Helen Salisbury: Goodbye to NHS England

After a flurry of resignations by NHS England’s (NHSE) top brass in the past few weeks—and while commentators and staff were still busy digesting the announcement of a 50% reduction in head count at the organisation—Keir Starmer has finally brought this episode to its obvious conclusion, announcing the complete abolition of NHSE.12

When NHSE came into being with the Lansley reforms of 2013, concern was expressed that the health secretary was washing his hands of the duty to provide a comprehensive service to patients.3 That duty, and the resulting opprobrium around gaps and failures, was passed from the government to an arm’s length organisation. On the ground, the separation between NHSE and the Department of Health and Social Care isn’t readily apparent: in the minds of doctors and patients, there’s little distinction between them. Now when there are gaps in the service, it’s still the government that’s blamed for failing to fund or organise the NHS properly. And when another unwelcome initiative is imposed on general practice (primary care networks, obligatory online consultations), it’s assumed that NHSE is doing the government’s bidding. Although NHSE may be at arm’s length, the arm is perceived to be very short.

There are good arguments for some decisions to be depoliticised and taken out of the hands of elected politicians who may opt for the popular choice, rather than the “right” one, when it comes to resource allocation—as one eye on the ballot box can affect those decisions.

Starmer and the current health and social care secretary, Wes Streeting, have promised to reform the NHS, but “reform” is one of the trickiest words in the political lexicon. Sometimes there’s good reason for change, especially when (as is very likely the case here) two organisations are engaged in overlapping tasks and are wastefully stepping on each other’s toes. However, reform usually just means cuts, and when done in a hurry there’s a real risk of unintended consequences. Some NHSE schemes won’t be missed, such as the planned massive expansion of physician associates without evidence of safety or cost effectiveness,4 but some other areas of work need to be continued seamlessly.

Since its 2023 takeover of Health Education England, NHSE is responsible for GP training and employs many GP educators who are now worried about their jobs. Responsibility for these roles is likely to be devolved to integrated care boards, but it’s not known whether they’re ready to take on this function. Even if all these staff are re-employed, doing the same work as before, much intellectual and emotional energy will be wasted in the transition. If this process isn’t handled well, the flow of newly qualified GPs into our surgeries could be compromised.

Older doctors who have worked for decades in the NHS are likely to be sceptical about this latest reorganisation (“Not another one!” to quote Brenda from Bristol). However, if it means that the government once again embraces its duty to provide a comprehensive health service, this must be a cause for celebration.