Wes Streeting has admitted he did not anticipate scrapping NHS England when he became health secretary but said it is a “necessary step”.

Before Labour won last summer’s election, Mr Streeting said he had “absolutely no intention of wasting time with a big costly reorganisation” of the NHS.

However, hours after Sir Keir Starmer dropped the bombshell that NHS England, the administrative body that runs the national health service, will be abolished to slash red tape, the health secretary said his mind had been changed.

Politics latest: Mood in NHS England ‘very low today’

He told Trevor Phillips on Sky News’ Politics Hub: “I didn’t anticipate coming in wanting to make this change to NHS England. It wasn’t on my list of priorities.

“I recognise that in order to achieve the change I want, this is a necessary step.”

He said his instincts were to not scrap the quango “unless it was necessary”.

“I’ve concluded that it is necessary because you can’t have a situation where you’ve got two head offices duplicating work, a man marking each other, sometimes working against each other,” he added.

9,000 plus will lose jobs

Mr Streeting also confirmed thousands of people will lose their jobs, answering “yes” when asked if the move means more than 9,000 civil servants will be out the door – around half of the 19,000 people the health secretary said work for NHS England and the Department of Health and Social Care.

He acknowledged it “will be an anxious time for them…there’s no way of sugarcoating” it.

“But we will be treating people with care and respect and the fairness that they are owned through this process,” he said.

He said the Conservatives inherited the “shortest waiting times and the highest patient satisfaction in history” when they won the 2010 election, but said they “turned it on its head”.

He claimed the Labour government “is fixing it” but added: “We do have to put a foot down on the accelerator.”

The health secretary reiterated his previous comments that it would “be daft not to use spare capacity in the private sector” to alleviate pressure on the NHS.

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However, he denied getting rid of NHS England is about part privatisation of the health service.

“With Labour, it would always be a public service free at the points of use,” he said.

“There are lots of people who are now paying to go private, and it’s those who can’t afford it who are getting left behind. I want to end that two-tier system.”

Sir Keir said axing NHS England will bring management of the NHS “back into democratic control” as it returns to the Department of Health and Social Care 12 years after the Conservatives created it.

The prime minister said the result would end the duplication from two organisations doing the same job, freeing up staff to focus on patients and putting more resources on the frontline.

Watch the full interview on Politics Hub With Trevor Phillips at 7pm.

When Sir Keir Starmer landed in Hull on Thursday as the latest prime minister proposing to reshape the state, he wanted to show he meant it, announcing he was abolishing the world’s largest quango – NHS England (and with it 9,000 jobs).

Significant, decisive and designed to make the point – the prime minister grabbed attention for the argument that he wanted to make around tackling an “ever-expanding” state that was, in his words, “weaker” than it has ever been, and failing to serve the public properly.

This is his diagnosis and his remedy, reform: dispensing of regulators, cutting red tape, injecting artificial intelligence in the backbone of the state to improve efficiency and cut costs (and jobs).

Politics latest: Thousands to lose jobs as PM abolishes NHS England

On most of this he was vague – heavy on rhetoric but light on detail, but the symbolism of abolishing NHS England was clear for all to see: this prime minister is borrowing from a Conservative playbook in an effort to improve services through deregulation, public service cuts and a bonfire of red tape.

Sir James Bethell, a Conservative peer and former health minister, retweeted the prime minister’s announcement on scrapping NHS England with the words: “I wish we’d had the guts to do this.”

Sir Keir is also signalling he’s prepared to have a fight – not just with the “blockers” or the “NIMBYs”, but with his own party, public sector workers and the unions as he takes a scalpel to the state.

Reforms are ultimately about winning a second term

The prime minister said every arm’s-length governmental body was up for review – and also, in a couple of weeks, he will take aim at the burgeoning welfare budget in an effort to find billions in savings as he looks to deal with the squeeze on the public finances through spending cuts rather than tax rises or loosening his chancellor’s self-imposed borrowing rules.

