“We have in the past challenged the relevance and usefulness of NHSE as a quango, viewing it as a vehicle for fragmenting the NHS and opening it to privatisation; we should not therefore mourn its demise. It is now starkly evident that the NHS buck stops with Streeting.”
From Keep Our NHS Public
Only days after Wes Streeting announced there would be massive cuts in NHS England’s (NHSE) workforce – halved from 13,000 to 6,500 to avoid ‘duplication’ of work by officials at the Department of Health and Social Care (DHSC) – the prime minister Keir Starmer declared on 13 March that NHSE will be entirely abolished.
This was justified on the spurious grounds of a ‘cut to bureaucracy’ and bringing management of the health service ‘back into democratic control’. But what does this mean for the future of the NHS, and is it anything other than more disruptive restructuring (albeit with a populist spin), in the middle of a major NHS crisis?
To answer this question we have to understand what NHSE is, and the context in which this abolition is taking place. While campaigners have often fought for more democracy in NHS decision making, Starmer and Streeting, the architects of this latest spate of cuts, are enthusiastically in favour of expanding the involvement of the private sector in our NHS.
So who is really taking control of our NHS?
NHSE was set up under the 2012 Health and Social Care Act as an executive non-departmental body (a ‘quango’ organisation that is funded by taxpayers but not controlled directly by central government). It oversaw the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England, including compulsory tendering of NHS services in competition between the NHS and the private sector. In other words, it took the money provided by the government and funnelled it into the different parts of the health service – or… private health companies. Although quasi-autonomous, it has been NHSE’s job to translate ministers’ directives into the services people get on the frontline including ensuring that NHS key waiting times, such as the targets for maximum four-hour wait for A&E care and 18-week wait for hospital treatment, were delivered.
In practice, the Secretary of State for Health and Social Care is now taking back the duty to provide comprehensive health services, abolished by the 2012 Lansley Act. Campaigners have demanded the return of this accountability to Parliament and the electorate ever since 2012, but Streeting’s new powers do not give cause for celebration.
Starmer used abolition of NHSE as the main example of how he will remedy the ‘overstretched’ and ‘unfocused’ state. This comes amid major cuts to disability benefits and job cuts to the civil service.
The parallels with events unfolding in the US are chilling. Some Labour aides have taken to referring to the agenda as “project chainsaw“, a reference to the dramatic and legally questionable cuts to the US executive branch currently being overseen by Elon Musk.
We have in the past challenged the relevance and usefulness of NHSE as a quango, viewing it as a vehicle for fragmenting the NHS and opening it to privatisation; we should not therefore mourn its demise. It is now starkly evident that the NHS buck stops with Streeting. Huge numbers of staff are facing redundancy and the Government has behaved disgracefully in the timing of announcements. The loss of so many experienced staff may save some money short-term – a tiny fraction of what the NHS needs to be rebuilt – but it will have a negative impact on how the NHS is run nationally. The 42 local Integrated Care Boards are stripped bare, instructed merely to fulfil the function of commissioning NHS services, and under direction to increasingly consider outsourcing to the private sector.
The central question remains – how is Labour going to fix the NHS as it promised and as the electorate demands?
Clearly appropriate concern over not meeting targets for NHS performance has fuelled the desire for more centralised control while overemphasising modest gains. In March, we saw that the 2 million more appointments in the first seven months of office were trumpeted as Labour delivering on its manifesto promises. This will have made but a small dent in the waiting list of 6.25 million people waiting for 7.43 million treatments and a lot more will have to be done to shift the dial. Meanwhile, other manifesto commitments including building new hospitals and rolling back outsourcing have simply been abandoned.
Those now taking charge in the DHSC include Alan Milburn, Paul Corrigan and others from the Blair-Brown years. They are strongly associated with the policies of privatisation and marketisation of health care which substantially failed in the 2000s. Then, it was the serious investment in the NHS itself that ended long waiting lists and restored public satisfaction. Instead of learning from Labour’s past experience in office, we are seeing an emphasis on a return of private investment to solve lack of capital funding and billions invested to expand the private sector with incentives for providers. Even if there might be some scope for efficiency savings from fewer workers duplicating roles, going back to failed policies coupled with even more drastic constraints on revenue funding is unlikely to deliver meaningful change.
It is difficult at present to see the abolition of NHSE and thousands of redundancies as anything other than a move to facilitate Labour plans for ’reform’. The bad news is that ‘reform’ looks like another reorganisation where the beneficiaries will be private companies as an increasingly fragmented NHS is opened up to commercial interests. It’s no surprise that NHSE staff are ‘in shock and awe’ at the scale of the job cuts, which have spiralled from 2,000 just weeks earlier to 6,500 last week to now, with 10,000 job losses said to make £500 million savings.
Now in our 20th anniversary year, KONP is needed more than ever to put the case for a well-resourced publicly funded, provided and accountable NHS based on its founding principles. After this power grab, it is clearer than ever that Streeting, as Secretary of State, and the Labour Government will be the ones held to account if after all their commitment to ‘change’ they fail to restore a healthy NHS to meet the needs of the population.
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- This article was orginally published by Keep Our NHS Public on 14th March 2025.
