Abolishing NHS England: risks and opportunities

Abstract

NHS England (NHSE) was always an uneasy compromise, caught between the NHS and ministers. Designed as the NHS headquarters and free to operate without day-to-day political involvement, it is nevertheless accountable to ministers for NHS performance and achieving ministerial goals. Unsurprisingly this led to duplication of activities between NHSE and the Department of Health and Social Care (DHSC) which monitors it on behalf of ministers. Both organisations need expertise in relevant areas, and continuous supervision inevitably leads to tensions and rivalry. Part of NHSE’s role is to hold NHS organisations to account for performance and, again unsurprisingly, the same duplication, tensions, and rivalry occur. It is also no surprise that at this time of crisis and financial pressure politicians are frustrated and want to cut out this intermediary and take back direct control. There are, however, many risks and downsides. Success will depend on how this massive change is managed and on creating a workable future relationship between ministers and NHS organisations. Any reorganisation risks losing focus and vital skills and wasting time and money. Performance is likely to …