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.
Elon Musk wields a chainsaw, February 20 2025
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.
Wes Streeting, in conversation with Andrew Marr, for Policy Exchange fringe event
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.
In case you missed it: KONP co-chair Tony O’Sullivan on Novara Media responding to NHSE news here
JOIN THE PROTEST: Tuesday 25 March 6:30pm outside Conway Hall, 5 Red Lion St, London WC1R 4RL
Keep Our NHS Public, Just Treatment, Socialist Health Association and NHS Workers Say NO, have called a protest outside Conway Hall on March 25, from 6:30pm where Wes Streeting and Guardian Political Editor, Pippa Crerar, are holding a discussion called ‘England’s health and social care system is in crisis. How does Labour plan to turn it around?’
Streeting must listen to the demands of NHS campaigners, patients, and workers, commit to ending the private involvement that ultimately weakens our NHS and invest urgently to rebuild the NHS.
Please join us outside Conway Hall on 25 March from 6:30pm 8:30 to let Wes Streeting know the NHS is here to stay, privatisation no way!
Brilliant account of the situation. Campaigners should use it to stimulate discussions with their MP and others. Many new Labour MPs especially are open to alternatives to what Stamer and Streeting are saying and doing.
This is totally a government act of fraud , we have paid our NHS ever since it first started he knows that if he has a brain at all it is down to his greedy self and government they are the ones who have enticed this by bringing in unknown numbers of illegals who have been given free reign in our country by a traitorist government who have robbed us blind to pay the never ending money to people who have never paid a penny in and that also applies across the spectrum including schools and houses never in my 78 years has a government ever condemned our citizens how they sleep at night I will never know next thing will be we will be hoarded on boats to cross into countries. Like they have
Quite frankly Linda your comment is offensive and wholly inaccurate
Too right Well said
This is briliant news, hopefully it means they will get RID of the managers that are on eighth of a million quid a year. Said managers have only ever been jobs for the boys and not people who are qualified for the position.
How is it brilliant news ?What happens when you run out of money and nobody will treat you
We have been served well by the nhs for near on 80 years what you gonna do when you run out of cash and cannot be treated.
I’m forever greatfull to our NHS it got me through 2 serious cancers and I’ve just been diagnosed with a third. Less serious this time but still needs treating
Few years back I paid for 2 ops but it’s it’s looking like a knee job might be needed shortly
I know people who have paid £30 grand where do you dig that up from just like that
What Sir Kier Starmer is doing is disgusting Privatising the NHS for a member of the Labour Party,he is another Blairite, another version of the Tories. I am glad I resigned a member. Mr N Bevan will be turning over in his grave. the whole of NHS was devised for people who can’t afford to go private and people are still struggling to afford the cost of living. I wish Jeremy Corbin was still the Leader.
The NHS was designed for ALL people resident in the UK, not just those that couldn’t afford to pay privately. It should be universal, comprehensive, publicly funded and publicly staffed.
Why is money going towards a Private NHS when it could be donated to a Public NHS?