What is NHS England – and what does abolishing it mean?
Sir Keir Starmer has confirmed plans to abolish the “arms-length body” NHS England.
But what is the quango – and why is the prime minister scrapping it?
What is NHS England and how does it work?
NHS England was established in 2013 by former Tory health secretary Andrew Lansley to give the NHS greater independence and autonomy – with an intention for it to operate at arm’s length from the government.
It was set up as a quango – an organisation that is funded by taxpayers, but not controlled directly by central government – and is responsible for delivering high-quality care, supporting staff, and ensuring value for money.
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Its website states that it has a “wide range of statutory functions, responsibilities and regulatory powers”, which include working with the government to agree funding and priorities for the NHS and overseeing the delivery of safe and effective NHS services.
NHS England employs about 13,000 people.
As health is a devolved matter, the equivalent bodies for Scotland, Wales, and Northern Ireland cannot be abolished by the prime minister.
Why has it been scrapped?
The prime minister has said abolishing the body will bring management of the NHS “back into democratic control”.
This move will put the NHS “back at the heart of government where it belongs,” he said during a speech in east Yorkshire on Thursday, “freeing it to focus on patients, less bureaucracy, with more money for nurses”.
He added that the NHS will “refocus” on cutting waiting times at “your hospital”.
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PM to abolish NHS England
When answering a question from a cancer patient on how the decision would improve NHS services, Sir Keir said: “Amongst the reasons we are abolishing it is because of the duplication.
“So, if you can believe it, we’ve got a communications team in NHS England, we’ve got a communications team in the health department of government; we’ve got a strategy team in NHS England, a strategy team in the government department. We are duplicating things that could be done once.”
He said by stripping out the duplication, it allows the government to “free up that money to put it where it needs to be, which is the front line”.
The Health Secretary Wes Streeting said: “This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history.
“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.”
What will happen now?
NHS England will be brought back into the Department of Health and Social Care (DHSC), it was announced, in order to end duplication.
The department said the reforms would reverse the 2012 reorganisation of the NHS “which created burdensome layers of bureaucracy without any clear lines of accountability”.
The government said the changes will also “give more power and autonomy to local leaders and systems – instead of weighing them down in increasing mountains of red tape”.
“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,” the government said.
Board members stepped down days before
In the days before Sir Keir’s announcement, NHS England said three leading board members were stepping down at the end of the month.
Chief Financial Officer Julian Kelly, NHS Chief Operating Officer Emily Lawson and Chief Delivery Officer and National Director for Vaccination and Screening Steve Russell will leave their roles in the coming weeks.
At the time, NHS chief executive Amanda Pritchard – who is also stepping down – said the board members made their decision based on the upcoming changes to the size and function of the centre.
Sir James Mackey, who will be taking over as transition chief executive of NHS England, said while he knows the announcement will “unsettle staff” it will also bring “welcome clarity” as the NHS focuses on “tackling the significant challenges ahead”.
Incoming NHS chair, Dr Penny Dash, added she will be working to “bring together NHSE and DHSC to reduce duplication and streamline functions”.
The government has published witness statements submitted by a senior official connected to the collapse of a trial involving two men accused of spying for China.
Here are three big questions that flow from them:
1. Why weren’t these statements enough for the Crown Prosecution Service (CPS) to carry on with the trial?
For this prosecution to go ahead, the CPS needed evidence that China was a “threat to national security”.
The deputy national security adviser Matthew Collins doesn’t explicitly use this form of words in his evidence. But he comes pretty close.
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In the February 2025 witness statement, he calls China “the biggest state-based threat to the UK’s economic security”.
Six months later, he says China’s espionage operations “harm the interests and security of the UK”.
Yes, he does quote the language of the Tory government at the time of the alleged offences, naming China as an “epoch-defining and systemic challenge”.
But he also provides examples of malicious cyber activity and the targeting of individuals in government during the two-year period that the alleged Chinese spies are said to have been operating.
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Witness statements published in China spy trial
In short, you can see why some MPs and ex-security chiefs are wondering why this wasn’t enough.
Former MI6 head Sir Richard Dearlove told Sky News this morning that “it seems to be there was enough” and added that the CPS could have called other witnesses – such as sitting intelligence directors – to back up the claim that China was a threat.
Expect the current director of public prosecutions (DPP) Stephen Parkinson to be called before MPs to answer all these questions.
2. Why didn’t the government give the CPS the extra evidence it needed?
The DPP, Stephen Parkinson, spoke to senior MPs yesterday and apparently told them he had 95% of the evidence he needed to bring the case.
The government has said it’s for the DPP to explain what that extra 5% was.
He’s already said the missing link was that he needed evidence to show China was a “threat to national security”, and the government did not give him that.
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What does China spy row involve?
The newly published witness statements show they came close.
But if what was needed was that explicit form of words, why was the government reticent to jump through that hoop?
The defence from ministers is that the previous Conservative administration defined China as a “challenge”, rather than a “threat” (despite the numerous examples from the time of China being a threat).
The attack from the Tories is that Labour is seeking closer economic ties with China and so didn’t want to brand them an explicit threat.
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Is China an enemy to the UK?
3. Why do these statements contain current Labour policy?
Sir Keir Starmer says the key reason for the collapse of this trial is the position held by the previous Tory government on China.
But the witness statements from Matthew Collins do contain explicit references to current Labour policy. The most eye-catching is the final paragraph of the third witness statement provided by the Deputy National Security Adviser, where he quotes directly from Labour’s 2024 manifesto.
He writes: “It is important for me to emphasise… the government’s position is that we will co-operate where we can; compete where we need to; and challenge where we must, including on issues of national security.”
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In full: Starmer and Badenoch clash over China spy trial
Did these warmer words towards China influence the DPP’s decision to drop the case?
Why did Matthew Collins feel it so important to include this statement?
Was he simply covering his back by inserting the current government’s approach, or was he instructed to put this section in?
A complicated relationship
Everyone agrees that the UK-China relationship is a complicated one.
There is ample evidence to suggest that China poses a threat to the UK’s national security. But that doesn’t mean the government here shouldn’t try and work with the country economically and on issues like climate change.
It appears the multi-faceted nature of these links struggled to fit the legal specificity required to bring a successful prosecution.
But there are still plenty of questions about why the government and the CPS weren’t able or willing to do more to square these circles.
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