Prime Minister Keir Starmer has announced he will abolish NHS England, the administrator managing the health service, as experts warn of the ‘critical’ impact on dentistry.
NHS England will be brought into the government to avoid duplication of jobs across the two organisations, resulting in a 50% reduction in staff.
The Department of Health and Social Care (DHSC) said this was to avoid ‘layers of red tape and bureaucracy’. In particular, it hoped the restructuring would represent ‘an end to the duplication resulting from two organisations doing the same job’.
Speaking in Hull, Starmer said: ‘I don’t see why decisions about £200bn of taxpayer money on something as fundamental to our security as the NHS should be taken by an arm’s length body, NHS England.
‘And I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy. That money could and should be spent on, nurses, doctors, operations, GP appointments. So today, I can announce we’re going to cut bureaucracy across the state, focus government on the priorities of working people, shift money to the front line.
‘So I’m bringing management of the NHS back into democratic control by abolishing the arms length body NHS England. That will put the NHS back at the heart of government where it belongs, free it to focus on patients – less bureaucracy, with more money for nurses.’
What is actually happening to NHS England?
The DHSC has outlined what the abolition means in a press release today. It says: ‘NHS England will be brought back into the Department of Health and Social Care to put an end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients.
‘By stripping back layers of red tape and bureaucracy, more resources will be put back into the front line rather than being spent on unnecessary admin. The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability. As Lord Darzi’s independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system.
‘The current system also penalises hardworking staff at NHS England and the Department of Health and Social Care who desperately want to improve the lives of patients but who are being held back by the current overly bureaucratic and fragmented system.’
Speaking on the abolition, Health secretary Wes Streeting said: ‘When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.
‘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 doesn’t mean it shouldn’t 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.’
‘Radical reform’
While the changes are estimated to save roughly £175 million per year, around 6,500 jobs may be at risk across NHS England and the DHSC.
NHS England chief executive Amanda Pritchard acknowledged that the news would be ‘unsettling’ for staff but maintained that now was the time for ‘radical reform’. She continued: ‘The transition team will develop plans over the coming weeks and we know that colleagues will want this to be completed as soon as possible to provide future certainty.’
NHS Confederation chief executive Matthew Taylor said that ‘it makes sense to reduce areas of duplication at a national level and for the NHS to be led by a leaner centre’. However he said the changes were ‘happening at a scale and pace not anticipated to begin with’.
The DHSC said work would begin immediately to bring NHS England under government control. It said: ‘Too much centralisation and over-supervision has led to a tangled bureaucracy, which focuses on compliance and box-ticking, rather than patient care, value for money, and innovation.’
How has the dental profession reacted?
The British Dental Association (BDA) warned that the restructuring could ‘critically undermine an already fragile dental public health function’. The association said that the ‘vital specialty’ had already been ‘extensively diminished’ over the past decade.
The BDA advised against changes that could ‘further erode’ capacity. It said: ‘Since the transfer of the national dental public health function from Public Health England to the DHSC, the number of dental public health consultants in this sector has decreased from six to just two.’
Professor Robert Witton, chair of the BDA’s Dental Public Health Committee said: ‘The cuts at NHS England are unprecedented. There’s no duplication of effort with dedicated dental public health professionals, who are already in very short supply. Government wants to shift the focus from treatment to prevention. Putting these jobs on the line won’t achieve that goal.’
It is unclear whether the staff cuts would affect the headcount of dental public health consultants. The BDA said that reducing the number of these consultants would ‘significantly hinder, perhaps irreversibly, the ability of the workforce to carry out its vital role’.
The association also stressed that promised improvements to public oral health would rely on ‘a fit for purpose dental public health consultant workforce to drive the prevention agenda and effectively measure its success’. It then ‘implored’ NHS England and the DSHC to ‘advocate for the safeguarding of the dental public health consultant workforce’.
Thomas Reynolds, director of policy and communications at the Medical Defence Union (MDU), said: ‘Today’s announcement by the prime minister that NHS England is to be abolished has the potential to be a landmark moment in the NHS’s story.
‘However, the NHS is not about structures and agencies, it’s about people. Healthcare professionals and patients. Regardless of where control of the NHS sits in England – with central government or another body – the same challenges remain.
‘From ensuring the workforce is properly supported, to having regulatory frameworks which enable healthcare professionals to get on with the job of caring for patients, to tackling unsustainable costs facing the NHS such as those associated with clinical negligence: all require urgent attention. They cannot be sidelined in this latest health service structure. That is why the MDU will continue to champion and highlight these issues.’
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