Abolished to perfection? Building a better centre for the NHS

In March this year, Prime Minister Sir Keir Starmer announced that NHS England – the arm’s-length body overseeing, planning and funding the health service – would be abolished, with its functions brought back into the Department of Health and Social Care. He said the change would “put the NHS back at the heart of government where it belongs, freeing it to focus on patients”.

The transition is already under way: a dedicated team has been established, senior joint appointments made, and initial steps taken towards the pledged 50% headcount reduction. The change comes amid intense political and public scrutiny, with public satisfaction with the NHS at a record low, and commitments to improve the health service’s performance forming the centrepiece of national government priorities.

Structural reorganisation in and of themselves are rarely the answer to deeper systemic problems facing public services. But this moment presents a key opportunity to reset the centre of the NHS – how it operates within government, but also its relationship with local systems.

This report draws on evidence from two private roundtables held by the Nuffield Trust and the Institute for Government in July this year, involving officials engaged in the current transition, individuals with experience of past reforms, independent experts, and representatives from NHS bodies and central government. It also draws on experiences of historical reorganisations to identify lessons for managing the change effectively.