One year on: Where has the government’s decision to abolish NHS England left the NHS?

On 13 March 2025, Keir Starmer gave a speech that was trailed as being about increasing the use of AI in the public sector. Instead, he announced the abolition of NHS England (NHSE), the largest public body in the country.  

The PM’s big reveal came just a few weeks after health secretary Wes Streeting reiterated his commitment to not abolishing NHSE, arguing he “could spend a hell of a lot of time […] and a hell of a lot of taxpayers’ money changing some job titles […] email addresses and not make a single difference to the patient interest.” ¹⁷ https://www.hsj.co.uk/acute-care/exclusive-govt-abandons-commitment-to-hit-cancer-mental-health-and-aande-targets/7038590.article

Streeting wasn’t wrong. A year on, the department for health and social care (DHSC), NHSE and integrated care boards (ICBs) are elbow deep in a reorganisation which involves an awful lot of time and a lot of money – and the benefits have yet to materialise.

The government’s approach to NHSE abolition has improved

We have been critical of the way that the government handled the announcement of the abolition. Without re-treading too much ground, the government struggled to provide a coherent vision for what it was supposed to achieve, and left staff uncertain of their futures, among other problems. One senior civil servant working in the department described the ongoing process to us as “utter chaos”.  

That has improved in recent months. The government has now provided a better thought through timeline of the merger of NHS England and the health department, including an ambition that the entire reorganisation is concluded by April 2027. ¹⁸ https://www.hsj.co.uk/workforce/dhsc-nhse-merger-timetable-revealed/7040985.article

The government is also following a more coherent process for deciding the structure of the new department. That’s an important step for deciding how to approach the – still extensive – redundancies that are needed to meet the government’s target of a 50% reduction in the headcount between NHSE and the DHSC.

Integrated Care Board reorganisation is turning into a fiasco

One area, however, that has emerged as being far more problematic than even pessimists expected is Integrated Care Board (ICB) reorganisation.  

The last government created ICBs to encourage better integration between both NHS services and with other public services (local authorities, the police, adult social care providers etc), among other roles. This government has decided to consolidate the existing 42 ICBs into 26, while cutting 50% of ICB staff. Thus far, the process of ICB reorganisation has been as chaotic as the abolition of NHSE ²⁴ https://www.theguardian.com/society/2025/sep/20/nhs-integrated-care-boards-england-job-cuts-row – and the aims project itself seems dubious, at best.

The government has been vague about what functions and services ICBs will be responsible for. For example, in May 2025, the government designated special educational needs and disabilities (SEND) services as under “review for transfer” out of ICBs. ²⁵ https://www.england.nhs.uk/long-read/update-on-the-draft-model-icb-blueprint-and-progress-on-the-future-nhs-operating-model/  Since then, there has been no clarification of how SEND services will be managed, despite it being a government priority. The result is a mess. Some ICBs have already made those staff redundant.  

The government also wants to better integrate public services. Doing so requires relatively similar sized local organisations that can work together to understand and meet the needs of residents. But new ICBs will cover huge populations and will have to work with many more local partners than they do currently, despite large staff cuts.

Integration also requires good relationships between different agencies. They develop over years of collaboration. The ICB restructure tears those up, setting progress back years.

ICBs are vital organisations for the design, commissioning and delivery of services at a local level. The government is treating them like nothing more than a money drain. It is a mistake to do so.

The government is learning the cost of reorganisation

The government’s stated plans for the NHS are very ambitious, arguably requiring the service to go further and faster than it has at any point in its history.  

Those changes will not happen by magic. They require a lot of work from people working in the Department for Health and Social Care (DHSC), NHSE and ICBs. Most of those staff are now focused on a fight for their jobs, or else on a re-design of the organisations in which they work. In that thicket of distractions, capacity is reduced elsewhere – for example on conducting the extensive analytical work that will underpin the government’s new population health budgets. ²⁶ https://www.england.nhs.uk/long-read/fit-for-the-future-towards-population-health-delivery-models/

Streeting will also struggle to get discretionary effort from the workforce. There is strong evidence that morale is cratering in those organisations. DHSC was the Whitehall department with the largest drop in staff engagement between 2024 and 2025. ²⁷ https://www.gov.uk/government/publications/civil-service-people-survey-2025-results/civil-service-people-survey-2025-results-highlights  All the 19 ICBs that responded to the 2025 NHS staff survey saw a decline in staff morale. ²⁸ https://www.hsj.co.uk/policy-and-regulation/icb-morale-plummets-amid-restructures/7041263.article

A year on from Keir Starmer setting out the government's plans to abolish NHSE, the haste of the announcement and the lack of a clear vision for what would come next look even more misguided.

Watch our event on how the government can make a success of the abolition of NHS England