World’s largest quango scrapped under reforms to put patients first

Reforms to reduce bureaucracy, make savings and empower NHS staff to deliver better care for patients have been set out today [Thursday 13 March] by the Prime Minister Keir Starmer. 

NHS England will be brought back into the Department of Health and Social Care to put an end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients. 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.  

The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability. As Lord Darzi's independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system.

The current system also penalises hardworking staff at NHS England and the Department of Health and Social Care who desperately want to improve the lives of patients but who are being held back by the current overly bureaucratic and fragmented system.

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 can't 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 doesn't mean it shouldn't be done. This government will never duck the hard work of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for you when you need it.”

Sir James Mackey, who will be taking over as Transition CEO of NHS England, said:

“We know that while unsettling for our staff, today's 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.”

Incoming NHS England Chair, Dr Penny Dash said:

“I am committed to working with Jim, the board and wider colleagues at NHS England to ensure we start 25/26 in the strongest possible position to support the wider NHS to deliver consistently high-quality care for patients and value for money for taxpayers.

“I will also be working closely with Alan Milburn to lead the work to bring together NHSE and DHSC to reduce duplication and streamline functions.”

Work will begin immediately to return many of NHS England's current functions to the Department. A longer-term programme of work will deliver the changes to bring NHS England back into the department, while maintaining a laser-like focus on the government's priorities to cut waiting times and responsibly manage finances. It will also realise the untapped potential of the NHS as a single payer system, using its centralised model to procure cutting-edge technology more rapidly, get a better deal for taxpayers on procurement, and work more closely with the life sciences sector to develop the treatments of the future.

The reforms to deliver a more efficient, leaner centre will also free up capacity and help deliver significant savings of hundreds of millions of pounds a year, which will be reinvested in frontline services to cut waiting times through the government's Plan for Change.

The changes will crucially also give more power and autonomy to local leaders and systems – instead of weighing them down in increasing mountains of red tape, they will be given the tools and trust they need to deliver health services for the local communities they serve with more freedom to tailor provision to meet local needs.  

The number of people working in the centre has more than doubled since 2010, when the NHS delivered the shortest waiting times and highest patient satisfaction in its history. Today, the NHS delivers worse care for patients but is more expensive than ever, meaning that taxpayers are paying more but getting less.

Too much centralisation and over-supervision has led to a tangled bureaucracy, which focuses on compliance and box-ticking, rather than patient care, value for money, and innovation. In one example, highlighted by Dame Patricia Hewitt's 2023 review, one Integrated Care System received 97 ad-hoc requests in a month from DHSC and NHSE, in addition to the 6 key monthly, 11 weekly and 3 daily data returns.

The review also revealed the challenges caused by duplication – citing ‘examples of tensions, wasted time and needless frictional costs generated by uncoordinated pursuit of organizational goals that do not take account of their wider effects'. 

Substantial reform, not just short term investment, is needed to deliver the government's Plan for Change mission to get the NHS back on its feet and fit for the future, and this announcement is one of a series of steps the government is taking to make the NHS more productive and resilient so that it can meet the needs of the population it cares for.

NHS England's new leadership team, Sir Jim Mackey and Dr Penny Dash, will lead this transformation while reasserting financial discipline and continuing to deliver on the government's priority of cutting waiting times through the Plan for Change.

These reforms will provide the structure necessary to drive forward the three big shifts identified by government as crucial to building an NHS fit for the future – analogue to digital, sickness to prevention, and hospital to community.

Since July, Government has already taken significant steps to get the NHS back on its feet, including bringing an end to the resident doctor strikes, delivering an extra 2 million appointments 7 months early and cutting waiting lists by 193,000 since July.