success for this overhaul, Dr. Grover remained cautious. He highlighted a key concern: “Government efforts to reduce bureaucracy often end up re-employing the same people in different roles. We saw this when CCGs replaced PCTs, and then ICPs replaced CCGs. The same personnel remain in different organisations under new names. We will have to wait and see if this is the case for NHS England as well.”
Ethnic minorities and the impact of reform
Dr. Grover also highlighted that the NHS is struggling to catch up after Covid, facing severe capacity shortages. The UK has only two hospital beds per 1,000 patients, compared to Germany’s eight. Despite healthcare workers doing their best, there is a limit to how much efficiency can be extracted from limited resources. He also pointed out that whenever resources are stretched, the most disadvantaged communities suffer the most.
“Those who know the system—who speak the language, who understand how to advocate for themselves—can push for appointments and services. They call GP surgeries multiple times, submit complaints, and escalate issues, ensuring they get the care they need. Meanwhile, those who are less informed, less vocal, and rely on the system to take care of them often get left behind.
“This is not just an issue for South Asian communities but for all deprived groups. Those who speak up get more resources, while those who do not fall through the cracks.”
A history of NHS reforms
Overall, Dr Grover has mixed views about Keir Starmer and Wes Streeting’s plans. “I can tell you that this is not the first attempt to streamline the system. Every time a top-down reform has been introduced in the NHS, it has led to more confusion and failure because the same people are expected to implement the changes.
“Frontline workers—such as GPs, nurses, and hospital managers—who are responsible for delivering services will struggle to adapt. They will need time to understand the new system and figure out where to seek answers, which ultimately reduces their efficiency.”
Prof Phil Banfield, chair of the BMA council, echoed similar concerns, stating, “The systematic fragmentation and incremental cuts to the NHS have made it too complex and unclear to frontline staff, patients, and the next generation of doctors just who is responsible for today, tomorrow, and the future. Any reorganisation must ensure that the Government retains the expertise needed in the coming battle to mend the NHS.
“This is a high-stakes move from the Government. Without NHS England acting as a buffer between itself and the delivery of healthcare to patients, the buck will now well and truly stop with the Health Secretary.”
