Farewell NHS England
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- Published: Wednesday, 12 March 2025 14:38
- Written by Peter Ingle
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It is not every day that the “The biggest quango in the world” gets terminated. But that may be the reason that history remembers NHS England.
Following talk of a planned 50% cut in its headcount, Wes Streeting told the House of Commons that, "Today we’re abolishing the biggest quango in the world."
In his announcement, the Health Secretary said that: “Every pound that is wasted on inefficient bureaucracy in good times or bad is a pound that can’t be spent on treating patients faster.”
There is always a duty on ministers to get as much value for taxpayers money as is possible. I cannot honestly say that is achievable with the way my department and NHS England are set up today."
As part of the now generally discredited Lansley reforms in 2012, NHS England was created to run the health service as primary care trusts were scrapped in favour of GP-led clinical commissioning groups to organise local services. According to the current Health Secretary a "number" of Conservatives have told him in private they have come to regret that 2012 reorganisation.
NHS England has a wide range of statutory functions, responsibilities and regulatory powers, which are focused on supporting and overseeing the wider NHS to deliver high quality and effective care. Its tasks include working with government to agree funding and priorities for the NHS, overseeing the delivery of services and negotiating the best terms for products and services.
The Quango status derives from NHS England being an executive non-departmental public body. It is however sponsored by the Department of Health and Social Care. As a result it is not counted as a government department, although it delivers public services using public funding.
NHS England’s status has left both Labour and Conservative Health ministers expressing frustration that the single-biggest part of their brief was outside their control.
There is a political tight rope to be negotiated, with the Prime Minister stressing that employees of NHS England are hugely qualified and that the government will not be abandoning anybody, even as it abolishes the organisation. But, he said that the government could not look people who want quicker appointments in the eye and say that they were fearful of taking big decisions.
Over the next two years NHS England will be brought into the Department of Health entirely, with a 50% headcount reduction. There will be savings of hundreds of millions of pounds a year that will go to the frontline of the NHS.
Politically, Quango bashing is likely to be a popular stance, and the Prime Minister was keen to present today’s news as making an argument about democratic control.
The Government recognises that one of the biggest factors if they are to win the next general election, will be whether NHS waiting lists come down and voters feel that the service is improving. So it follows that ministers want more control.
Former Conservative Health Secretary, Jeremy Hunt, commended the "boldness" of the announcement. He did though, go on to warn that if this only serves to replace bureaucratic over-centralisation with political over-centralisation that it would fail. The removal of NHS England will leave Wes Streeting more exposed if things do not go well, as he will not be able to claim that it is holding him back.
At one point answering a question from BBC Political editor, Chris Mason, the Prime Minister admitted that: "The power of government has gone."
This may put some context into other comments today, when Keir Starmer spoke of there being too much regulation and too many regulators.
"I’m not a believer in lowering standards," he said, noting there are also too many inconsistencies in regulation.
While this was in response to a question on how the government plans to boost investment in innovation, if followed through, it might have as much, or more influence on UK healthcare, as the demise of NHS England.
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