Political reporter
NHS England will be abolished and brought under “democratic control” in an attempt to cut bureaucracy and duplication, Sir Keir Starmer has announced.
The organisation, which oversees the country’s health service, will be brought into the Department of Health, and the PM said the move would free up money for frontline services.
The government said it expected around 50% of the jobs at NHS England, which as of December had 14,400 staff, and the Department of Health, which has 3,500 staff, to go.
In a speech in Hull, Sir Keir said for too long politicians had “chosen to hide behind vast arrays of quangos” – organisations funded by taxpayers but not directly controlled by the government.
The government said work would begin immediately to return many of NHS England’s current functions to the Department of Health and Social Care, with the aim of completing the process in two years.
The significant move gives the government more control and accountability over one of their key pledges – to cut NHS waiting times.
NHS England – which the government dubbed “the world’s largest quango” – oversees the health service, working with government to agree funding and priorities, as well as monitoring the performance of local NHS services.
It was given autonomy by the then-Conservative Health Secretary Andrew Lansley in 2012, with the aim of freeing the organisation from interference by politicians.
Health Secretary Wes Streeting said the changes would “liberate” frontline workers from excessive and “competing directions”.
Speaking to BBC Radio 4’s PM programme, he said the result would be “better value for taxpayers and better outcomes for patients because the hundreds of millions of pounds we can save will be redeployed to the front line delivering better care”.
Conservative leader Kemi Badenoch welcomed the move to bring the management of the health service back under ministerial control, but warned Labour “cannot hide if things go wrong”.
She did not have “high hopes” because Labour already ran the NHS in Wales and that was “doing a lot worse than the rest of the country”, she said.
Liberal Democrat leader Sir Ed Davey backed the plans, but argued they were not the main issue for the NHS.
To fix it, the government needed to focus on “getting more GPs, more NHS dentists, more community pharmacists, making sure that social care actually works”, he said.
The Health Foundation think tank warned the reorganisation would distract senior leaders.
And Sharon Graham, head of the Unite union, said: “Taking an axe to these jobs is an ill-thought-out strategy that could end up meaning frontline healthcare staff struggle to do their jobs effectively if they aren’t paid on time, don’t have basic medical supplies or are forced to do additional administrative work rather than treat patients.”
The news comes after senior NHS England figures including chief executive Amanda Pritchard and medical director Sir Stephen Powis announced they were stepping down.
The announcement came as part of a wider speech on reforming the state, which Sir Keir described as “overstretched” and “unfocused”.
“Over a number of years politicians have chosen to hide behind vast arrays of quangos, arm’s length bodies, regulators, reviews,” the prime minister said.
“A sort of cottage industry of checkers and blockers using taxpayer money to stop the government delivering on taxpayer priorities.”
The number of quangos has fallen by more than half since 2010 but there are still more than 300 across the UK.
They include regulators, cultural institutions and advisory bodies, ranging from large organisations like NHS England, to smaller ones like the Gambling Commission and the British Film Institute.
The water regulator Ofwat could be among other government quangos in line to be scrapped.
Ofwat’s role – along with the Environment Agency, the Drinking Water Inspectorate and Natural Resources Wales – is among the organisations already being looked at in a review of the whole water system in England and Wales, by an Independent Water Commission established last year.
Government sources would not pre-empt the outcome of the review but all options for regulating water are understood to be on the table, except nationalising water companies.
The new Labour government has set up more than 20 new quangos since winning power.
These include Great British Energy, which will invest in renewable energy to help meet the government’s clean power goals, and Skills England, which aims to support people to find jobs.
The government has also suggested it wants to cut the size of the Civil Service, which has a headcount of more than 500,000.
Civil servants are politically impartial officials employed by the government, covering areas including policy development and services like benefits and prisons.
In his speech, Sir Keir linked the need to reshape government to global instability which has pushed up bills at home, saying the state needs to be operating at “maximum strength”.
He promised to cut the costs of regulation for businesses by 25% to boost economic growth.
His plan also includes greater use of artificial intelligence, underpinned by the mantra that civil servants should not be spending time on tasks where digital or AI can do it better and quicker.
Earlier this year, Sir Keir faced a backlash saying “too many people in Whitehall are comfortable in the tepid bath of managed decline”.
In his speech he was keen to stress his criticism was not aimed at individuals but the system as a whole.
Having spent the last few weeks focused on diplomatic wrangling over Ukraine, the speech saw the prime minister return to domestic challenges – specifically a feeling that services in the country do not work well enough.
It also reflected growing concern in Downing Street that there are too many organisations that ministers can not directly control.
For the public, the key question will be whether these changes result in any perceptible improvement.
Former head of the Civil Service Lord [Gus] O’Donnell told the BBC the government’s messaging to civil servants was “nothing short of disastrous”.
Speaking on Radio 4’s PM programme, he referenced Sir Keir’s “tepid bath” comment and a government briefing to the Guardian on Wednesday saying “they wanted to do ‘project chainsaw’. Trying to be a mini Elon Musk?”.
He described these remarks as “absolutely ridiculous” and “really damaging” for the prime minister and what he wanted to achieve.
Mike Clancy, head of the Prospect trade union, which represents civil servants, agreed reform was needed but added: “The government must recognise that there is a fine line between cutting back bureaucracy and undermining the essential functions of the state.”
“Civil servants in agencies such as HSE [Health and Safety Executive] and the Environment Agency are at the frontline of delivering on the government’s missions – writing them off as ‘blockers’ is a profound mistake.”
