While removing NHS England will eliminate some bureaucratic overhead, it won’t solve the system’s deeper issues. Without substantial investment, meaningful workforce support, and a coherent social care strategy, the core challenges facing the NHS will remain. Structural change alone isn’t a silver bullet – what’s urgently needed is stable leadership, integrated approaches, sustainable funding, and long-term planning.
While removing NHS England will eliminate some bureaucratic overhead, it won’t solve the system’s deeper issues. Without substantial investment, meaningful workforce support, and a coherent social care strategy, the core challenges facing the NHS will remain. Structural change alone isn’t a silver bullet – what’s urgently needed is stable leadership, integrated approaches, sustainable funding, and long-term planning.
For those with longer memories, it’s beginning to feel inevitable: structural changes to the NHS tend to follow the general election. Despite pledging stability, both major parties have a track record of introducing major NHS reforms once in power. The Conservatives vowed not to reorganize the NHS in their 2010 manifesto – just as Labour did in 2024 – yet both ultimately pursued structural changes.
Why? At their core, these reforms were attempts to address the NHS’s long-term care challenges. When the NHS was founded, it was designed for a population largely affected by acute illnesses — short-term, treatable conditions. But today’s health landscape looks very different: people are living longer with complex, chronic conditions; social care remains underfunded; and patients expect more advanced and personalized care.
The NHS has struggled to adapt to the modern healthcare landscape. Its current pressures stem not just from structural mismatches, but from the cumulative effects of long-term underinvestment, rising demand, politically focused restructurings, workforce shortages, and a fragmented approach to healthcare. The COVID-19 pandemic exposed just how overstretched, under-resourced, and unworkable the system had become.
Despite repeated attempts at reform, many of the NHS’s core issues remain. Services remain fragmented, often with unclear responsibilities across different bodies. Past restructures have disrupted clinical progress and diverted attention and funding from frontline care, infrastructure, and equipment.
So, will the recent decision to abolish NHS England (NHSE) lead to better care and higher staff morale?
The honest answer is: it has potential, but it’s too soon to tell if this reform will lead to clinical improvements.
Medical professionals have responded with a mix of cautious optimism and deep concern:
Professor David Oliver, NHS consultant and visiting fellow at The King’s Fund, offered a sobering view:
“The NHS faces record waiting lists, staff unrest, and worsening health inequalities. Constant structural reorganisation hasn’t solved these problems. The separation of the Department of Health and Social Care from the arm’s length NHSE created blurred lines of accountability and duplication of staff and expertise. I understand why NHSE—never loved or wanted by many of us—is going. But its demise will be no panacea for the NHS’s woes.”
Professor Phil Banfield, Chair of the British Medical Association (BMA) Council, commented:
“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… 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.”
Professor Azeem Majeed, Head of Primary Care & Public Health at Imperial College London, noted:
“Patients could benefit from improved care delivery through reduced bureaucracy and redirected resources to frontline services… but NHS staff may face uncertainty and morale issues. Careful management will be critical.”
Professor Nicola Ranger, General Secretary of the Royal College of Nursing (RCN), warned:
“The chaotic reorganisation that created NHS England cost billions and distracted from clinical care. We can’t afford a repeat at a time when NHS performance is already at a historic low. The government must not lose sight of the public’s priorities.”
Dr. Naeem Nazem, Head of Medical at MDDUS, added:
“Abolishing NHS England is a bold step… but with so much at stake, there are no easy options and upheaval is inevitable. Burnout, staff shortages, and workload pressures must be addressed. There needs to be safeguarding in place to prevent the oncoming transition slowing the implementation of the new workforce plan.”
As a country, the UK needs to have an honest discussion about what it expects from the NHS going forward and how we will pay for those expectations to be fulfilled. The structural problems around funding, recruitment and retention and social care provision remain difficult issues to face. We hope that the scrapping of NHS England will, in the future, be seen as the first step on a necessary but painful road as the country gets to grips with the realities of healthcare provision in the 21st century. But only time will tell.
By our senior moderator Leigh Hart
We contacted Omar Ali, Head of Payers Verpora and former adviser to NICE for a comment.
‘Whilst we can debate the pros and cons of NHS England’s role and what they add by retaining a level of separation from DHSC, there is something far more insidious and sinister at play which should be troubling everyone who has interest in access for medicines to our patients. Until now, ICB/CCG model has allowed for localised commissioning and devolved budgets to pay for primary care diseases (i.e. COPD, hypertension, asthma, hay fever, cholesterol etc) and the drugs that go with them.
‘All the specialised medicines, typically high-cost drugs that have been NICE/NHSE approved (oncology, rare/orphan disease, specialist/tertiary centres, genetic/inherited disorders, specialist neurology etc) all get sent a bill to the bank of ‘Mum & Dad’ (AKA NHS England). These are where the dramatic year on year drug costs are rising exponentially and where we have hit that anomalous situation where a drug is cost effective, but we can’t afford it (i.e. budget impact thresholds).
‘So, by removal of NHSE, to further move that ability to write blank cheques for specialist medicines will now fall to those NHS organisations within a ‘fixed cash envelope’ is going to be potentially catastrophic. The bank of ‘Mum & Dad’ no longer exists. The Fixed cash envelope won’t cover the University Fees, Student Accommodation nor Living Expenses. And accountability is going to land as a giant meteorite impacting on the front line of the NHS.’
