Legal Insights
NHS England is being abolished
NHS England is being abolished
This is not what most people think it is
This is not what most people think it is
Alin George Ilinca
Mar 15, 2025
Prime Minister Keir Starmer has announced the abolition of NHS England, a move he claims will ‘cut bureaucracy’, save money, and bring management of the health system back under ‘democratic control’.
But what does this really mean ?
NHS vs. NHS England: What’s the difference?
First, a clarification: The National Health Service (NHS) and NHS England are not the same. The NHS, founded in 1948, is the publicly funded healthcare system that provides free care.
NHS England, however, was created much later, in 2013, under the Health and Social Care Act 2012, introduced by David Cameron’s Conservative government. It was designed as a quasi-autonomous non-governmental organisation (quango) that operated independently from the government, even though it still relied on public money.
It employs around 15,000 staff, mostly managers and officials. The Department of Health and Social Care sets the priorities and allocates funding, while NHS England develops strategic plans and distributes the money across the healthcare system.
Why was NHS England Created?
NHS England was established with several objectives in mind. One of them was to improve efficiency and patient care by distancing the NHS from direct political oversight. The idea was that healthcare decisions should be led by medical professionals rather than politicians.
However, over time, this separation weakened. The 2022 Health and Care Act restored the Secretary of State’s power to intervene in individual NHS decisions, increasing political involvement. New targets were introduced mid-year, many of which went unmet for years. As public frustration grew, the government responded by reintroducing layers of bureaucracy to shift accountability.
Another reason for NHS England’s creation was to introduce market forces into healthcare—a step toward semi-privatisation. The aim was to make NHS providers (such as hospitals and GP practices) operate more like business, competing for contracts and funding rather than simply receiving money from the government.
But this didn’t last. By 2014, the government shifted its focus from competition to collaboration. This culminated in the 2019 Long Term Plan, which ended the requirement for competitive tendering (bidding for contracts) in NHS services.
Now, however, the new government seems interested again in market incentives, arguing that “money will increasingly follow the patient, and incentives will drive improvements in waiting times.” However, this approach faces a major challenge: If funding remains tight, financial incentives may fail to drive meaningful improvements, leaving struggling hospitals reliant on further government bailouts—perpetuating the very cycle these reforms were meant to break.
Another motivation behind NHS England’s creation was to relieve the DHSC of the day-to-day management of the NHS. The idea was for the DHSC to focus on broader public health priorities like disease prevention, mental health, and social care. However, this never fully materialised. Public health funding has constituently shrunk, falling by over 21% from 2016 to 2022.
The current government says it’s committed to shifting healthcare toward prevention rather than just treatment. But history shows that unless there’s significant investment and structural change, the pressure to prioritise short-term targets over long-term preventative measures will persist.
In the end, the very organisation designed to shield healthcare from political interference has been undone by it. Prime Minister Keir Starmer put it plainly: “I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy.”
This is because, since its inception in 2013, NHS England and the DHSC have had significant overlap, with many teams performing nearly identical roles. Now that NHS England is being abolished—or rather merged with the DHSC—the government hopes to cut waste, simplify decision-making, and save an estimated £500 million a year.
However, the restructuring comes at a cost—over 9,000 jobs are expected to be cut. The transition will take approximately two years, during which NHS England’s functions will be gradually absorbed into the DHSC.
What Happens Next?
Once the merger is complete, the DHSC will take over NHS England’s responsibilities. In theory, this could lead to a more streamlined and efficient system, as Health Secretary Wes Streeting argues. In practice, it could also mean greater political interference in the day-to-day operations of the NHS.
Yet, abolishing NHS England does not address the root problems plaguing the NHS—chronic underfunding, long waiting times, staff shortages, and growing public dissatisfaction. While the government insists that the abolition of NHS England will reduce waste and improve efficiency, these are the same promises that have accompanied almost every major NHS reform in history.
For now, daily interactions with the NHS probably won’t change much. GP appointments, hospital visits, and emergency care will continue as normal. But behind the scenes, decisions about NHS funding, staffing, and performance targets will be more directly influenced by government ministers. Whether this creates a more accountable and efficient healthcare system—or just a more politicised and bureaucratic one—remains to be seen.
