What abolishing NHS England means and how it will affect YOU (2025)

Prime Minister Sir Keir Starmer has announced the abolition ofNHSEngland after 13 years as the Government seizes control of the health service.

We take a look at what the £13bn-a-year organisation is, and if and how the move will affect patients.

What is NHS England?

NHSEngland is a national organisation headquartered in London that is paid by the government to control the NHS's budget and policies.

It is what is known as a quango – a quasi-autonomous non-governmental organisation - or an arm's-length body.

This means it is run with government money but is allowed to make its own decisions instead of being totally controlled by politicians.

NHS England employs more than 15,000 staff but not doctors and nurses.

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They are ultimately responsible for instructing local health boards on how to run and what their priorities should be, and dividing up the NHS' £192billion budget.

NHS England is not part of the government but it translates what ministers want into workable plans for hospitals and GP practices.

When was it formed?

NHSEngland was formed 13 years ago in 2012 by David Cameron's Conservative and Liberal Democrat coalition government.

Before this, the health service was run by hundreds of GP-led organisations and dozens of separate health authorities that ran hospitals.

NHS England was set up to oversee a system of fewer but bigger local organisations that ran GP services and hospitals from under one roof.

The reforms were divisive and have been criticised for adding extra layers of office work and regulation without clear benefits.

A review last year by Lord Ara Darzi, ordered by Health Secretary Wes Streeting, said the number of bureaucrats had become a burden on medical staff.

Why is it being scrapped?

The Government claims axingNHSEngland will free up funding for the frontline, as well as cutting red tape to help speed up improvements in the health service.

On a visit to Hull, Prime Minister Sir Keir Starmer told one patient the move will reduce the "duplication" of work inNHSEngland and the Department of Health.

Five senior leaders have already quit, with the CEO, medical director and chief finance, operations and delivery officers all announcing in the past month that they will stand down.

Patients care about getting high-quality treatment when they need it, not about which organisation is in charge of the NHS

Rachel PowerPatients Association

NHS England cost almost £13billion to run last year, its accounts show.

Not all this money will be saved as most of its functions will still be needed but performed by the Department of Health and Social Care instead.

Health Secretary Wes Streeting said: "When money is so tight, we can't justify such a complex bureaucracy with two organisations doing the same jobs.

"We need more doers, and fewer checkers, which is why I'm devolving resources and responsibilities to the NHS frontline."

Who will run the NHS now?

The Department of Health and Social Care will take control of the NHS and some extra powers will be given to local bosses.

The Department of Health is at the heart of the Government and is currently run by Labour MP Wes Streeting, who will now shoulder full responsibility for the NHS' successes and failures.

Many staff from NHS England will be shuffled into the Whitehall offices.

Overall, the number of staff at the two organisations will be halved – with some 9,500 people made redundant – and the end result will be a total of about 10,000 workers left over.

The government will have nobody to blame but themselves

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Ministers hope this will speed up their plans because orders will flow straight from Mr Streeting's offices to local NHS bosses.

It will also save cash by paying fewer staff, and lower the risk of people objecting to or slowing down the Health Secretary's orders.

MPs recently accused officials in both departments of being "complacent" and slowing down improvements either deliberately or through incompetence.

How long will this take?

Mr Streeting told MPs on Thursday he wants the transition to be completed in two years.

How will it affect patients?

Nobody knows yet how the move will affect patients.

Rachel Power, chief of the Patients Association, said: "Patients care about getting high-quality treatment when they need it, not about which organisation is in charge of the NHS.

"The real test of these reforms will be whether they lead to shorter waiting times, better access to services, and improved care outcomes for people across England."

It is not likely to have an immediate impact on waiting times or the services that are available, as England's 42 local integrated care systems (ICSs) remain in control of the NHS in their areas and are not being changed.

Streeting said money saved at the top will "flow down" to the frontline, potentially meaning more money and therefore more staff for hospitals and GP surgeries in future.

He added: "We will set local NHS providers free to innovate, develop new, productive ways of working and focus on what matters most, delivering better care for patients."

The difference is likely to be that future reforms planned by the Labour Party – which will be set out in a 10-year plan in the coming months – may happen faster.

For example, in the current system, NHS England could warn the Department of Health that hospitals need 100 more scanners and then the government would decide what to do about it.

If it agreed to fund the new scanners, it would ask NHS England to make plans for where the machines should be posted and which cash hospitals should use to buy them.

Under the new system, the Department will have to do every step, including recognising what the health service needs, deciding if it is affordable, drawing up the plans based on the areas most in need, and distributing the money.

The changes may lead to more political arguments about how the health service is being run.

It has not been common for people to harshly criticise NHS England but politicians, experts and the public will not pull their punches for Streeting and Starmer.

What do the experts think?

Reaction to the news was mixed on Thursday as medics and experts said reducing paperwork was a good thing but there is a risk of chaos if the government takes on too big a job with too few staff.

Thea Stein, chief of the Nuffield Trust think-tank said: "It does make sense to remove duplication and bureaucracy and patients and the public are probably not going to shed many tears over the shifting of power from an arm’s-length body into central government.

“But profound problems facing the NHS remain and it is not immediately clear that rearranging power at the top will make a huge difference to these issues."

Top NHS psychologist and professor at King’s College London, Dame Til Wykes, said: "The government may regret having complete responsibility – there will be no-one to blame except themselves."

Professor Phil Banfield, chair of the British Medical Association, said: "It has been increasingly clear that NHS England no longer has a grip on the health service.

"The NHS has become too complex and unclear to frontline staff, patients, and the next generation of doctors

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"Any reorganisation must see that the Government retains the expertise needed in the coming battle to mend the NHS.

"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."