“The administration of the internal market requires thousands of staff both in commissioning organisations such as NHS England AND in provider hospitals and other services. Simply moving these roles from NHS England to the Department won’t address this issue.”

The SHA calls for a publicly provided and properly funded NHS in the context of a fully functioning welfare state. Its position on the 2012 reforms that created NHS England, removing commissioning and planning responsibilities from democratic accountability, was that these reforms should be reversed and that the NHS should be reinstated per the NHS Reinstatement Bill. This includes to:

• reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services,
• abolish the NHS Commissioning Board (NHS England) and re-establish it as a Special Health Authority with regional committees,
• abolish NHS trusts,
• ….. repeal the competition and core marketisation provisions of the 2012 Act

This remains our position; of course the consolidation of responsibilities within the Department of Health and Social Care could lead to clearer lines of accountability and decision-making. However the summary dismantling of NHS England and the cutting of costs by “at least £500m per annum”- up to 9,000 staff in the Department of Health and Social Care and in NHS England will not in themselves deliver the Reinstatement of the NHS.

Dismissing commissioning staff will not create more frontline staff from nowhere. Delivering services to the front line is constrained by the lack of trained staff as a result of years of neglect and underfunding; neglect because of the lack of coherent and funded staff planning and training, and underfunding resulting in poor pay- but resulting in crises of recruitment and retention. People simply cannot afford to work in the NHS. The 2024 Kings Fund report on NHS Workforce found that:

• In the NHS Staff survey in 2024, less than a third of NHS Staff were happy with pay or staffing levels; and
• There are around 111,000 unfilled posts in NHS providers.

Staffing gaps lead to a cycle of increasing pressures, poor staff wellbeing and poor staff retention. The BMA reports rising levels of stress, fatigue, burnout and mental health problems, contributing to absenteeism and staff attrition.

Furthermore, the slashing of the NHS England bureaucracy must be in the context of removing the internal market and the national tariff. The administration of the internal market requires thousands of staff both in commissioning organisations such as NHS England AND in provider hospitals and other services. Simply moving these roles from NHS England to the Department won’t address this issue.

Our 2024 report In Place of Profit described the Policy thinking in the English NHS, as “being confined to a type of business thinking not dissimilar to the commercial practice of corner cutting. But after over thirty years’ experience, this model has not proven it has any social purpose – despite repeated, performative “reforms” which have simply taken it further.” The 2012 reforms indeed took this “business thinking” further, as did the Heath and Care Act 2022 reforms to constitute Integrated Care Boards.

It is our view that if this “business thinking” remains anchored in the economics of the market place and of competition, the removal of NHS England will not achieve improvement in ethos and purpose.

Conclusion

To restore the NHS to its founding principles and take us forward with the NHS we need, we should:

“…restore the NHS as an accountable public service…abolishing the purchaser/provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.”

The removal of NHS England is a necessary but not sufficient step towards this end. It will not deliver staffing and services to the front line without a robust workforce plan and sufficient attention to staff pay and conditions. It must be accompanied by the dismantling of the internal market and its ethos and bureaucracy. It must be accompanied by the Reinstatement of the NHS.

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