Rammya Mathew: Abolishing NHS England is a reckless gamble with uncertain returns

The sudden and unexpected announcement that NHS England is being abolished has left many of us in NHS leadership roles feeling deeply unsettled. The language used by the prime minister, Keir Starmer, and the health and social care secretary, Wes Streeting—referring to NHS England as “the world’s largest quango”1—was not only offensive but also dismissive of the vast and essential work carried out by people in the organisation. These are the same individuals who orchestrated the most significant vaccination campaign of our lifetime during the covid pandemic, yet they now find their work reduced to mere “needless bureaucracy” while simultaneously learning that their jobs are on the line.

Even more concerning is the complete lack of detail about what happens next. Streeting himself admitted that this was a decision he “didn’t expect to make.” Such a U turn in approach, with no clear plan for transition, is a recipe for years of chaos. This level of reorganisation also runs contrary to the recommendations of Ara Darzi,2 whose recent report on the NHS stated that further restructuring was unnecessary and unlikely to improve patient care.

Labour claims that this move will redirect significant funding to frontline NHS services, but the reality is far more complex. A significant portion of the savings will be swallowed up by redundancy payouts. Moreover, millions of pounds will inevitably be handed to consultancies drafted in to determine which NHS England functions must be retained and how these will be integrated into the Department of Health and Social Care. In effect, we may be trading one form of bureaucracy for another—only this time at a greater cost and with reduced institutional knowledge.

On the very same day that the government announced that NHS England would be dismantled, integrated care boards (ICBs)—the bodies responsible for planning, commissioning, and overseeing NHS services at a local level—were instructed to reduce their running costs by 50%.34 This comes after successive cuts and reorganisations that have already stripped ICBs of vital resources. It’s now difficult to see how they can sustain even basic operational functions, let alone drive meaningful improvements in population health.

To put this into context, in my two-day-a-week role as a borough medical director in an ICB I already oversee 51 general practices and seven primary care networks, while supporting integrated care across all providers in a borough serving a registered GP population of over 500 000 people. If resources are to be cut further, I struggle to see how we can continue to deliver meaningful work.

The fundamental question remains: how does Labour intend to direct more money to the NHS front line without the necessary strategic oversight to ensure that it’s spent effectively? Throwing cash at providers and selecting a handful of metrics to hold them to account may produce headline friendly results in the short term, but it won’t create a sustainable or meaningful improvement in population health. The risk is that this becomes another exercise in target driven care—one that may generate positive political optics in the lead-up to the next election but ultimately results in a narrow and shortsighted vision of “health” for our population. In the rush to make bold political moves, we must not sacrifice the structures that keep our health service functioning effectively.