Reforms to reduce bureaucracy, make savings and empower NHS staff to deliver better care for patients have been set out by the Prime Minister, Keir Starmer.
NHS England will be brought back into the Department of Health and Social Care (DHSC) to put an end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients. By stripping back layers of red tape and bureaucracy, more resources will be put back into the front line rather than being spent on unnecessary admin.
The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability. As Lord Darzi’s independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system.
The reforms to deliver a more efficient, leaner centre will also free up capacity and help deliver significant savings of hundreds of millions of pounds a year, which will be reinvested in frontline services to cut waiting times through the government’s Plan for Change.
The changes will crucially also give more power and autonomy to local leaders and systems – instead of weighing them down in increasing mountains of red tape, they will be given the tools and trust they need to deliver health services for the local communities they serve with more freedom to tailor provision to meet local needs.
The number of people working in the centre has more than doubled since 2010, when the NHS delivered the shortest waiting times and highest patient satisfaction in its history. Today, the NHS delivers worse care for patients but is more expensive than ever, meaning that taxpayers are paying more but getting less.
Too much centralisation and over-supervision has led to a tangled bureaucracy, which focuses on compliance and box-ticking, rather than patient care, value for money and innovation. In one example, highlighted by Dame Patricia Hewitt’s 2023 review, one integrated care system received 97 ad-hoc requests in a month from DHSC and NHS England, in addition to the 6 key monthly, 11 weekly and 3 daily data returns.
The review also revealed the challenges caused by duplication – citing examples of tensions, wasted time and needless frictional costs generated by uncoordinated pursuit of organisational goals that do not take account of their wider effects.
Substantial reform, not just short term investment, is needed to deliver the government’s Plan for Change mission to get the NHS back on its feet and fit for the future, and this announcement is one of a series of steps the government is taking to make the NHS more productive and resilient so that it can meet the needs of the population it cares for.
NHS England’s new leadership team, Sir Jim Mackey and Dr Penny Dash, will lead this transformation while re-asserting financial discipline and continuing to deliver on the government’s priority of cutting waiting times through the Plan for Change.
These reforms will provide the structure necessary to drive forward the 3 big shifts identified by government as crucial to building an NHS fit for the future – analogue to digital, sickness to prevention and hospital to community.
