UK Dismantles NHS England: Potential Public Health Disruptions without Obvious Solutions?

UK Prime Minister Keir Starmer’s government continues its push to overhaul the country’s iconic National Health Service (NHS). After originally announcing plans to restructure NHS England, the body that manages the NHS in England, it has now decided to eliminate it altogether. In a move that Starmer said would increase efficiency, NHS England will be merged into the Department of Health and Social Care (DHSC). The reshuffle will potentially cause disruptions, but the impact it will have on issues like staff shortages and procedure backlogs remains to be seen.

Reducing Red Tape

In the Keir Starmer government’s latest move to reform Britain’s ailing public health system, the prime minister announced that NHS England will be eliminated and merged into the DHSC in a process that should take two years. Getting rid of the organisation that has some 15,000 staff will, Starmer said, “cut bureaucracy” and bring management of the public health service “back into democratic control.” He claimed that axing NHS England would effectively free up funding for doctors, nurses and frontline services and step up the overall process of reform within the public health system.

Health secretary Wes Streeting who called NHS England “the biggest quango in the world,” said that abolishing it was the “final nail in the coffin of the disastrous 2012 [NHS] reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history.”  Streeting has long criticised the duplication of work between the DHSC and NHS England and previously announced his plans to downsize both structures. Now, however, the government has decided that a straightforward elimination of NHS England is the best way to increase efficiency and save money.

Britain’s public health system is chronically understaffed and riddled with backlogs that add up to 6.4 million people waiting for 7.5 million treatments. While the Starmer government has made NHS reform a priority on its agenda, giving the service a major funding boost of GPB 22.6 billion in its first budget, its latest move has generated both scepticism and concern.

Upheaval and Disruption

Apart from the potential elimination of 10,000 jobs, some experts warn that merging the two entities stands to bring about significant upheaval, potentially diverting attention from pressing issues and interrupting service during the transition period. “Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients,” said Hugh Alderwick,  director of policy at the Health Foundation charity.

For the organisation that encompasses the whole of the UK’s healthcare system, the NHS Confederation, getting rid of NHS England is a radical change. “This is the end of an era for the NHS and marks the biggest reshaping of its national architecture in a decade,” said Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers.

Others see the new shift as a step in the right direction. According to James Mackey, the transitional chief executive of NHS England, despite the probable upheaval, it will position the NHS to eventually “deliver the biggest bang for our buck for patients, as we look to implement three big shifts: analogue to digital, sickness to prevention, and hospital to community.”

Healthcare professionals remain cautious. “Abolishing NHS England is a bold step to take in the re-structuring of England’s healthcare system, but with so much at stake there are no easy options and upheaval is inevitable,” said Dr Naeem Nazem, head of Medical at the Medical and Dental Defence Union of Scotland (MDDUS).

The pressing issues faced by the NHS will not be automatically be resolved by the change, Nazem warned. “Staff shortages, a burned-out workforce and increasing workloads must be addressed.” Thea Stein, chief executive at the independent health think tank, the Nuffield Trust, agreed. “Profound problems facing the NHS remain: how to meet growing patient need in the face of spiralling waiting lists and how to invest in care closer to home with the NHS’s wider finances already underwater.”

The government’s decision to abolish NHS England and integrate its functions into the DHSC will most certainly have implications for patients in the short and long run. As Professor Azeem Majeed, head of the Department of Primary Care and Public Health at Imperial College London pointed out, “patients could benefit from improved care delivery through reduced bureaucracy and redirected resources to frontline clinical services, though there is a risk of temporary disruption that will require careful management.”

Louise Ansari, chief executive at the independent champion for health and social care services users, Healthwatch England, acknowledged the intention behind the change. “We know people want better access to care for everyone.” Yet she also alerted that caution should be exercised during the transition. “During the forthcoming period of change, it’s important that everything possible is done to ensure that patients’ care is not disrupted and that the progress the NHS has been making in some areas is not reversed.”

Stimulating Life Sciences

In addition to reforming the NHS, the UK government has also taken steps to encourage the country’s lagging life sciences sector. The investment of GBP 20.4 billion designed to boost Britain’s R&D efforts and the pledge to fully fund the UK’s association with Horizon Europe, are two good examples.

Nonetheless, the  pharma industry has complained that Britain’s Voluntary Scheme for Branded Medicines, Pricing, Access and Growth (VPAG), designed to limit what the NHS pays for drugs, is making the UK “un-investable.” In a new report from the Association of the British Pharmaceutical Industry (ABPI), the organisation representing the industry claims that the clawback tax, far exceeding the predicted 15 percent for the year, is significantly higher than in countries like France or Germany where it is between six and nine percent.

“The government has rightly identified life sciences as a critical growth sector for the economy, but unless these excessive payment rates are addressed, the UK will not see the growth and investment we all want,” said the ABPI’s chief executive Richard Torbett.

Perhaps open to discussion about the VPAG, the government has invited pharmaceutical industry representatives to a summit in April, reports the Financial Times.