What we know as NHS England abolished by Keir Starmer

Sir Keir Starmer’s plan to abolish NHS England as part of an overhaul of the public sector has been labelled “high stakes” by the British Medical Association (BMA).

Explaining his decision during a speech laying out plans to make the “overcautious, flabby state” more effective, including putting the NHS “back into democratic control”, the prime minister said decisions about billions of pounds of taxpayer money should not be taken by an “arms-length” body.

He said the move would free up cash for doctors, nurses and frontline services, and cut red tape to help speed up improvements in the health service amid frustrations about the pace of change.

The BMA said NHS England had lost its grip on the health service and cautiously welcomed the plans. But it added that the changes would mean “the buck will now well and truly stop with the health secretary” and warned the plans may lead to “chaos and confusion”.

The changes will reverse the 2012 shake-up of the NHS under the Conservative-Liberal Democrat coalition, which the current government says created “burdensome” layers of bureaucracy without any clear lines of accountability.

The prime minister promised sweeping reforms which the government says will deliver better care for patients. Starmer said the previous Tory government had been mistaken to make NHS England more independent from central government, as he said the state was “weaker than ever”.

The government said work would begin “immediately” to return many of NHS England’s functions to the Department of Health and Social Care.In a statement in the Commons about the abolition of NHS England, health secretary Wes Streeting said staff were “drowning in the micromanagement”, which could now be solved.Streeting added that value for money was not achievable with the current system, telling MPs: “There is always a duty on ministers to get as much value for taxpayers’ money as is possible and I cannot honestly say that it is achievable with the way that my department and NHS England are set up today.“Frontline NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy.”Why is Starmer abolishing NHS England?Speaking on a visit to Hull, Starmer said that the government wanted to push power to frontline workers “and away from the bureaucracy which often holds them up”.He said: “So today I can announce we’re going to cut bureaucracy, focus government on the priorities of working people, shift money to the front line.“So I’m bringing management of the NHS back into democratic control by abolishing the arms-length body NHS England.”

Answering a question from a cancer patient on how the decision would improve NHS services, Starmer said: “Amongst the reasons we are abolishing it is because of the duplication.

“So, if you can believe it, we’ve got a communications team in NHS England, we’ve got a communications team in the health department of government, we’ve got a strategy team in NHS England, a strategy team in the government department. We are duplicating things that could be done once.

“If we strip that out, which is what we are doing today, that then allows us to free up that money to put it where it needs to be, which is the frontline.”

Streeting also said the “curse of cost and demand” needed to be broken with more staff always needed.

The government said it expected abolishing NHS England would free up “hundreds of millions” for frontline services.

What’s the reaction been?
The plan has been cautiously welcomed by the Conservatives and the Liberal Democrats but it has been criticised by unions.

Former health secretary and chancellor Jeremy Hunt praised the “boldness” of the proposals but warned bureaucratic centralisation should not be replaced with political centralisation.

Shadow health minister Dr Caroline Johnson said her party was “supportive of measures to streamline” the NHS but criticised the government’s recently passed employment rights bill that they said would increase red tape.

Matthew Taylor, the chief executive of NHS Confederation, which oversees the health service in England, Wales and Northern Ireland, told the BBC it was a “logical step” which was a “confirmation of a reality that has existed for a while.”

The BMA called it a “high stakes move” from the government by removing the “buffer of” NHS England, the “buck will stop” with Streeting

But they noted NHS England “no longer had a grip on the health service” after years of “fragmentation and incremental cuts” made the organisation too complex and unclear to members of staff.

They added: “If removing a layer from the NHS brings the immediate priority of staff retention closer to ministers’ noses, then all the better. If it merely creates chaos and confusion, then far less so.”

The reaction has been less warm from other unions, with Unison saying “this announcement will have left NHS England staff reeling”, and they said the way it had been handled was “nothing short of shambolic”.

They did note a renewed “focus and greater investment in the entire NHS team of staff, not just nurses and doctors, would “help turn around the fortunes of a floundering NHS”.

Unite general secretary Sharon Graham said the NHS was a hugely complex organisation that required highly skilled administrative staff and “taking an axe to these jobs is an ill-thought-out strategy that could end up meaning frontline healthcare staff struggle to do their jobs effectively”.

What about job cuts?
NHS England currently employs 15,300 people, but Streeting has said half of this workforce will be cut straight away.

These cuts will come from teams that the government say duplicate a lot of the work done by the Department of Health.

The remaining 7,650 will be asked to remain in their jobs until NHS England is fully closed in two years. In the meantime, ITV News reported the remaining staff will be asked to monitor local health providers, intervening when they perform badly and offering rewards for those that succeed.

They will also be asked to manage procurement of expensive medical equipment and centralising medical research with universities and pharmaceutical firms.

What is NHS England and what does it do?
NHS England was set up in 2013 by Andrew Langley, the former Tory health secretary under the coalition government.

It was established to give the NHS greater independence and is responsible for overseeing and delivering health services across England.

While funded by taxpayers, NHS England is a quango and therefore is not controlled by central government.It collaborates with local clinical commissioning groups to address regional needs, distinct from the devolved NHS bodies in other UK nations, which have their own governance.NHS England currently employs around 15,300 people.What is a quango?A quango, short for ‘quasi-autonomous non-governmental organisation’ is a public body that is funded by taxpayers but operates with some independence from direct government control. However, it is still accountable to ministers.Quangos handle specialised tasks – in the case of NHS England, it oversees healthcare services in England – and they are designed to bring expertise and flexibility, free from day-to-day political meddling.However, critics argue that quangos are unelected and often duplicate the efforts of government departments. Starmer said on Thursday that politicians had chosen to hide behind quangos, which had become a “cottage industry of checkers and blockers slowing down delivery for working people”.What happens next?Once NHS England is scrapped, it will be folded back into the Department of Health and Social Care.The process is expected to take around two years after legislation is introduced in the King’s Speech and the government hopes that it will save around £100m.NHS England said three board members are leaving next month and a new leadership team will be brought in to oversee the NHS England’s abolition.

Sir James Mackey will be taking over as transition chief executive of NHS England and he said while he knows the announcement will bring “welcome clarity” – but accepted it will “unsettle staff”.The NHS, already grappling with waiting lists and a projected £6.6 billion overspend in 2025/26, faces a precarious transition – most notable perhaps will be clarifying the fate of the current 13,500 staff members.The government will also have to prove that savings will be spent on things like employing more doctors and nurses and improving patient care.