The Government announced on 13 March 2025 that NHS England will be abolished. A decision of this significance at a time of high waiting lists for patients is a bold step by the Prime Minister and one that poses major challenges.
The announcement aims to streamline the NHS by reducing bureaucratic layers and enhancing patient care. This move effectively reverses the Health and Social Care Act 2012 introduced by former Health Secretary Andrew Lansley, that established NHS England as an independent body. During a speech on cutting regulation and government reform, the Prime Minister emphasised that decisions involving substantial taxpayer funds should not rest with an arm’s length entity.[1] By dissolving NHS England, the Government aims to free up resources for frontline services, reduce red tape, and accelerate improvements within the NHS.
Addressing Parliament on the same day, the Health and Social Care Secretary, the Rt Hon Wes Streeting MP, echoed the Prime Minister’s sentiment, referring to the 2012 top-down reorganisation of the NHS as disastrous, the effects of which he said were still felt today.[2] Streeting emphasised the need for a ‘one-team approach’ between NHS England and DHSC to build an efficient health service that is fit for the future.[3] He said these reforms will take place over the next 2 years.
Who will lead the transition?
On 17 March 2025, NHS England announced the newly formed NHS Transformation Executive Team which will replace the current NHS England Executive Group and support ongoing business priorities, statutory functions and day to day delivery.[4] Sir James Mackey, appointed as Chief Executive of the Transformation Team, acknowledged that while the changes might be unsettling for staff, they would bring ‘welcome clarity’ and allow the DHSC to focus on delivering the Government’s priorities for patients.[5]
Reactions to the announcement
The Government’s announcement received mainly negative reactions from key stakeholders. Union leaders expressed concerns about job cuts and the abrupt nature of the changes. The British Medical Association called the news a ‘high stakes move from Government’ and that doctor’s experiences of reorganisations of the NHS have ‘not been positive.’[6]
Unite’s General Secretary, Sharon Graham said: ‘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 if they aren’t paid on time, don’t have basic medical supplies or are forced to do additional administrative work rather than treat patients.’[7]
Hugh Alderwick, Director of Policy at The Health Foundation, cautioned that while the move is significant, ‘history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect.’[8]
According to The Kings Fund, the largest risk of the abolition is the loss of expertise within NHS England.[9] Lord Darzi’s report on the NHS specifically cited the loss of management talent that occurred as a result of the 2012 reforms, and cautioned against further reorganisation that might repeat that disruption.
Chief Executive of The Nuffield Trust, Thea Stein, commented that ‘with public finances under extraordinary pressure it does make sense to remove the duplication and bureaucracy that currently exists.’[10]
Next Steps
As the transition unfolds over the next two years, the Government will need to carefully navigate these challenges to ensure that the primary focus remains on improving patient care while minimising the negative consequences of such a significant restructure.
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Notes
[1] Prime Minister’s Office, 10 Downing Street and The Rt Hon Sir Keir Starmer KCB KC MP, ‘PM remarks on the fundamental reform of the British state: 13 March 2025’, 13 March 2025, Link
[2] Department of Health and Social Care and The Rt Hon Wes Streeting MP, ‘NHS England: Health and Social Care Secretary’s statement’, 13 March 2025, Link
[3] Ibid
[4] NHS England, ‘NHS England names new executive team to lead transition’, 17 March 2025, Link
[5] Department of Health and Social Care, NHS England and The Rt Hon Wes Streeting MP, ‘World’s largest quango scrapped under reforms to put patients first’, 13 March 2025, Link
[6] BMA, ‘BMA responds to the Government’s plan to abolish NHS England’, 13 March 2025, Link
[7] Unite the Union, ‘Unite blasts decision to make huge job cuts in NHS England’, 13 March 2025, Link
[8] The Health Foundation, ‘The Health Foundation responds to the announcement that NHS England will be abolished’, 13 March 2025, Link
[9] The Kings Fund, ‘Keir Starmer to abolish NHS England – the pros and cons’, 14 March 2025, Link
[10] The Nuffield Trust, ‘NHS England to be scrapped: Nuffield Trust responds,’ 13 March 2025, Link
