14 March 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.
