NHS England gets the axe, with job cuts planned for DHSC

The Government has announced a major restructuring of NHS England, bringing it back under direct control of the Department of Health and Social Care (DHSC) to streamline operations, cut bureaucracy, and improve patient care.

The Prime Minister described the plans as essential to address "burdensome layers of bureaucracy" saying these changes will eliminate duplication and redirect vital resources from administration to front-line patient care.

Headcount across both NHS England and the DHSC is expected to be cut by around 50 per cent and it has been reported that the savings could release around £500 million. When combined, the two organisations have a workforce of over 18,000 staff.

The Secretary of State would not be drawn at this stage on how this will be cut across the two organisations: this will be worked through by the transformation team. 

Health and Social Care Secretary Wes Streeting described the reforms as "the final nail in the coffin of the disastrous 2012 reorganisation," which he argued had led to record waiting times, low patient satisfaction, and spiralling costs. Streeting emphasised the need for "more doers and fewer checkers," highlighting that the current structure penalised hardworking NHS staff, restricting their ability to improve patient outcomes.

The move follows findings by Lord Darzi’s independent review, which highlighted inefficiencies and fragmented accountability resulting from the existing structure. The review concluded the current system created unnecessary obstacles for NHS staff and negatively impacted patient care.

Sir James Mackey, appointed as Transition CEO of NHS England, welcomed the changes, acknowledging they might initially be unsettling for staff but insisting they will offer greater clarity and enable a more targeted focus on patient care. Mackey pointed to successful past initiatives led by NHS England, including managing the COVID-19 vaccine rollout and introducing innovative treatments, underscoring that the reorganisation aims to build on these successes by reducing internal complexity.

However, the announcement drew criticism from Christina McAnea, general secretary of UNISON, the UK’s largest union representing NHS staff. She stated: “Everyone wants more to be spent on frontline services so the sick and injured can be treated sooner," adding that the NHS urgently needs "thousands more staff" and better retention strategies, including "a decent pay rise."

McAnea described the handling of the announcement as "nothing short of shambolic," noting NHS England staff have been left "reeling" after previously being informed of significant job cuts. She called on ministers to reassure NHS employees, demanding a "robust plan to rejuvenate a flailing NHS and deliver for working people," and insisted that the valuable skills of affected staff must be redeployed effectively to benefit patients and the restructured NHS.

Immediate steps will begin transferring NHS England’s responsibilities back to the DHSC, with a longer-term programme planned to complete the full integration. The reforms promise significant annual savings, estimated at hundreds of millions of pounds, which will be reinvested in frontline NHS services to reduce waiting times, in line with the government’s "Plan for Change."

Additionally, the reforms aim to empower local NHS leaders by reducing centralised oversight and bureaucracy, enabling greater flexibility to tailor health services to local community needs. This move addresses criticisms that excessive centralisation and administrative burdens have hampered innovation and effective patient care.

This restructuring forms part of broader strategic shifts intended by the Government to modernise the NHS, specifically transitioning from analogue to digital healthcare, emphasising prevention over treatment, and strengthening community-based services.