The biggest NHS shake-up in a decade

The Prime Minister has announced the abolition of NHS England, promising to merge it into the Department of Health and Social Care over the next two years. Health Secretary Wes Streeting described NHS England as “the biggest quango in the world”. However, Unison has described the announcement as “shambolic”, warning that it will leave thousands of employees “reeling”. The proposal has made headlines today - Olly Scargill discusses what it will mean for the long-term governance of our health service.

Established in 2013 under the coalition government, NHS England was designed to give the health service more independence from direct political control. The Health and Social Care Act (2012) also meant huge restructuring for other parts of the NHS as well, including the creation of what we now know as Integrated Care Systems (ICSs), intended to reduce bureaucracy at the time. It’s not clear at this point how autonomous ICSs will remain once NHS England has been merged back into the DHSC.

Whilst the government has been keen to emphasise its intention to devolve powers locally, this is ostensibly a step back to centralisation. In July 2024, IPSOS found that the NHS was the top priority of 47% of people in Britain. Government will no doubt consider centralisation as a means of removing bureaucratic barriers and more easily achieving its manifesto aims - such as shorter waiting lists.

But what will centralisation mean for local priorities?

The differences in regions and populations across our country means local allocation is vital for effective health promotion, prevention and protection. There’s also more stark examples: an ICS in a rural area like the South West will need to co-ordinate their ambulance services with a population who are many miles from the nearest Emergency Department, whilst in an urban area like London the challenges are different.

ICSs will have to navigate the priorities of ministers, who will now be responsible for budget allocation, and addressing the concerns and priorities in the local area that they serve.

The NHS has been through many iterations since 1948, but the closure of NHS England marks the biggest governance shift of the health service in the last decade. While the details of what comes next are still unclear, what we know so far indicates that government intends to pursue national rather than place-based solutions to NHS reform.

As these changes become reality, an impactful Health Scrutiny Committee will need to keep a watching brief to ensure that local priorities are addressed. Our Scrutiny Reviews can assist authorities to maximise the impact of scrutiny and ensure it is best placed to serve local people.