On March 13, 2025, Prime Minister Keir Starmer announced a historic change in the healthcare landscape of England by declaring the abolition of NHS England (NHSE). This bold move aims to integrate NHSE back into the Department of Health and Social Care (DHSC), where it was originally established. Starmer elaborated that this restructuring is intended to reduce bureaucratic duplication and inefficiencies while enhancing direct funding towards frontline services.
Health and Social Care Secretary Wes Streeting affirmed that NHSE would be fully absorbed into the DHSC within the next two years, driving forward the government's aim to streamline processes across healthcare agencies. According to David Stockdale, Chief Executive of the British Healthcare Trades Association (BHTA), the announcement raised expectations for improved technological procurement. He welcomed the initiative to expedite the deployment of cutting-edge technology through a centralized procurement model, stating, "In theory, the idea of abolishing NHS England to reduce duplication across NHSE and DHSC and speed up procurement of cutting-edge technology is great news."
Stockdale expressed hope that the reform would simplify the procurement process, making it less fragmented and more consistent across the NHS. He suggested that this change might eliminate the need for repeat submissions for NHS contracts, ultimately enabling local systems to select innovative products that add value rather than simply opting for the lowest price.
However, not everyone shares this optimism. Hugh Alderwick, Director of Policy at the Health Foundation, voiced concern over the potential disruptions this restructuring could cause to patient care. He described the abolition of NHSE as a watershed moment that would conclude a 12-year experiment aimed at managing the NHS independently from political influence. "Abolishing NHS England is... disruptive and could end up impacting patient care negatively," he said. Alderwick noted the inherent challenges of reorganizing NHS structures and cautioned that such changes often distract from care improvements.
Sarah Woolnough, Chief Executive of The King’s Fund, similarly questioned the justifications for this significant shift. She emphasized the need for clarity on how abolishing NHSE would facilitate better access to GP appointments and expedite planned care. Woolnough remarked, "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?" She highlighted that while reducing duplication might deliver some efficiencies, the overall cost savings are likely to be minimal.
Adding to the debate, Bath MP Wera Hobhouse also supported the move but emphasized that addressing the chronic staffing shortages in accident and emergency (A&E) departments is critical. Hobhouse expressed concern that without addressing these shortages, dismantling NHSE could lead to further risks to patient safety. According to her, "Cutting the red tape will make little difference if we don’t address the enormous gaps in staffing."
Amid these transitions, critical voices in the NHS have raised heightened alarms, particularly regarding the cybersecurity infrastructure within the organization. Denis Lafitte, Chief Digital Information Officer at Guys’ and St Thomas’ NHS Foundation Trust, expressed deep concern about the future of NHSE’s cybersecurity team. The recent ransomware attack on NHS pathology provider Synnovis in June 2024 had severe repercussions, leading to the postponement of over 10,000 outpatient appointments and 1,700 elective procedures. Lafitte marked the cyber team as essential during the crisis, noting, "The cyber security team from NHSE has been absolutely lifesaving for us in this incident. We don’t have cyber security experts in our IT department."
Lafitte underscored the necessity for continued NHSE support in cybersecurity amid the government’s reorganization plans. He explained that the cyber team played a crucial role in managing the incident effectively, enabling the trust to begin recovery operations swiftly. He insisted it was vital for trusts and frontline staff to maintain access to such support, reiterating the urgent need for solid security protocols as digital solutions continue to evolve within the NHS.
Further highlighting the need for robust cyber defense, Dr. Susan Robinson, Pathology Lead at Guys’ and St Thomas’, remarked on the alarming impacts of the attack on pathology services. She noted, “There was a real sense of a limit regarding the resilience of large-scale failings in pathology and transfusion services and the ability to respond at speed to resolve things.”
As the healthcare system braces for these sweeping reforms, stakeholders across the board are calling for clarity and a cohesive plan that not only addresses structural changes but also prioritizes staffing, patient safety, and cybersecurity safeguards. The success of these reforms lies in the balance between streamlining operations and ensuring that essential services adapt to meet the ongoing challenges faced by the healthcare system.
The initiative to abolish NHS England marks a pivotal shift in governance and underscores a pressing imperative for comprehensive planning and execution to enhance patient care capabilities while ensuring safety and efficiency within the evolving landscape of the NHS.
