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.
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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1:56
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 chancellor has insisted that “we do need to get a grip” on the welfare budget, saying the “current system is not working for anyone”.
Rachel Reeves said the “bill for welfare is going up by billions of pounds in the next few years”, and argued the system should “get people into work so that more people can fulfil their potential”.
Her comments come ahead of an expected announcement next week of “radical” reforms to the welfare system, with many fearing drastic cuts to support for the most vulnerable.
Asked by broadcasters on Friday about those fears, the chancellor said: “Well, we’ll set out our plans for welfare reform. But it is absolutely clear that the current system is not working for anyone.
“It is not working for people who need support, it’s not working to get people into work so that more people can fulfil their potential, and it’s not working for the taxpayer when the bill for welfare is going up by billions of pounds in the next few years.
“So we do need to get a grip. We need to spend more on national defence, we need to reform our public services, and we need to reform our broken welfare system.”
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Welfare system ‘letting people down’
Ms Reeves’s comments come after the work and pensions secretary said the current system has locked “millions” out of work and called it “dysfunctional” as the system places a person in binary categories of either “fit for work” or “not fit for work”.
The government has promised to either reform or replace the Work Capability Assessment – which determines if a person is fit for work or not – as they say it currently drives people who want to work “to a life on benefits”.
Ministers have been priming MPs and the public for cuts to a ballooning welfare bill since the start of the year, with details expected next week ahead of an announcement in the chancellor’s spring statement on 26 March.
Image: Rachel Reeves during a visit Babcock in Rosyth. Pic: PA
The expected welfare cuts
Ms Reeves is expected to announce several billion pounds of spending cuts after losing her £9.9bn headroom since the October budget, with the welfare budget a key target for cuts.
Fiscal headroom is the amount by which government can increase spending or cut taxes without breaking its own fiscal rules.
The welfare cuts are expected to include £5bn in savings by making it harder to qualify for Personal Independent Payments (PIP), which help people with the additional costs of their disability.
PIP payments next year are also expected to be frozen and the basic rate for Universal Credit paid to those searching for work, or in work, is expected to be increased while the rate for those judged as unfit for work will be cut.
The department for work and pensions said new figures show 1.8 million people are now considered too sick to look for work due to a “broken work capability assessment” so are on Universal Credit but getting no support to find work.
It said the number has almost quadrupled since the start of the pandemic when 360,000 were considered too sick to look for work.
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‘Government’s plan to cut welfare is terrifying’
Labour MPs concerned about cuts
A growing number of Labour MPs are publicly raising concerns and, in an unusual move, all 404 Labour MPs were asked to attend “welfare roundtables” in Downing Street with the Number 10 policy unit on Wednesday and Thursday.
On Wednesday, Sir Keir Starmer faced down Labour MPs unhappy over the rumoured welfare cuts – especially for disabled people.
Richard Burgon pleaded with him to make the “moral” choice, telling the Commons disabled people are “frightened” as he urged the PM to introduce a wealth tax instead of “making the poor and vulnerable pay”.
Sir Keir pledged to “protect those who need protecting”, but later added there is no “bottomless pit”.
He said the Tories “left a broken welfare system, which locks millions out of work, that is indefensible in my view, economically and morally”.
Image: Sir Keir Starmer was asked about the welfare cuts at PMQs
Another Labour MP, John Slinger, urged the PM to reassure the Commons he will “provide compassion to those who can’t work”.
Labour MP Nadia Whittome told the BBC the government should impose a wealth tax instead of “placing that burden on disabled people who have already borne the brunt of 14 years of austerity”.
She added that she “can’t look her mum in the eye and support this”.
Russian companies have been using cryptocurrencies like Bitcoin and USDt to facilitate trade with China and India amid international sanctions, according to a Reuters report.
Russian oil companies have used crypto assets including Bitcoin (BTC) and Tether’s USDt (USDT) for international trade, Reuters reported on March 14, citing four sources with direct knowledge of the matter.
One Russian oil trader reportedly conducts tens of millions of dollars worth of monthly transactions using digital assets, according to a source who spoke on condition of anonymity due to a non-disclosure agreement.
While the Russian finance minister publicly declared in late 2024 that Russia is free to use assets like Bitcoin in foreign trade, the use of crypto in oil transactions with China and India had not been previously reported.
Russia’s oil trade in crypto: How does it work?
According to Reuters, Russia’s foreign oil trade in crypto involves intermediaries who manage offshore accounts and facilitate transactions in the buyer’s local currency. One example includes a Chinese buyer of Russian oil that pays a trading company acting as a middleman in yuan into an offshore account.
The middleman then converts payments into crypto assets and transfers it to another account, which then sends it to a third account in Russia and converts it to Russian rubles, sources said.
Crypto will be used no matter of sanctions
According to one of Reuters’ sources, crypto will likely continue to be used in Russia’s foreign oil trading regardless of whether any sanctions are in place and even if the sanctions are lifted and Russia is free to use the dollar.
“It is a convenient tool and helps run operations faster,” the report said, citing the source.
Bitcoin remains highly restricted in mainland China
While Russia has been increasingly open to Bitcoin, including its use in foreign trade, mainland China has maintained a cautious and restrictive approach toward cryptocurrency.
Reform UK’s most senior woman has told Sky News the Rupert Lowe row “doesn’t look great” and she doesn’t “want to see it in the news any more days”.
Dame Andrea Jenkyns, who defected to Reform last year, accepted it was “clearly a big falling out” but suggested these spats do not always cut through to the public.
She insisted she was concentrating on winning as she looks to become the party’s first ever mayor in May.
In an interview with Sky News, Dame Andrea also spoke for the first time about her experience of domestic abuse, denying Reform has a “woman problem” but accepted “we need to start talking more about issues, what women are interested in”.
