The government has announced that NHS England will be brought back into the Department of Health and Social Care (DHSC) "to put an end to the duplication resulting from two organisations doing the same job".
The Government claims that by "stripping back layers of red tape and bureaucracy, more resources will be put back into the front line rather than being spent on unnecessary admin."
Health and Social Care Secretary, Wes Streeting, said: "This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction and most expensive NHS in history. When money is so tight, we cannot justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.
"NHS staff are working flat out but the current system sets them up to fail. These changes will support the huge number of capable, innovative and committed people across the NHS to deliver for patients and taxpayers. Just because reform is difficult does not mean it should not be done."
Sir James Mackey, who will be taking over as Transition CEO of NHS England, said: "We know that while unsettling for our staff, this announcement will bring welcome clarity as we focus on tackling the significant challenges ahead and delivering on the government’s priorities for patients.
"From managing the COVID pandemic, the biggest and most successful vaccine campaign which got the country back on its feet, to introducing the latest, most innovative new treatments for patients, NHS England has played a vital role in improving the nation’s health. I have always been exceptionally proud to work for the NHS - and our staff in NHS England have much to be proud of.
"But we now need to bring NHS England and DHSC together so we can deliver the biggest bang for our buck for patients, as we look to implement the three big shifts - analogue to digital, sickness to prevention and hospital to community - and build an NHS fit for the future."
Work will begin immediately to return many of NHS England’s current functions to DHSC, while a longer-term programme of work will deliver the changes to bring NHS England back into the department. NHS England’s new leadership team, Sir Jim Mackey and Dr Penny Dash, will lead the transformation.
Responding to the announcement that NHS England will be abolished, Hugh Alderwick, Director of Policy at the Health Foundation, said: "Abolishing NHS England is a watershed moment in how the English NHS is governed and managed – and ends a 12 year experiment with trying to manage the NHS more independently from ministers. There is some logic in bringing the workings of NHS England and the government more closely together – for example, to help provide clarity to the health service on priorities for improvement. And – in reality – it is impossible to take politics out of the NHS.
"But history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect. Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients. It will also eat up the time of ministers, with new legislation likely needed.
"Expected cuts to local NHS management budgets will add to the disruption, and may undermine the NHS’s ability to implement the government’s plans for improving the NHS. Reforming NHS bureaucracy is not the same as reforming patient care – and government must be careful that these changes don’t get in the way."
Nuffield Trust Chief Executive Thea Stein said: “This news will be devastating for staff at all levels of NHS England, and we must remain mindful of the human cost of this decision. With the public finances under extraordinary pressure it does, however, make sense to remove the duplication and bureaucracy that exists currently – and patients and the public are probably not going to shed many tears over the shifting of power from an arm’s-length body into central government.
“But profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists and how to invest in care closer to home with the NHS’s wider finances already underwater and social care reform in the long grass. It is not immediately clear that rearranging the locus of the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the government.
“Furthermore, the government should be careful that this doesn’t lead to even more top-down micro-management of local services from Whitehall, which has been the bane of the health service. NHS England was set up to take the politics out of the NHS, but today politics has taken out NHS England.”
Sarah Woolnough, Chief Executive of The King’s Fund, added: "The most important question is how will the abolition of NHS England make it easier for people to get a GP appointment, shorten waits for planned care and improve people’s health? That hasn’t yet been set out – ministers will need to explain how the prize will be worth the price.
"It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role. It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions and therefore staff, than it was originally designed to do.
"Having now made the decision to abolish NHS England, and while we still wait for the publication of the NHS 10 Year Plan, the government must be clear why this significant structural change at this time is necessary, and how it fits into their wider plans. The potential cost savings would be minimal in the context of the entire NHS budget, and so they must ensure that the changes produce the improved effectiveness which is sought by making this change.
"As with previous NHS restructures, structural change comes with significant opportunity cost, with staff who would otherwise be spending their time trying to improve productivity, ensure safety and get the best outcomes for patients, now worrying about whether they will have a job."