Taking on the state in one form or the other is something many a Conservative prime minister, not least Liz Truss, have often talked about, and now Sir Keir is adopting this approach. But for him, the ultimate pragmatist, this is not about ideology but something else – delivery, and ultimately, trying to win a second term.

This is him explaining his motivations to his cabinet in a letter he sent to all his ministers last month: “Politics is no longer built around a traditional left-right axis. It is instead being reimagined around a disruptor – disrupted axis. If governments are not changing the system in favour of working people, then voters will find someone else who does.

“We need to be disruptors – on behalf of those ordinary, working people who just want more security in their lives and a country that is on its way back up again.

“That means taking on vested interests of all kinds, it means challenging laws that hold Britain back, stripping back regulation that stifles progress, moving power out of Westminster and back to communities across the country. It means standing up for ordinary people who feel shut out and ignored by elites. Whenever we see barriers to renewal, this government will tear them down.”

At its heart is the admission from the prime minister that if his government doesn’t deliver, the winners will be Reform UK, or even a revived Conservative opposition.

Starmer prepared to fight for his public sector reforms

But as much as he makes this argument, there will be many in his party, in the union movement, and who voted Labour who hear the word austerity when they hear Sir Keir say “reform”.

That’s why I asked him, at the event in Hull, whether this drive was a return to austerity, or, at the very least, will appear that to those on the receiving end of these cuts.

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After all, at the general election manifesto launch, when I asked the prime minister whether there would be a return to austerity under a Labour government, he vowed: “There will not be austerity under a Starmer government.”

On Thursday, he insisted there would be “no return to austerity”.

“Part of the problem we’ve got with our public services is what was done to them a decade or so ago. So we’re not going down that route, and none of our plans are going down that route,” he said.

But when those welfare cuts are announced later this month, Sir Keir’s “reforms” might look rather different, as might his plans for public sector reform if thousands of workers lose their jobs.

What was clear as he made his argument on Thursday is that it’s a fight he’s prepared to have.

Police investigating the hospital where Lucy Letby murdered seven babies and attempted to murder seven others have widened their scope to include gross negligence manslaughter.

An investigation into corporate manslaughter was launched in October 2023 following the trial and conviction of ex-nurse Letby.

But Cheshire Constabulary have now widened their probe to determine whether gross negligence manslaughter took place.

While corporate manslaughter covers cases where a corporation’s negligence leads to a person’s death, gross negligence manslaughter is when an individual’s negligence causes death.

In a statement, Detective Superintendent Paul Hughes said: “This is a separate offence to corporate manslaughter and focuses on the grossly negligent action or inaction of individuals.

“It is important to note that this does not impact on the convictions of Lucy Letby for multiple offences of murder and attempted murder.”

Det Supt Hughes added: “Those identified as suspects have been notified. We will not be confirming the number of people involved or their identity as no arrests or charges have yet been made.

“Both the corporate manslaughter and gross negligence manslaughter elements of the investigation are continuing and there are no set timescales for these.

“Our investigation into the deaths and non-fatal collapses of babies at the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women’s Hospital between the period of 2012 to 2016 is also ongoing.

“Our priority is to maintain the integrity of our ongoing investigations and to support the many families who are at the heart of these.”

Letby, 35, from Hereford, is serving 15 whole-life orders after she was convicted across two trials at Manchester Crown Court of killing seven babies, and attempting to murder seven others – making two attempts on one of her victims – between June 2015 and June 2016.

Last month an international panel of neonatologists and paediatric specialists said bad medical care and natural causes were the reasons for the collapses and deaths.

Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hope her case will be referred back to the Court of Appeal.

A public inquiry into the events surrounding Letby’s crimes will reconvene at Liverpool Town Hall on 17 March for closing submissions, and the findings of Lady Justice Thirlwall are expected this autumn.

A spokesperson at the Countess of Chester Hospital NHS Foundation Trust said: “Due to the Thirlwall Inquiry and the ongoing police investigations, it would not be appropriate to comment further at this time.”