Having lost her seat as a Conservative in the 2024 election, Dame Andrea briefly quit politics only to return earlier this year as Reform’s newest recruit.
She is now standing as the party’s candidate to become the first Greater Lincolnshire mayor, in a race that psephologists think could be Reform’s best hope of turning itself from a party of protest into one that is governing.
That’s because Reform is on the march in Lincolnshire, which is a key battleground between the Conservatives and Reform in the local and mayoral elections in May.
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Richard Tice, Reform’s deputy leader, took the Conservative seat of Boston and Skegness in the last election as Reform came second in a further two of the county’s eight constituencies.
Image: Dame Andrea spoke to Sky News’ Beth Rigby
This farming country has long been part of the patchwork of Conservative England and it is in these heartlands that Reform hopes it can land a significant blow to its political rivals in the coming weeks.
“It’s a worry,” admits one Labour insider who doesn’t much relish the prospect of having to deal with a newly minted Reform party mayor should Dame Andrea win in May against Labour candidate Jason Stockwood, the Conservative Rob Waltham and independent Marianne Overton.
There is also the Lincolnshire council race, which Reform is targeting. All 70 seats are up for grabs and the Conservatives, which have a 38-seat majority, are defending 53 seats. The only way is up for Reform here, while the Conservatives, who have held this council for 10 of the past 13 elections, are bracing for a drubbing.
Tories say Jenkyns is from Yorkshire
The Conservatives make the point that they have a “strong local candidate who is born and bred in Lincolnshire, whereas Dame Andrea is from Yorkshire” when I ask them about the race.
“We are fighting hard, we have a proven track record of delivery in charge of local services whereas Reform aren’t tried and tested,” the Conservatives said.
“And if they’re anything like Reform nationally, who don’t turn up on important votes, then they won’t show up for people locally.”
Dame Andrea is still based in Yorkshire where she used to be an MP, as this is where her son attends school. But she rents a place in Lincolnshire and has vowed to move to the county should she win the mayoralty.
She also points out that she grew up in Lincolnshire and was a local councillor before moving to Yorkshire after her shock victory over Ed Balls in the 2015 general election.
Image: Dame Andrea is hoping to become Reform’s first mayor
‘Fed up’ farmers eyeing Reform
When we meet her on the road in Lincolnshire, she takes us to meet some farmers whose livelihoods are under intense pressure – be it over local flooding and flood defences or changes to inheritance tax and farming subsidies that are affecting their farms.
There is little love for Labour in the gathering of farmers, who in the main seem to be lapsed Conservative voters that are now eyeing Reform, as a number of them tell me how they are fed up with how the Environment Agency and local politicians are running their area.
“We’re fed up with all of them,” said one farmer.
“We just want some action. As farmers we know drainage is so important, we just want to get it sorted.”
They are also alarmed and anxious about the inheritance tax changes introduced by Labour and are pressing for carve-outs for small farms handed down from generation to generation amid fears they will have to sell up to pay the inheritance tax bills.
But the troubles at the top of Reform hadn’t gone unnoticed by this group. Unprompted, one of the farmers raised the row between the suspended Reform MP Rupert Lowe and the party leadership, telling Dame Andrea that while he “really likes Reform” he doesn’t much like what he’s seeing at the moment.
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Reform UK row explained
‘Spat looks worse because Reform is small’
The farmer said: “I don’t follow politics avidly. But I just look and say [Rupert Lowe] is full of common sense and I really like him and I don’t know what’s happened, but it looks from outside [he has been] chucked under the bus.
“And I’m like, am I getting second thoughts about Reform? I don’t know what’s gone on, but it concerns me about what’s going on with Reform.”
Dame Andrea tries to downplay it and says the “spat” looks worse because it’s a smaller party.
“To me it’s about the movement, the right policies, to carry on. What is the alternative? This will blow over and Reform will keep getting strong,” she said.
Can Jenkyns and Farage co-exist?
Dame Andrea would clearly like the infighting to stop, but it raises questions for me about how she will fit into this very male-dominated party, in which all four MPs are male, with Dame Andrea the only senior woman beyond the former Conservative minister Ann Widdicombe.
She is, like Nigel Farage, a disrupter – Dame Andrea was one of the first Tories to call for Theresa May and Rishi Sunak to stand down, and a conviction politician who fervently backed Boris Johnson and Brexit.
If she does win this mayoral race she will be a big personality in Reform alongside Farage, which leaves me wondering if they can co-exist in a party already at war.
Image: Dame Andrea says she doesn’t think the party has a ‘woman problem’
Jenkyns was in an abusive relationship
Reform does struggle with female voters, with fewer women voting for the party against all age cohorts, young to old. Dame Andrea tells me she doesn’t think the party has a “woman problem”, but she does think it needs to talk about more issues that she thinks women are interested in, citing education, special educational needs and mental health.
When I raise the matter of violence against women and how the party has handled revelations that one of its own MPs was jailed in a youth detention centre as a teenager for assaulting his girlfriend, Dame Andrea reveals to me she has been in an abusive relationship.
“I know how it can break you. I know how you sort of start losing your identity. So I’ve been on that side,” she said.
“And I’ve also helped constituents to fight against this, so it matters, we need to do more in society because whether it’s men or women, one is too much in my view.”
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Out on the campaign trail, even in the Labour territory of Lincoln where Hamish Falconer is the local MP, Dame Andrea gets a warm welcome. She tells me she thinks she can win it: “I might be living in blind hope here. But I’ve got that feeling.”
This corner of England has become a test bed for Reform to see if it can turn from a party of protest into one that has a shot at governing in the form of a regional mayor.
If Reform can succeed in that – what might come next? It would be a remarkable comeback for Dame Andrea and a remarkable victory for Reform too.