Labour government scraps NHS England

Costs of disruption

But scrapping NHS England altogether will be a massive distraction. Government says the changes will take two years.4 Evidence tells us that NHS reorganisations cause disruption and rarely deliver the benefits politicians expect.5 They also waste time and effort that could be spent on improving care instead.6 Most patients will not have heard of NHS England. But the changes needed to abolish it will be substantial and have knock-on effects. Government must now work out which of NHS England’s long and complex list of functions it wants to bring into the department, ask local NHS bodies to take on, give to some other national body, or scrap altogether. It must also decide what to do with NHS England’s regional offices and the intermediate tier of the health service. Legislation will be needed to make it happen.

Even then, it’s not clear what politicians will gain. Jeremy Hunt—Conservative health secretary from 2012 to 2018, who worked alongside Simon Stevens in NHS England—said he never thought he “lacked a power to give direction” to the NHS under Lansley’s reforms.7 His successor, Matt Hancock, thought differently but changed legislation to bring NHS England more firmly under political control.89 Ministers may regret losing someone else to point to: “centralising power means centralising blame.”10

Alongside the merger, the government says it plans to cut the combined staff of NHS England and the department by half, which could mean 10 000 jobs being lost.4 Senior NHS leaders will be busy drawing organograms and reapplying for their own jobs—time they could have spent reforming the service. Any financial savings will be small in the context of the NHS’s budget.11

Disruption will be felt locally too. The NHS’s new integrated care boards—42 area based bodies responsible for NHS planning and spending across England—will reportedly also be cut in half.12 Some may be merged to cope. Evidence suggests the NHS is undermanaged not overmanaged.13 And weaknesses in local planning have held back past efforts to redesign services.14 It is hard to see how diminishing local NHS management even further will help deliver government’s objectives on reform.

What are government’s objectives anyway? Labour has promised to recover NHS services and transform the health service for the future.15 Reform, we are told, will focus on achieving three “shifts”: more community based care, prevention of ill health, and use of digital technology. But—nine months into the new government—detail on what this means in practice remains thin. And resources to make it happen are constrained.16 Scrapping NHS England may look like tough political action while we wait for a plan for reform. Indeed, this may be the point. But disrupting an already overstretched health service is likely to make it harder to implement the 10 year plan when it arrives.

Government should remember it depends on NHS staff to improve the health service. While Starmer announced plans to scrap NHS England, the latest NHS staff survey results were published.17 The data make for grim reading. Four in 10 staff report feeling unwell because of work related stress. Around a third feel burnt out. Over a quarter often think about leaving. Meantime, NHS services are still in crisis: the elective waiting list has fallen slightly in recent months but is still over 7.4 million, 48 000 patients waited over 12 hours on trolleys in emergency departments for a hospital bed in February, and NHS plans project a potential deficit of almost £7bn this coming year.1819 Tinkering with national agencies while the health service is under such pressure is a distraction that NHS staff and patients could do without.