NHS in England Changes
Following the change in government in the summer of 2024, Professor Lord Darzi, who has worked in the NHS for more than 30 years, was asked to conduct an investigation into the state of the NHS in England.
His findings regarding financing of public health - slashed by more than 25% since 2015. Until 2018 spending grew at around 1% a year and has only increased to just under 3% a year in real terms since. There is a shortfall of £37 billion of capital investment and the backlog maintenance bill now stands at more than £11.6 billion.
He also identified the constant reorganisation of the ‘headquarters’ and ‘regulatory’ functions of the NHS, together with duplication of shared services’ provisions across the NHS and the sheer numbers of national organisations that can ‘instruct’ the NHS, has led to too many people holding people to account, rather than doing the job. (He also singled out the Care Quality Commission as not fit for purpose).
On top of that, too little is being spent in the community/on community healthcare - too few GPs, community nurses and health workers, mental health and care and support workers. More than 1 million people are currently waiting for community services and a further million are waiting for mental health services.
Lack of social and community care has led to too many people ending up in hospital and in the A&E departments and that, together with the lack of financing and capital investment, has decimated their productivity. On top of that there is the huge back-log of cancelled/post-poned care from the pandemic that is still being addressed.
So what is currently happening?
Plans for the publication of a 10 Year Health Plan in June and the outcome of the Spending Review are imminent, part of which is the intention to move back to a ‘fair shares’ allocation policy over time.
In the meantime the Government has announced the decision to abolish NHS England, bringing the health service under direct control of the Department of Health and Social Care. The restructuring wont just lead to the loss of jobs in NHS England but also across the Department of Health, Integrated Care boards and the Trusts themselves. A new team at NHS England, called the NHS Transformation Executive Team, went live on 1 April 2025, replacing the current NHS England Executive Group, and will support ongoing business priorities, statutory functions and day to day delivery as well as help lead the transition to the DHSC.
At a Trust level, several are experiencing leadership transitions; for instance a joint chief executive for both University Hospitals Bristol and Weston NHS Foundation Trust and North Bristol NHS Trust has been appointed, which may indicate a move towards more collaborative leadership structures.
All ICB’s have been ordered to cut costs by 50% by December 2025, looking at unnecessary duplicated functions like assurance and regulatory functions, and have been asked to concentrate on strategic commissioning and contracting, in addition to developing and commissioning for “neighbourhood health - with the delivery being a provider function over time (GPs, PCNs, community and mental health trusts, social care, acute trusts or others)”.
As part of neigbourhood/community health model, the pilot of the introduction of community health care workers (started in 2021) is to be expanded and rolled out initially to 25 areas. The aim is to not only reduce hospital and A&E visits, and, as much mentioned in recent press, reduce the number of people claiming sickness benefits, but improve the uptake of screening like Cancer and the uptake of NHS health checks. As part of the health care workers remit it is hoped they can help advise and increase the uptake of public health initiatives such as screening for cancer and and NHS health checks, as well as give advice on debt, unemployment and bereavement. It is believed that if the scheme is targeted at the areas with the highest need, it will cost around £300 million.
Since October 2025 over 1,500 GPs have already been hired after the Government slashed ‘‘red tape’ preventing practices from hiring newly qualified GPs and by providing an extra £82 million in funding.
All NHS providers have been asked to reduce their ‘corporate’ costs by 50% and to reinvest the savings locally. Corporate cost data will be collected monthly to track progress and benchmarking data will be shared for each provider to ensure that systems are collaborating, where appropriate, to determine the best approach. Since 2018/19, corporate costs in NHS providers have risen by 40% (£1.85 billion), excluding pay and pensions (56% including pay and pensions).
In addition NHS Trusts have been told to save 5% of their budget for this year through “cost improvement programmes”. The NHS Confederation, which represents the Trusts, has indicated that many Trusts will need financial help with the cost of such a scale in redundancies, which could amount to hundreds of thousands of workers and a £1 billion in payouts. There is also a concern about the scale and pace of the cost cutting measures and being able to find the right balance between improving performance and implementing the reforms.
Since 2019 there has been a substantial increase in the number of non-patient facing corporate nursing roles across NHS providers and ICBs. Duncan Burton, Chief Nursing Officer for England, will lead a benchmarking analysis to identify potential unwarranted variation and to ensure optimal deployment of the corporate nursing workforce.