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The government’s decision to abolish NHS England (NHSE) and reintegrate its functions into the Department of Health and Social Care (DHSC) within the next 2 years has sparked a debate about the implications for healthcare leadership, jobs, and patient care. 

Ministers have framed the move as essential for cutting bureaucracy, reducing costs, and improving frontline services. However, some healthcare leaders have warned that the transition risks destabilising an already strained NHS.

Bureaucracy and Accountability Under Scrutiny

Health Secretary Wes Streeting has described NHSE as the “world’s largest quango” and claimed that healthcare staff are “drowning in micromanagement” from “various and vast layers of bureaucracy.” 

At a session of the House of Commons Health and Social Care Select Committee  this month, Streeting said that having “two head offices” led to “duplication, waste, inefficiency, contradiction, and the system being pulled in different directions.”

“We want to devolve power, resources, and responsibility from the centre and closer to the frontline,” he told MPs.

What Was the Point of NHSE?

The NHS Commissioning Board, created under the 2012 Health and Social Care Act, aimed to make NHS oversight and organisation statutorily independent of political interference. 

Renamed NHSE in 2013, over time it evolved into a constellation of administrative organisations that included NHS Improvement, NHS Digital, and Health Education England.

Siva Anandaciva, director of policy, events, and partnerships at the King’s Fund, said that by 2025, NHSE had become “a Frankenstein-like mishmash of other bodies.”

The Government Plan 

Under current proposals, the combined size of NHSE and the DHSC will shrink by around 50%, and local integrated care boards (ICBs) will be expected to cut running costs by half. The expectation is that the cost savings should be diverted to improving patient care.

Streeting has praised NHS staff for “working extremely hard.” He said problems facing the NHS are “a failure of the system they work in.”

A British Social Attitudes survey this month showed that 59% of the public were ‘very’ or ‘quite’ dissatisfied with the NHS — the highest level since the survey began.

What Will Happen Now?

Sir Jim Mackey, who replaced Amanda Pritchard  as NHSE chief executive, is leading the transition team. In evidence to MPs this month, he said rather than “a blanket 50%” cut in costs for ICBs, “Some will have to spend more than others to get back to a more level playing field.” 

Anandaciva has warned that an unforeseen crisis, such as a cyberattack or disease outbreak, during the transition could lead to questions about whether NHS staff might have responded more effectively if they were not distracted by uncertainty over job security. 

He also highlighted that a reported £175 million in savings “pales in comparison” with the almost £7 billion financial deficit that NHS trusts anticipate for next year.

What is the Proposed Timescale?

Streeting has acknowledged that abolishing NHSE will take time due to its size and the complexity of its structure, but he emphasised urgency. He told MPs: “We don’t have time to waste. If we are going to achieve hundreds of millions of pounds’ worth of savings every year – foot down on the accelerator.”

A recent report stated that the transition team aims to complete the merger by October 2026, working within employment law and statutory requirements.

How Might Patient Care Be Affected?

Rachel Power, chief executive of the Patients’ Association, said patients care about getting high-quality treatment when they need it, not about organisational structure. “The real test of these reforms will be whether they lead to shorter waiting times, better access to services, and improved care outcomes,” she said. 

Power warned that financial discipline must not come at the cost of patient care and safety. Promises must result in “tangible improvements”.

Rebecca Hilsenrath KC, CEO of the Parliamentary and Health Service Ombudsman, anticipated gaining an understanding of how the plans will work in practice. “In particular, we see this as an opportunity to ensure that the NHS has the leadership and culture needed to improve patient safety and health outcomes,” she told Medscape News UK.

A spokesperson for the Association of the British Pharmaceutical Industry said the industry would work closely with the NHS to help make the “huge transition” as smooth as possible and minimise disruption.

Will There Be Job Losses?

Streeting has acknowledged that there are “lots of people whose jobs are at risk,” but pledged that staff reductions will be managed through “careful design, deliberation, and consultation.” 

“We have announced the big bang change,” he told the Commons committee, but its execution will proceed “in a careful and considered way.”

However, Christina McAnea, general secretary of UNISON, said that the changes had left NHSE staff “reeling” and “wondering what their future holds.” She added: “The way the news of the axing has been handled is nothing short of shambolic.”

What Do Healthcare Leaders Think of the Decision?

Hugh Alderwick, director of policy at the Health Foundation, said that merging NHSE and the DHSC might reduce fragmentation. However, “scrapping NHSE altogether will be a distraction,” he told Medscape News UK. 

He noted that NHS reorganisations rarely deliver expected benefits and waste valuable time and resources. 

“Government could achieve the same objectives with far less disruption,” Alderwick insisted. Instead, the government might consider bringing some functions into the DHSC while keeping others independent.

“Tinkering with national agencies while the health service is in crisis is a distraction that NHS staff and patients could do without,” said Alderwick.

Anandaciva also expressed concerns. He said reorganisations often “take far longer than you think, end up costing far more than you anticipate, and leave you with a distracted and demoralised workforce.”

He warned that dismantling an organisation as complex as NHSE needs a “carefully wielded scalpel” rather than a “wildly swinging chainsaw.”

Anandaciva concluded that the government risked erecting a “massive speedbump” on its road to reform.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.