On 13 March 2025, the UK Prime Minister, Keir Starmer, announced the government’s intention to abolish NHS England.
This has been an independent public body since 2013, holding responsibility for overseeing the purchasing and planning of public sector health services in England, allocating budgets to areas, carrying out specialized purchasing, and setting targets and standards. Mergers with other bodies had given it responsibility for overseeing the NHS trusts that deliver care, and more recently for medical and nursing training, health data and information technology.
In a further announcement, the Secretary of State for Health and Social Care stated that NHS England’s functions would be reintegrated directly into the Department of Health and Social Care (DHSC) over a two-year period, with the objective of streamlining operations and achieving significant cost savings. In the meantime, it would become more “focused” as duplication of officials with the DHSC was reduced [1].
The government stated that [2]:
- NHS England had become “bloated” at a cost of almost £2 billion a year, and savings were needed at a time of financial pressure in the NHS and wider UK public finances;
- Micromanagement and excessive reporting were a burden on NHS provider bodies and exacerbated by multiple “layers” of management; and
- Democratic accountability and control had been reduced by moving powers at arms length from ministers.
Around 9,000 jobs are expected to be removed as part of a move towards a future workforce 50% the size of the current combined total across NHS England and the DHSC.
Experts in the UK and stakeholder bodies generally shared the view that duplication existed between the two bodies [3]. However, some warned that the change could fail to reduce centralization or even worsen it, and that the frequency of radical organizational changes in the English NHS was a distraction [4].
Many details of the change remain currently unclear and will continue to take shape over the two-year period. These include whether other parts of the NHS will be structurally altered to reflect the new approach, what legislative powers will be moved to the DHSC, and whether responsibilities for medical training and other specific areas will sit with any particular units or bodies.