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Prime Minister Keir Starmer has announced the abolition of NHS England, a move he claims will ‘cut bureaucracy’, save money, and bring management of the health system back under ‘democratic control’.
But what does this really mean ?
NHS vs. NHS England: What’s the difference?
First, a clarification: The National Health Service (NHS) and NHS England are not the same. The NHS, founded in 1948, is the publicly funded healthcare system that provides free care.
NHS England, however, was created much later, in 2013, under the Health and Social Care Act 2012, introduced by David Cameron’s Conservative government. It was designed as a quasi-autonomous non-governmental organisation (quango) that operated independently from the government, even though it still relied on public money.
It employs around 15,000 staff, mostly managers and officials. The Department of Health and Social Care sets the priorities and allocates funding, while NHS England develops strategic plans and distributes the money across the healthcare system.
Why was NHS England Created?
NHS England was established with several objectives in mind. One of them was to improve efficiency and patient care by distancing the NHS from direct political oversight. The idea was that healthcare decisions should be led by medical professionals rather than politicians.
However, over time, this separation weakened. The 2022 Health and Care Act restored the Secretary of State’s power to intervene in individual NHS decisions, increasing political involvement. New targets were introduced mid-year, many of which went unmet for years. As public frustration grew, the government responded by reintroducing layers of bureaucracy to shift accountability.
Another reason for NHS England’s creation was to introduce market forces into healthcare—a step toward semi-privatisation. The aim was to make NHS providers (such as hospitals and GP practices) operate more like business, competing for contracts and funding rather than simply receiving money from the government.
But this didn’t last. By 2014, the government shifted its focus from competition to collaboration. This culminated in the 2019 Long Term Plan, which ended the requirement for competitive tendering (bidding for contracts) in NHS services.
Now, however, the new government seems interested again in market incentives, arguing that “money will increasingly follow the patient, and incentives will drive improvements in waiting times.” However, this approach faces a major challenge: If funding remains tight, financial incentives may fail to drive meaningful improvements, leaving struggling hospitals reliant on further government bailouts—perpetuating the very cycle these reforms were meant to break.
Another motivation behind NHS England’s creation was to relieve the DHSC of the day-to-day management of the NHS. The idea was for the DHSC to focus on broader public health priorities like disease prevention, mental health, and social care. However, this never fully materialised. Public health funding has constituently shrunk, falling by over 21% from 2016 to 2022.
The current government says it’s committed to shifting healthcare toward prevention rather than just treatment. But history shows that unless there’s significant investment and structural change, the pressure to prioritise short-term targets over long-term preventative measures will persist.
In the end, the very organisation designed to shield healthcare from political interference has been undone by it. Prime Minister Keir Starmer put it plainly: “I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy.”
This is because, since its inception in 2013, NHS England and the DHSC have had significant overlap, with many teams performing nearly identical roles. Now that NHS England is being abolished—or rather merged with the DHSC—the government hopes to cut waste, simplify decision-making, and save an estimated £500 million a year.
However, the restructuring comes at a cost—over 9,000 jobs are expected to be cut. The transition will take approximately two years, during which NHS England’s functions will be gradually absorbed into the DHSC.
What Happens Next?
Once the merger is complete, the DHSC will take over NHS England’s responsibilities. In theory, this could lead to a more streamlined and efficient system, as Health Secretary Wes Streeting argues. In practice, it could also mean greater political interference in the day-to-day operations of the NHS.
Yet, abolishing NHS England does not address the root problems plaguing the NHS—chronic underfunding, long waiting times, staff shortages, and growing public dissatisfaction. While the government insists that the abolition of NHS England will reduce waste and improve efficiency, these are the same promises that have accompanied almost every major NHS reform in history.
For now, daily interactions with the NHS probably won’t change much. GP appointments, hospital visits, and emergency care will continue as normal. But behind the scenes, decisions about NHS funding, staffing, and performance targets will be more directly influenced by government ministers. Whether this creates a more accountable and efficient healthcare system—or just a more politicised and bureaucratic one—remains to be seen.
