NHS England

NHS England is being abolished. Not tweaked, not restructured, not given a shiny new logo – scrapped. And about time too.

Before 2012, the NHS was hardly a model of slick efficiency, but at least it functioned. Hospitals ran, patients got seen, and while there were always grumbles, you didn’t need a degree in bureaucratic nonsense to understand who was in charge. Then along came Andrew Lansley and his grand idea of turning the NHS into a market. Out went the straightforward system of regional health authorities. In came NHS England, Clinical Commissioning Groups, and a mess of overlapping responsibilities that ensured nobody could get anything done without three meetings, a feasibility study, and a 60-page report on why something that worked perfectly well before was now impossible.

Even Hay, who works in the NHS and has the patience of a saint, thinks the bureaucracy is unbearable. If you want to do something simple – like hire a new nurse or move a bed – you practically need to summon a panel of experts, complete an environmental impact assessment, and cross-reference it with an initiative that was abandoned six years ago but still technically exists in a forgotten subcommittee. It’s a miracle anything happens at all.

The results of this managerial mess were about as predictable as a government IT contract.

• Waiting times shot up – In 2010, hitting the four-hour A&E target was routine. By the time NHS England had finished reinventing the wheel, the only thing hitting four hours was the length of time you spent waiting after seeing the triage nurse.
• Admin exploded – The whole point of the 2012 reforms was to cut red tape. Instead, we got a multi-layered system where hospitals had to bid for services, GP-led commissioning groups were supposed to act like tiny purchasing departments, and millions were wasted on contract negotiations that should never have existed in the first place.
• Nobody knew who was in charge – Before, the buck stopped with the Department of Health. After? If you wanted to know why your local hospital was in crisis, you had to navigate a bureaucratic jungle that made the European Parliament look streamlined.
• The COVID response was a shambles – At the exact moment the NHS needed to act as one, it was tangled up in competing structures that had spent the last decade being told to operate like a business. The result? A system so fragmented that half the people making decisions weren’t sure if they even had the authority to act.

And now, after twelve years of watching this slow-motion car crash, someone has finally had the bright idea of reversing it. NHS England is going, and that’s objectively a good thing. Before it existed, the NHS worked better. After it existed, it worked worse. That should really be the end of the debate, even though it's a bit simplistic.

Of course, there’s always the risk that this turns into yet another reshuffle with fancy talk of "streamlining" while everything stays exactly the same. The real test is whether they genuinely simplify the system, give local trusts back some autonomy, and stop pretending that turning hospitals into competing franchises was ever a good idea.

Ignore the Union concerns - their agenda is to preserve jobs and nothing else. They have a vested interest in not making the changes, and so they should - it's what they're paid for - but they're hardly objective.

The lesson here is simple: if something isn’t broken, don’t let a government minister "fix" it. And if they do, be prepared to spend the next decade undoing the damage. In the meantime, practitioners will continue battling the NHS bureaucracy while trying to actually help patients.