The Government has announced that it is abolishing NHS England to ‘reduce duplication’ with the Department of Health and Social Care. We will be featuring all the reaction to this news from the BMA to grassroots GPs. This will be constantly updated. If you would like to send in your reaction, email [email protected]
Professor Phil Banfield, chair of BMA council:
‘It has been increasingly clear that NHSE no longer has a grip on the health service, its staffing or the future of the NHS. While we have had our criticisms of NHSE’s leadership, this does not detract from the hard work they and their staff have done, and this news will be devasting for many of them.
‘The systematic fragmentation and incremental cuts to the NHS have made it too complex and unclear to frontline staff, patients, and the next generation of doctors just who is responsible for today, tomorrow, and the future. Any reorganisation must see that the Government retains the expertise needed in the coming battle to mend the NHS.
‘This is a high stakes move from Government. Without NHSE acting as a buffer between himself and delivery of healthcare to patients, the buck will now well and truly stop with the Health Secretary.
‘Doctors’ experiences of reorganisations of the NHS have not been positive. This must not become a distraction from the crucial task that lies ahead: dealing with a historic workforce crisis, bringing down waiting lists and restoring the family doctor.
‘If removing a layer from the NHS brings the immediate priority of staff retention closer to ministers’ noses, then all the better. If it merely creates chaos and confusion, then far less so. The reality is that the future of the NHS has always been in the hands of ministers and governments. Doctors and patients now expect them to deliver on their promises.’
Layla Moran MP, chair of the Health and Social Care Committee:
‘I welcome the boldness of today’s announcement. As it raises as many questions as it answers, I am pleased that the Health and Social Care Secretary has accepted our invitation to come before our committee and has committed to doing so as soon as possible and before Easter, so that we can drill down into the detail of these changes.
‘Our primary concern is that these changes deliver for patients and families across the country, and we will be holding the Government to account to ensure that they walk the walk not just talk the talk on improving outcomes for patients.’
Professor Azeem Majeed, head of the Department of Primary Care & Public Health at Imperial College London:
‘The Government’s decision to abolish NHS England and integrate its functions into the Department of Health and Social Care has implications for patients, NHS England, and staff. Patients could benefit from improved care delivery through reduced bureaucracy and redirected resources to frontline clinical services, though there is a risk of temporary disruption that will require careful management.
‘NHS staff may face uncertainty around job security and morale issues during restructuring, but increased local autonomy may empower leaders to innovate and respond more effectively to local health needs.
‘Efficiency savings are expected through reduced administrative duplication and significant workforce reductions, although essential expertise and organisational memory must be preserved. Throughout the transition, maintaining uninterrupted essential operational functions will be critical.’
Dr Rocco Friebel, associate professor of Health Policy at the London School of Economics and Political Science (LSE):
‘Bringing the NHS back under ministerial control is a bold move — and while cutting bureaucracy sounds good on paper, we can’t forget that NHS England’s distance from politics was meant to give stability and focus on long-term patient care.
‘Ministers will now have to own the NHS’s day-to-day problems, but they’ll need serious capacity in Whitehall to manage something this complex. If the Labour government gets it right, there’s a real chance to refocus on patients and frontline staff — but if they don’t, it could make an already stretched system even more chaotic.’
Sarah Woolnough, chief executive of The King’s Fund:
‘Today’s announcement lands on the same day that NHS stats show people continue to wait days in A&E and many patients remain stuck in hospital beds despite being well enough to leave. The most important question is how will the abolition of NHS England make it easier for people to get a GP appointment, shorten waits for planned care, and improve people’s health. That hasn’t yet been set out – ministers will need to explain how the prize will be worth the price.
‘It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role. It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions, and therefore staff, than it was originally designed to do.
‘Having now made the decision to abolish NHS England, and whilst we still wait for the publication of the NHS 10-year plan, the government must be clear why this significant structural change at this time is necessary, and how its fits into their wider plans. The potential costs savings would be minimal in the context of the entire NHS budget, and so they must ensure that the changes produce the improved effectiveness which is sought by making this change. As with previous NHS restructures, structural change comes with significant opportunity cost, with staff who would otherwise be spending their time trying to improve productivity, ensure safety, and get the best outcomes for patients, now worrying about whether they will have a job.’
