David Oliver: Abolishing NHS England is no panacea for the NHS’s woes

Abstract

On 13 March the prime minister, Keir Starmer, announced that NHS England (NHSE) was being abolished. He described it as the “world’s biggest quango,” saying that he wanted to “bring the NHS back into democratic control” and to “cut bureaucracy,” as “the state” had become “flabby and unfocused.”1 But is such a “big bang” structural reorganisation of central government agencies any solution to the NHS’s current problems—especially when the health and social care secretary, Wes Streeting, had said repeatedly that he didn’t want to pursue more structural reorganisation but wanted to focus instead on improving services?2 The service needs to tackle record waiting lists for elective care, long waiting times, overcrowding and unsafe bed occupancy in emergency care,3 record low satisfaction among patients and staff, workforce unrest (especially among younger employees),4 and wider issues around population health, inequalities,5 and social care.6 While Starmer’s sudden announcement was a surprise even to the health policy community, it followed the replacement of NHSE’s board chair and chief executive with Streeting’s own picks and the appointment of the former Labour health secretary Alan …