Abolishing NHS England Will Not Work, Says Former Health Secretary Behind Its Creation
Lord Andrew Lansley was the Conservative health secretary between 2010 and 2012 (Alamy)
5 min read
The government plan to abolish NHS England will not work, according to the former health secretary whose proposed reforms led to the creation of the arms-length body.
Lord Lansley likened the move to re-arranging deck chairs, writing "there is no difference in centralising control in a department of state as compared to a national arm’s-length body".
NHS England (NHSE) was originally set up under a Conservative government, following reforms put forward by Lansley as health secretary in 2012.
These changes have since been widely criticised by both Labour and Tory senior figures, however, with Lord Darzi writing in a landmark report that the Health and Social Care Act of 2012 was a "calamity without international precedent" which proved "disastrous".
Last week, the prime minister and health secretary announced that NHSE will be absorbed into the Department for Health and Social Care (DHSC), with Wes Streeting saying he was “bringing management of the NHS back into democratic control”.
The move, which is set to result in the loss of thousands of jobs, is part of the government's wider drive to make Whitehall more efficient. It received praise from figures across the political spectrum, including from former Tory health secretary Jeremy Hunt.
The relationship between DHCS and NHSE has often been an awkward one, with successive ministers and officials feeling that the creation of NHSE had essentially created duplicate units, leading to a sense that there was a lack of distinction between the ministry and the body.
Writing for The House this weekend, Lansley – now a Conservative life peer – agreed that NHSE should not continue in its current form, describing it as a “centralised, bureaucratic system that failed to achieve the potential for improvements in outcomes”.
He wrote that NHSE was an "irresponsible monopoly" that had gone “far beyond” what his reforms had originally envisaged, adding that this would have been avoided had ministers implemented all of his proposed reforms to the health service.
Lansley stressed, however, that the plan set out by Starmer and Streeting will not work.
He called the decision to merge NHSE into DHSC a “strategic error” that would “hand every problem back to the department” and see “NHSE functions being recreated in Integrated Care Boards (ICBs) all across the country”.
“Control is the obsession of self-serving bureaucracies,” he wrote.
“Improving outcomes is the driving force of a clinically-led health service. I know which I prefer.”
He said Labour ministers "look doomed to repeat the mistake" of over-centralisation.
“There is no difference in centralising control in a department of state as compared to a national arm’s-length body – save the fact that decisions will now be taken by ministers for political rather than clinical or managerial reasons. In practice, politicised needs will reach deep into operational decisions."
PoliticsHome understands that the decision to abolish NHS England altogether largely came straight from No10 – with pressure mounting on the government to show the public and its own supporters that it is capable of delivering fundamental change to public services.
Jennifer Dixon, chief executive of the influential Health Foundation think tank, wrote in The House that the decision to abolish NHSE came amid "permissive signals from DOGE’s activities in the US, impatience with perceived hypercautious ‘blockers and checkers’ of the regulatory state slowing progress, and the ‘move-fast-and-break-things’ insurgency in the air".
Having worked in health policy for more than 30 years, Dixon cited the "almost Maoist creation then swift destruction of government agencies over the last three decades", including the NHS Modernisation Agency, the NHS University, the Commission for Health Improvement, the Healthcare Commission, the Audit Commission, Public Health England, Monitor, NHS Improvement.
"The colossal cost, disruption and loss of expertise has not been profiled enough, and the feedback loop to ministers responsible is lost as they move swiftly to another job," she said.
Dixon added that the "abrupt" announcement had been "chilling, avoidable and very sharply demotivating" for NHS leaders who would be needed to implement the changes.
"When government agencies are successful, they are generally quiet and deliver," she continued.
"Politics today doesn’t demand quiet, however, but increasing excitement, audacity and disruptive combat to show progress.
"The Prime Minister said he wants a government of stability and moderation. The chainsaw approach is not a sign of a healthy state."
Former No10 spokesperson Max Blain, who also worked in DHSC, has also expressed doubts about the government's plans. He told this week's The Rundown podcast by PoliticsHome that the government aim to deliver NHSE reforms in two years would be "ambitious” and “expensive".
While there are still questions over how the planned merger will work in practice, in the meantime senior NHSE figures are keen to combat any suggestion that the body has been a failure, and PoliticsHome understands that in the coming weeks, they plan to publish a record of the organisation's positive delivery.
There is a close inner circle at the top of NHS leadership, with new NHSE chair Dr Penny Dash and interim CEO Jim Mackey keeping major upcoming decisions about what services will be cut tightly under wraps from other staff.
The government has already announced, however, that Integrated Care Boards (ICBs) will have to cut their costs by half, and there have been signals from NHS chiefs that sweeping cuts could be made to non-clinical administrative staff more widely across the NHS.
Liam Cahill, a health-tech expert and former special adviser to NHS England and NHS Improvement, said that cutting administrative staff would be “absolutely insane”.
“Go and speak to any clinical team and say who do you want to protect? Most of all, they'd say our admin, because they keep us going.”
The new top team is largely made up of CEOs of acute trusts, which in Cahill’s view suggests that NHS trusts might have more of an ability to push back against cuts.
Cahill described how the NHS goals of shifting to prevention, moving care away from hospitals and into the community, and effectively integrating digital technology into healthcare were “very complex” in practice and would require the NHS to “unpick how local services operate”.
He added that in conversations with senior figures in NHSE, meeting these “huge objectives” while also attempting major efficiency drives sometimes felt like an “idealistic pipe dream”.
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