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Prime Minister Keir Starmer has announced the abolition of NHS England, a move he claims will ‘cut bureaucracy’, save money, and bring management of the health system back under ‘democratic control’.
But what does this really mean ?
NHS vs. NHS England: What’s the difference?
First, a clarification: The National Health Service (NHS) and NHS England are not the same. The NHS, founded in 1948, is the publicly funded healthcare system that provides free care.
NHS England, however, was created much later, in 2013, under the Health and Social Care Act 2012, introduced by David Cameron’s Conservative government. It was designed as a quasi-autonomous non-governmental organisation (quango) that operated independently from the government, even though it still relied on public money.
It employs around 15,000 staff, mostly managers and officials. The Department of Health and Social Care sets the priorities and allocates funding, while NHS England develops strategic plans and distributes the money across the healthcare system.
Why was NHS England Created?
NHS England was established with several objectives in mind. One of them was to improve efficiency and patient care by distancing the NHS from direct political oversight. The idea was that healthcare decisions should be led by medical professionals rather than politicians.
However, over time, this separation weakened. The 2022 Health and Care Act restored the Secretary of State’s power to intervene in individual NHS decisions, increasing political involvement. New targets were introduced mid-year, many of which went unmet for years. As public frustration grew, the government responded by reintroducing layers of bureaucracy to shift accountability.
Another reason for NHS England’s creation was to introduce market forces into healthcare—a step toward semi-privatisation. The aim was to make NHS providers (such as hospitals and GP practices) operate more like business, competing for contracts and funding rather than simply receiving money from the government.
But this didn’t last. By 2014, the government shifted its focus from competition to collaboration. This culminated in the 2019 Long Term Plan, which ended the requirement for competitive tendering (bidding for contracts) in NHS services.
Now, however, the new government seems interested again in market incentives, arguing that “money will increasingly follow the patient, and incentives will drive improvements in waiting times.” However, this approach faces a major challenge: If funding remains tight, financial incentives may fail to drive meaningful improvements, leaving struggling hospitals reliant on further government bailouts—perpetuating the very cycle these reforms were meant to break.
Another motivation behind NHS England’s creation was to relieve the DHSC of the day-to-day management of the NHS. The idea was for the DHSC to focus on broader public health priorities like disease prevention, mental health, and social care. However, this never fully materialised. Public health funding has constituently shrunk, falling by over 21% from 2016 to 2022.
The current government says it’s committed to shifting healthcare toward prevention rather than just treatment. But history shows that unless there’s significant investment and structural change, the pressure to prioritise short-term targets over long-term preventative measures will persist.
In the end, the very organisation designed to shield healthcare from political interference has been undone by it. Prime Minister Keir Starmer put it plainly: “I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy.”
This is because, since its inception in 2013, NHS England and the DHSC have had significant overlap, with many teams performing nearly identical roles. Now that NHS England is being abolished—or rather merged with the DHSC—the government hopes to cut waste, simplify decision-making, and save an estimated £500 million a year.
However, the restructuring comes at a cost—over 9,000 jobs are expected to be cut. The transition will take approximately two years, during which NHS England’s functions will be gradually absorbed into the DHSC.
What Happens Next?
Once the merger is complete, the DHSC will take over NHS England’s responsibilities. In theory, this could lead to a more streamlined and efficient system, as Health Secretary Wes Streeting argues. In practice, it could also mean greater political interference in the day-to-day operations of the NHS.
Yet, abolishing NHS England does not address the root problems plaguing the NHS—chronic underfunding, long waiting times, staff shortages, and growing public dissatisfaction. While the government insists that the abolition of NHS England will reduce waste and improve efficiency, these are the same promises that have accompanied almost every major NHS reform in history.
For now, daily interactions with the NHS probably won’t change much. GP appointments, hospital visits, and emergency care will continue as normal. But behind the scenes, decisions about NHS funding, staffing, and performance targets will be more directly influenced by government ministers. Whether this creates a more accountable and efficient healthcare system—or just a more politicised and bureaucratic one—remains to be seen.
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