March 14, 2025 - 7:00am
Yesterday’s announcement from the Prime Minister marks a landmark shift in Government policy on the NHS. The scrapping of NHS England under Labour’s Milei-esque chainsaw could inject the service with a new lease of life, allowing it to escape the decade of suffocation it endured under its previous bureaucratic control.
In 2012, then-health secretary Andrew Lansley reorganised the health service, allowing it to be managed independently from the state. The ensuing decade combined austerity, rising bureaucracy, and a lack of responsibility for the deeply-entrenched problems within the health service to create a dismal legacy.
Current Health Secretary Wes Streeting yesterday admitted he could not count the number of Tories who had privately admitted their regret at the reorganisation and “wished they’d reversed it in office”. Various Conservative governments over the past decade seemed instead to dither around a disaster of their own making, before throwing money at the problem when it was already too late. Labour has now introduced reforms which may actually improve the NHS in the long run — and a true flagship policy for Streeting.
In his statement, the Health Secretary acknowledged the extent of the bureaucratic strata that define the health service for those on the front line. What’s more, after much reformist talk over the last few months, he is finally taking action to resolve the problem, cutting headcount by 50% and putting the NHS back under Government control.
Those working within the NHS are often overwhelmed by the sheer scale of the problem, finding themselves frustrated at the drawn-out nature of seemingly simple tasks. Patients don’t often understand why there are such delays during their hospital stays, or the complexity of the system in which they find themselves. It adds to the feeling of a service which has gone off the boil, with no one knowing where to begin when trying to address the problems.
The duplication of various services in NHS England is deeply illogical, a waste of desperately-needed time and money. To see Streeting recognise the sheer stupidity of doctors having to wait for broken computers to work (something we deal with on a daily basis) and instead stream the money saved towards technology and investing in the front line is the most hopeful I have felt about the NHS since I started working in it.
In 2022 Steve Barclay, the health secretary at the time, revealed that more than 400 bureaucrats employed by NHS England were on a salary of over £100,000 — roughly the same amount it would cost to invest in reducing logging in times for NHS staff, which could increase the number of patients seen. But over the next decade, there will need to be sustained investment into actual technology and AI for the health service; and it will need to be used, because it is the only chance the NHS has for survival in anything resembling its current form.
While yesterday’s cull is a risky move for both Starmer and Streeting, leaving them open to more scrutiny and responsibility for the NHS, it is still a commendable decision. And it’s not just doctors who support this new direction. Think tanks such as Reform have long acknowledged the service’s bureaucratic bloat and suggested abolishing NHS England before Labour entered power, giving more “strategic control” to the Department of Health and Social Care.
Of course, talk is easy — especially from politicians. Streeting has been vocal about NHS reform, but action is quite different to sound bites. With Labour embarking on its project of restructuring the NHS, focus must turn to what comes next. At least we now know that Starmer and Streeting are not afraid of accountability.
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SubscribeAmazing how different the response is to this versus if the Tories had done the same thing. The NHS doesn’t need to be recentralized, it needs to actually be abolished.
Labour themselves would have vigorously opposed and tried to scupper any such reforms the Tories might have suggested for political points.
I can’t agree with the need to abolish the NHS. I can certainly see the benefits of a hybrid system; no business (and that includes the NHS) should have an effective monopoly.
But you’re bang on about the howls had a Conservative government suggested it!
Idiotic article by beneficiary of current system.
He obviously forgot huge pay rises given to NHS parasites after, most of them, had 2 years holiday during covid “pandemic”.
Report about NHS showed productivity per head 25% below pre covid, already low, level.
No private organisation would award huge pay rises to underperforming workforce.
I had to deal with NHS over the last 3.5 years to get my knee replacement.
Total farce, duplication and mismanagement.
20% of staff look clinically obese, many standing in corridors gossiping instead of dealing with patients.
You come to hospital appointment and you see 2 or 3 people in reception of each unit with maybe 10 patients waiting to be seen.
Claiming that NHS is underfunded is farcical.
Money is just wasted on massive scale.
Does any other country adopted NHS model?
No, because no sane government would do that.
As to claims that NHS is envy of the world, I always add: yes Third world.
Many of them getting free treatment on NHS because there are no checks.
Article doesn’t really tell us much, except that doctors don’t like managers. And if it was an act of pure stupidity to create NHS England in the first place, what guarantee do we have that politicians are wiser now, and not brewing up the next crisis.
As a punter, the impression I get of the NHS is that it is poorly managed, from top to bottom. Will this improve?
10,000 roles to go, apparently, which is not the same as 10,000 redundancies. Sadly. No doubt there will be 5,000 new roles needed at the DHSC and the rest will find their new niches in an NHS trust somewhere across the country. Public sector headcount reduction? Nah!
In my role in a large acute hospital contact with NHSE non existent and most of my clinical colleagues wouldn’t know what they do. Our more senior managers do deal with them regularly as they have to answer for the performance standards and finances. However the duplication referred to is a nonsense and good news that finally being dealt with. Hopefully the redundancy costs can be reduced by redeployments into non clinical vacancies in front-line services as we constantly have issues with HR, Finance etc support – albeit AI may change what is needed too. Darzi report last autumn said the problem was in some areas the NHS is chronically under-managed and I can see that daily from where I work – albeit recognise inherent bias too.
Politically Starmerism, if one can start to call it that, is quite different from DOGE/Millieu Chainsaw-ism. They don’t believe the State can do anything much. Starmer clearly believes the State essential for so many lives but needs to be much more efficient. He’s right.
I think what is happening is that where the TBI* interns have influence on policy within this government, things are being done which, whether or not one agrees with them, resemble a policy and direction. Where the TBI people have little or no influence – the Treasury, Education, and crucially foreign affairs – ideology and panicky thrashing about continues.
*the Tony Blair Institute
Maybe, although I’m not sighted on the placement of specific TBI interns. You may be right on this but I’m slightly sceptical because elements of the media would have been all over it were it that straightforward. I agree though elements of TBI influence in how Starmer’s Labour think about things discernible.
On Foreign Policy – you may again be correct but Jonathan Powell seems to be a v astute appointment and he’ll have been a TB recommendation.
in some areas the NHS is chronically under-managed
It’s the impression you get as a punter too. And having studied it formally: provider capture, impotent managers and a kind of culture war between management and medical staff.
My first thought was “State run health service, what could possibly go wrong?” but it is in dire straits as it is. I have a loved one currently at the mercy of what passes for mental health care and it ain’t pretty. It is now almost routine that for any specialist diagnoses we have to look to going private. It is unsustainable for us and for many others, but when the profits of Pharma are examined it should be a cause for rage. Maybe this the road to recovery, maybe.
Sack them all.
Can we borrow the chainsaw for a while?
Let it now be overlooked that it was the Conservatives who set up NHS England. What a shower of manure!
What we’ll probably get are stupendous redundancy terms, and the same people re-employed in the same role with a different title.
If people want endless reports and league tables, waiting list sizes, comparisons between providers , they get bureaucratic bloat. So dump all that , simples. But you also lose clinical standards, patient safety frameworks and other mechanisms of scrutiny. Be careful what you wish for
Decentralisation is the key. Each trust should be allowed to control its own budget. Years ago a Hospital was taken out of the system as a trial and left to its own devises from procurement to wages. It actually made a profit showing that it could be done which frightened the powers to be and they scrapped the trial.