On 13th March 2025, prime minister Keir Starmer announced the abolition of NHS England (NHSE). What does this actually mean?
First of all, it does not mean the end of the NHS in England. The NHS, and NHSE are entirely separate beasts. So the first and most important message is that abolition of NHSE will not affect your hospital care, GP care, or community care.
It probably won't affect anything so quite a while, regardless. Things like this take time, to ensure proper handovers and passing of the baton. It's expected to take around 2 years to complete (so I don't know why I feel a need to get this post out on the same day...) (NHS Confederation, 2025).
What is NHSE?
NHSE currently has 7 regional teams- East of England; London; Midlands; North East and Yorkshire; North West; South East and South West.
NHSE is an arms-length body (or 'quango', which is a new word I learnt today!) which serves a commissionary function on behalf of the government in the Department of Health and Social Care (DHSC). It has a part role as a regulatory body for hospitals and acute care, and oversees integrated care boards (ICBs) on a regional and national level to commission local services. NHSE sets operational priorities for the NHS in England.
It has had a more prominent role and been operationally independent of government since the Health and Social care Act in 2012, which sought to decrease central (governmental) control of the NHS- the very move which is being undone now in order to have the NHS 'brought back into democratic control' to minimise overcentralisation, duplication of work, and bureaucratic red tape (NHS Confederation, 2025).
What does abolition look like?
As yet, we don't know. There are around 18,000 jobs across NHSE and DHSC, and initial reports suggest that up to 50% of these jobs will be lost (NHS Confederation, 2025). It's not yet known how departments will merge and who or what will get the chop.
We also don't know how frontline services will be affected. ICBs have been asked to reduce their running costs by 50% by the end of 2026 (NHS Confederation, 2025) but again, there's no clear picture on what this looks like in reality to prioritise and further promote patient care, which one only hopes will be the ultimate outcome from this exercise.
According to Health Sec Wes Streeting, it's felt that removing NHSE will prevent duplication of work also apparently carried out by DHSC, whilst avoiding footing a £2 billion bill that leads to 'taxpayers paying more but getting less' (Gov.UK, 2025). He also feels that there has been too much top down management of the NHS which prevents people acting on a local level to provide the care that is needed on the ground due to micromanagement and bureaucracy. In his words, one team will become one organisation.
I can't say that I see DHSC taking over as a way to minimise bureaucracy and micromanagement- rather, shift it to another cantankerous organisation which is likely to be somewhat short sighted on local needs, whilst slashing budgets for those on the ground in ICBs. But I'll cast my skepticism aside and see what happens next.
With love always,
Christie x
References:
NHS Confederation (2025) 'Abolishing NHS England: what you need to know'. Available at: https://www.nhsconfed.org/publications/abolishing-nhs-england-what-you-need-know
Gov.UK (2025) 'NHS England: Health and Social Care Secretary's statement' . Available at: https://www.gov.uk/government/speeches/nhs-england-health-and-social-care-secretarys-statement
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