Policy briefing: abolition of NHS England

What has been announced?

The Government has announced that NHS England will be abolished and merged into the Department of Health and Social Care (DHSC) within two years. As part of Government plans to "avoid duplication" with DHSC, it is expected that this will result in thousands of job cuts at NHS England, with the aim of saving hundreds of millions of pounds per year.

The Secretary of State for Health and Social Care, Wes Streeting, has stated that the 2012 NHS reorganisation by ‘The Health and Social Care Act’, referred to as the ‘Lansley reforms’ that established NHS England and clinical commissioning groups, had created “burdensome layers of bureaucracy without any clear lines of accountability”.

The Secretary of State also highlighted that the Hewitt review had concluded that having DHSC and NHS England carrying out the same job has caused tension and wasted resources. These changes will directly influence the 10-Year Health Plan, and it is envisaged that this will lead to a stronger push towards the three big shifts: hospital to community; analogue to digital; and sickness to prevention. While these reforms come into force, the Secretary of State has said he expects NHS England to hold local providers to account for the outcomes that matter to the public, including to cut waiting times and to manage finances responsibly.

What do we say?

We broadly welcome the streamlining of the NHS and in particular the aim to move towards a more agile and responsive governance process for the NHS. We also welcome the news that there will be two national clinical directors, one for primary care and one for secondary care, but it is important that the director for primary care is an advocate for all parts of primary care, including optometry. These reforms must embrace the breadth of skills and talent across all of the primary care sector and not simply focus on tackling the challenges faced by GP colleagues. Only by doing so will the issues identified by Lord Darzi be tackled successfully.

Understandably our members will have many questions, and the answers to some of those questions will only become apparent as more details are announced and the merger of the two organisations proceeds. However, given the intended reduction in staff across the merged organisations, and a shift to a decentralised model with more power and autonomy to local leaders and systems, it will be critical to understand how decisions will be made and by whom.

For some time, we have called for the NHS to make better use of the skills and equipment in primary eye care to tackle the NHS backlog, reduce the pressure on hospital eye services and GPs, and cut the number of patients who are losing their sight. This was highlighted in our report by PA Consulting, which recommends four key interventions to transform eye care and eye health. We hope that this restructure of the NHS will provide new impetus to enhance and rebalance how eye care is delivered and tackle longstanding problems such as the lack of digital infrastructure that for so long has hindered new ways of working.

In any NHS restructure there are always risks and we will continue to monitor those risks carefully. Despite the positive intentions of this change, there is a concern that until new systems and processes are embedded, decision making slows rather than speeds up. Local commissioning may bring many benefits, but it is also our opinion that services such as the General Ophthalmic Services (GOS) contract should remain nationally commissioned. As the recent PA Consulting report highlighted, GOS delivers excellent value for the NHS, despite being chronically underfunded. It is important that these reforms do not undermine this essential service which does so much, for so many, for so little. Likewise, currently commissioned eye care services continue to provide health and economic benefits, and we argue these services should not be subject to a postcode lottery of care for the public.

The changes announced by the Government are not expected to impact healthcare in the Scotland, Wales or Northern Ireland, as decisions about healthcare have been devolved to these nations for some considerable time.