Hugh Alderwick, director of policy at the Health Foundation:
‘Abolishing NHS England is a watershed moment in how the English NHS is governed and managed – and ends a 12 year experiment with trying to manage the NHS more independently from ministers.
‘There is some logic in bringing the workings of NHS England and the Government more closely together – for example, to help provide clarity to the health service on priorities for improvement. And – in reality – it is impossible to take politics out of the NHS.
‘But history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect. Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients. It will also eat up the time of ministers, with new legislation likely needed. Expected cuts to local NHS management budgets will add to the disruption, and may undermine the NHS’s ability to implement the Government’s plans for improving the NHS. Reforming NHS bureaucracy is not the same as reforming patient care – and government must be careful that these changes don’t get in the way.
‘Today’s staff survey shows that the NHS workforce is in a fragile state: four in ten staff report feeling unwell because of work-related stress and a third say they feel burnt out. More than one in four think about leaving their jobs. Improving NHS care and productivity can’t happen without a workforce that is stable, feels well, and able to make improvements.’
Louise Ansari, chief executive at Healthwatch England:
‘We know people want better access to and experience of care for everyone, in particular those facing health inequalities, including disabled people, carers, and those on low incomes.
‘During the forthcoming period of change for NHS England, it’s important that everything possible is done to ensure that patients’ care is not disrupted and that the progress the NHS has been making in some areas is not reversed. Going forward, any changes in structures need to have improvements in patient access to and experience of care at their heart.’
Thomas Reynolds, director of policy and communications at the Medical Defence Union (MDU):
‘Today’s announcement by the Prime Minister that NHS England is to be abolished has the potential to be a landmark moment in the NHS’s story.
‘However, the NHS is not about structures and agencies, it’s about people. Healthcare professionals and patients. Regardless of where control of the NHS sits in England – with central government or another body – the same challenges remain.
‘From ensuring the workforce is properly supported, to having regulatory frameworks which enable healthcare professionals to get on with the job of caring for patients, to tackling unsustainable costs facing the NHS such as those associated with clinical negligence: all require urgent attention. They cannot be sidelined in this latest health service structure. That is why the MDU will continue to champion and highlight these issues.’
Thea Stein, chief executive at the Nuffield Trust:
‘Today’s news will be devastating for staff at all levels of NHS England, and we must remain mindful of the human cost of this decision. With the public finances under extraordinary pressure it does, however, make sense to remove the duplication and bureaucracy that exists currently – and patients and the public are probably not going to shed many tears over the shifting of power from an arm’s-length body into central government.
‘But profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists and how to invest in care closer to home with the NHS’s wider finances already underwater and social care reform in the long grass. It is not immediately clear that rearranging the locus of the power at the top will make a huge and immediate difference to these issues, which ultimately will be how patients and the public judge the Government.
‘Furthermore, the Government should be careful that this doesn’t lead to even more top-down micro-management of local services from Whitehall, which has been the bane of the health service. NHS England was set up to take the politics out of the NHS, but today politics has taken out NHS England.’
Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers:
‘This is the end of an era for the NHS and marks the biggest reshaping of its national architecture in a decade.
‘Our members will understand the dynamics at play here, but it comes at an extremely challenging time, with rising demand for care, constrained funding and the need to transform services. History tells us this will cause disruption while the transition is taking place.
‘Much of trust and ICS leaders’ focus will need to go on stabilising the NHS in the short term as thy prioritise patient care, but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming 10-year plan.
‘Our members will want to see strong voices maintained for the health service in future policy making and the major decisions that affect leaders and their staff. NHS England was set up to provide arms-length operational independence for the NHS from government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery.
‘The NHS Confederation, NHS Providers and our diverse memberships will work with the Government to help this transition go smoothly and to ensure the 10-year plan helps the Government to meet its ambitions. Local NHS organisations and other bodies will need to be involved in this transformation as the immediate next steps become clearer, so that an optimum operating model can be created.’
More to follow
