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\n 4 min read13 April
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Wes Streeting has defended his decision to abolish NHS England, but admitted he can \u201cunderstand why so many of my predecessors didn\u2019t bother\u201d given the scale of disruption and opposition.<\/p>\n
The Health Secretary insisted the overhaul was necessary to cut duplication and improve accountability in the NHS,\u00a0despite critics warning that the reorganisation risks\u00a0distracting wider efforts to improve patient care.<\/p>\n
His comments come after the Institute for Public Policy Research (IPPR) think tank published a report which found that transforming the NHS funding model to a European-style insurance system would not improve performance across the healthcare system. The report highlighted the high risks of transitioning from one system to another, which could cost billions and take decades to complete.<\/p>\n
Speaking at the report launch on Monday morning, Streeting agreed with the findings, saying that the government\u2019s approach would instead be to \u201cinvest in the NHS, to modernise it and transform the way it delivers healthcare\u201d.<\/p>\n
However, one of the biggest reforms Streeting has introduced so far has been the abolition of the arms-length body NHS England (NHSE). Prime Minister Keir Starmer announced in March 2025 that NHSE would be abolished and its responsibilities brought into the Department for Health and Social Care over a two-year transition period, as part of a wider bid to make the state more efficient and remove unnecessary red tape.<\/p>\n
While Streeting\u2019s allies argue the old structure was dysfunctional, with blurred accountability and internal gridlock frustrating ministers and stalling policy, NHS insiders say the\u00a0transition has not been totally smooth up to now. At the same time,\u00a0experts have described the move\u00a0as risky.<\/p>\n
Staff are due to reapply for roles in a merged organisation in early 2027, a timeline many insiders expect to slip, while others warn the upheaval could consume energy better spent on improving services.<\/p>\n
Asked by PoliticsHome whether the abolition of NHSE was also proving to be a distraction from improving care for patients, Streeting said: \u201cWe’re doing the right thing for the right reason, and in process terms, I don’t see how else we could have gone about this, because there wasn’t a way of engaging with the workforce of that size\u2026\u201d.<\/p>\n
\u201cI have to say I can understand why so many of my predecessors didn’t bother and just sat there with a totally unsatisfactory bureaucracy and loads of waste and\u00a0duplication,\u201d he continued.<\/p>\n
\u201cThe level of opposition that you get when you try and do things like this is astonishing, and the weight and volume of vested interests is just extraordinary.\u00a0<\/p>\n
\u201cAnd I’m afraid this is why you do need strong political leadership. I’m not interested as a politician in meddling in clinical decisions.\u201d<\/p>\n
He said that he thought it had been the right decision to keep the planning of the NHSE abolition \u201cquite close with NHS leaders\u201d before it was announced.\u00a0<\/p>\n
Streeting acknowledged that the restructure was \u201chard on people who work in ICBs [Integrated Care Boards], and it’s hard on people who work in NHS England\u201d: \u201cI don’t treat that lightly or carelessly.\u201d<\/p>\n
However, he defended the decision and said that the idea that \u201cdemocratically elected politicians shouldn’t keep an eye on how that money is spent and to make sure it’s used effectively is for the birds\u201d.<\/p>\n
\u201cThere are so many professional vested interests with a quiet, easy life who will always oppose these big changes, and I think ultimately, we will have done the right thing and the benefit will be to frontline patient services.\u201d<\/p>\n
A source close to Streeting previously told The House<\/a> that the health secretary has found the \u201cinvisible barriers\u201d to getting things done in government \u201charder than most\u201d.\u00a0<\/p>\n\u201cHe has struggled to get his priorities through,\u201d they said. \u201cHe\u2019s a very sharp guy. But when he came in, after getting his own way on policy in opposition, he was shocked about needing Treasury sign-off… It was a rude awakening.\u201d<\/p>\n
Commenting on the IPPR report findings, head of health at IPPR and report author Sebastian Rees said: \u201cThere is no structural silver bullet for the NHS. The idea that simply switching to a European-style insurance model would fix its problems is a pointless distraction and not supported by the evidence.\u00a0<\/p>\n
\u201cThe NHS\u2019s challenges are real \u2013 but they are the result of a decade of chronic underinvestment and choices on how money is spent, not the funding model itself.\u00a0<\/p>\n
\u201cPolicymakers should focus on what actually works: investing in infrastructure, strengthening primary care, and tackling the drivers of poor health.\u201d<\/p>\n
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<\/p>\n","protected":false},"excerpt":{"rendered":"Wes Streeting spoke at an event hosted by the IPPR on Monday morning (Alamy)
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