Report

Abolished to perfection? Building a better centre for the NHS

This report from UK think tank the Institute for Government examines how the abolition of NHS England creates both risks and opportunities.

The abolition of NHS England comes with significant opportunities to make the health service’s centre work better within government and in leading the service. It also carries significant risks. The consistent lesson from past reforms is that change of this scale only works when there is a clear and shared purpose from the outset. For NHS England, this has not been consistently articulated or communicated from the start, making it much harder for the system to align around what this reform is meant to achieve.

Another lesson from history is that disruption and distraction are inevitable features of abolishing public bodies. This change will slow service development and the delivery of operational and policy goals under the 10 Year Health Plan. Planning carefully and then moving fast would have been a better way to implement this change: delays are a source of concern.

Bringing powers together in the Department of Health and Social Care (DHSC) makes it more possible to control the excessive cascade of priorities and orders currently sent to NHS trusts and integrated care boards. It may also enable better links between the NHS and the rest of government, which have often been lacking, and may create better conditions for cross-government working, enabling a clearer focus on health goals for the population.

Dysfunctional dynamics have existed between NHS England and the DHSC, with duplication in scrutinising others doing similar tasks and wrangling over data in an environment of mistrust. This should be significantly improved by the merging of powers.