UK’s Starmer scraps NHS England to cut red tape and improve efficiency but patients worry about care quality

UK PM Keir Starmer is re-merging the National Health Service (NHS) England with the Department of Health and Social Care (DHSC) to, in his words, lower bureaucracy, cut costs, and improve patient care. The NHS is England’s publicly funded healthcare system that provides care and treatment. For nutrition, it informs dietary guidelines and policy, weight management and diabetes prevention, and hospital nutrition, including public health campaigns.

Citing the move as the “world’s largest quango scrapped,” the government wants to put patients first under reforms. Based on Lord Ara Darzi’s independent investigation, the effects of the NHS’ broken system on patients are felt today, with some worse off.

DHSC Secretary Wes Streeting believes: “NHS staff are working flat out, but the current system sets them up to fail. These changes will support the huge number of capable, innovative, and committed people across the NHS to deliver for patients and taxpayers.”

“Just because reform is difficult does not mean it should not be done. This government will never duck the hard work of reform. We will take on vested interests and change the status quo so the NHS can once again be there for you when you need it.”

Jobs to be halved

The reforms could mean cuts to thousands of jobs. 

UK PM Keir Starmer (Image credits: labour.org.uk).“NHS England has 15,300 staff; the DHSC has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings,” Streeting explains.

“Taxpayers are paying more but getting less. We have been left with two large organizations doing the same roles, with enormous duplication.”

Annette Mansell-Green, director of Trade Union and Public Affairs at the British Dietetic Association, tells Nutrition Insight that it is aware of the government’s decision, but it has caused turmoil for its members working in NHS England over the past few days.

“We are concerned that following weeks of speculation about the extent of potential cuts, the decision to abolish NHSE was announced without prior warning. We have no detail yet as to how and if the change will affect dietetic services and programs.”

“We are working closely with other health unions to press for meaningful engagement in the spirit of partnership to ensure that the rights of workers are adhered to and that allied health professionals are rightly and properly represented in any new structures at the DHSC.”

Restructuring health and nutrition

The UK Health Security Agency informs Nutrition Insight that Public Health England (PHE) was disbanded in 2022, and its nutrition responsibilities were transferred to the DHSC. 

Starmer scrapped NHS England and merged it with DHSC to cut bureaucracy, reduce costs, and improve patient care.Now, the government is making another major structural change by bringing NHS England — previously an independent body — back under DHSC control. Both nutrition policy and NHS services are now housed within DHSC.

The announcement says the reforms will reverse NHS’s 2012 top-down reorganization, which created extra bureaucracy and red tape.

Streeting continues: “This is the final nail in the coffin of the disastrous 2012 reorganization, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history.”

“When money is tight, we cannot justify a complex bureaucracy with two organizations doing the same jobs. We need more doers and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.”

The government believes the current system punishes NHS staff and DHSC, who want to improve patient lives but cannot due to the fragmented system.

Prof Azeem Majeed FMedSci, head of the Department of Primary Care & Public Health at Imperial College London, comments: “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.”

“NHS staff may face uncertainty around job security and morale issues during restructuring, but increased local autonomy may empower leaders to innovate and respond more effectively to local health needs. Efficiency savings are expected through reduced administrative duplication and significant workforce reductions, although essential expertise and organizational memory must be preserved.”

Potential health service challenges

Majeed cautions that maintaining uninterrupted essential operational functions will be critical during the transition.

The government is looking to reduce the overall headcount across NHS and DHSC by 50%.Professor Dame Til Wykes FMedSci, head of the School of Mental Health and Psychological Sciences at King’s College London, says: “The problems within the NHS are mostly due to lack of funding, not management.”

“The last CEO, Amanda Pritchard, was quietly solving the difficulties to produce a reduction in waiting lists. With the demise of NHS England, the government may regret having complete responsibility for all issues that arise — there will be no one to blame except themselves.”

“If scrapping NHS England means more involvement of the private-for-profit sector, then the health services are in for a difficult time — taking away services from the NHS makes the NHS less efficient and costs more to run.”

The Patients Association stresses that, from a patient perspective, the NHS’s success should not be judged by its administrative structure but by measurable improvements in care quality, access to services, and health outcomes.

“Patients need reassurance that clinical decisions will remain independent and based on evidence rather than political expediency, even as the NHS comes under more direct ministerial control.”

Diabetes.co.uk believes that NHS England’s abolition could lead to localized decision-making power for integrated care boards, allowing them to tailor services to local populations.

However, the community platform warns of potentially inconsistent access to medications and technology and the integration of diabetes care with preventative services. The workforce and specialist services may also be affected. The success of these reforms depends on their implementation and whether they improve patient care rather than simply shifting administrative responsibilities.

New leadership 

The government has announced Sir Jim Mackey, CEO of NHS Improvement, and Dr. Penny Dash, chair of the NHS North West London Integrated Care Board, will lead the transition and transformation of the NHS, focusing on financial discipline and restoring the body to its former health and fitness for the future.

From a patient perspective, the NHS’s success should not be judged by its administrative structure but by measurable improvements in care quality, access to services, and health outcomes.Mackey, who will be taking over as transition CEO of NHS England, says: “We know that while unsettling for our staff, today’s announcement will bring welcome clarity as we focus on tackling the significant challenges ahead and delivering on the government’s priorities for patients.”

“We now need to bring NHS England and DHSC together so we can deliver the biggest bang for our buck for patients as we look to implement three big shifts — analog to digital, sickness to prevention, and hospital to community—and build an NHS fit for the future.”

The government has taken actions to help the NHS, such as ending the strikes by resident doctors, cutting waiting lists by 193,000, and delivering an additional two million appointments seven months ahead of schedule.

Saving taxpayer money

The UK government says that transition work begins immediately, while assuring it will prioritize cutting waiting times and responsibly managing finances. It expects this will 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.”

Incoming Dash says he is committed to working with Jim to “ensure we start 2025 to 2026 in the strongest possible position to support the wider NHS to deliver consistently high-quality care for patients and value for money for taxpayers.”

The government believes new leadership will unlock the NHS’s unrealized potential as a single-payer system. The NHS will use technology to create future treatments and collaborate more closely with the life sciences industry.

In 2010, the NHS had the shortest waiting times and highest patient satisfaction, even though workers at the NHS have more than doubled since then, reveals the government. “Today, the NHS delivers worse care for patients but is more expensive than ever, meaning that taxpayers are paying more but getting less,” it reports.

The current government blames over-centralization and -supervision for increasing bureaucracy, where patient care, value for money, and innovation are underprioritized.