NHS England Update

Caroline Johnson Excerpts

Thursday 13th March 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I thank the Secretary of State for advance sight of his statement. It is disappointing, once again, that it was not made to the House first; in recent days, there have been numerous media briefings about this potential restructure.

Under new leadership on the Conservative Benches, we believe in a leaner and more efficient state. That means using resources effectively, reducing waste and preventing duplication, spending money where it is most beneficial. After all, the public understandably want to see the focus on patient care and not on backroom managers. Therefore, we are supportive of measures to streamline management, and we do not oppose the principle of taking direct control, but we need to know what steps will be taken to meet targets while all the upheaval happens. We need to know the specifics of what is being planned.

What are the timeframes for the abolition of NHS England? By what date will it be completed? How many people will be moved into different roles? How many people will lose their jobs altogether? How much money is that expected to save? Labour runs the NHS in Wales, which has the highest waiting lists and the longest waiting times in Great Britain. What lessons has Labour learnt from its failure in Wales?

NHS England, as the Secretary of State said, has just lost much of its leadership. Is that because they no longer had confidence in the Secretary of State, or because he did not have confidence in them? Perhaps he can tell the House whether Alan Milburn will keep his job in the upheaval. We also need to be clear that moving people into different roles will not fix the challenges that face the NHS.

The Secretary of State has spoken about taking direct control. That may help him ensure that the NHS stops wasting money on expensive diversity, equity and inclusion staff, and ensures that it provides dignity and privacy for female staff and patients, but what does it mean for clinical prioritisation? Will conditions that are less common and have less glitzy campaigns and fewer celebrity backers suffer because the Secretary of State now has political considerations? Does the Secretary of State have the bandwidth for this, given he has such a busy role already? How does the centralisation of power measure up with the commitment to give more powers to regional bodies and local integrated care boards?

In the first six months after entering office, the Government announced 14 reviews, consultations and calls for evidence, all of which require more staff. Are those jobs at risk, or are other pre-existing roles set to be cut? This announcement comes the same week as Labour’s Employment Rights Bill passes through the Commons. Is the Secretary of State getting a move on because he knows that red tape and bureaucracy will dramatically increase afterwards and make the decisions he has to take more difficult to deliver?

A drive to improve efficiency in the civil service and the management of the health service is welcome, but what about the NHS itself? The Government slimmed down our productivity plan and delivered a 22% pay rise in return for no modernisation or reform. How will those decisions improve efficiency? I asked the Department what proportion of people with a nursing qualification working in the NHS are in patient-facing roles, but the Minister said that they did not know. How can he use the skills and resources effectively if he does not know where those skills and resources are?

The Prime Minister is making a lot of noise about productivity and cutting waste, but he still refuses to set a target for cutting the civil service headcount. Thanks to the decisions he and the Chancellor took at the Budget, the size of the state is growing rapidly, not shrinking, while changes to national insurance contributions have diverted funding away from the frontline into compensating the Treasury. Ultimately, any restructure will be challenged by the Government’s continued failure to tackle immigration. While steps to improve efficiency in the healthcare service are welcome, these words ring hollow across Government.

[Wes Streeting]

I will take the more serious questions from the shadow Minister first. On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years.

The shadow Minister asks about the reduction in the number of officials. NHS England has 15,300 staff; the Department of Health and Social Care has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings. The exact figures will be determined by the precise configuration of staff, and we will obviously keep the House updated on that.

The shadow Minister asks about clinical leadership. One change we will be making with the transformation team is to have two medical directors succeeding Professor Sir Stephen Powis, whose departure from NHS England was planned long before these changes. There will be one medical director for primary care and one for secondary care, underpinning our commitment to the shifts we have described. I must say, there are enormous improvements to be made in clinical leadership for patient outcomes, patient safety and productivity, and I am demanding stronger clinical leadership to drive those improvements to productivity. Frankly, many consultants and clinical teams on the frontline will welcome that liberation—they are hungry for change.

The shadow Minister asks about the workforce data and complains that we have not been able to give her the precise answers. I agree: it is frustrating not having that precise information at my fingertips. I would gently remind her, though, on this as on so many things, that her party was in power for 14 years. She cannot very well complain eight months in given that they left us a woeful, embarrassing data architecture and infrastructure.

The shadow Minister asks about efficiency. Once again, she refers to the resident doctors deal as if it was a failure. The actual failure was leaving doctors on the picket line, not on the frontline, and wasting huge amounts of taxpayers’ money, with cancellations and delays to patients’ appointments, operations and procedures. We stopped that within weeks of coming into office. The deal does include reforms to improve productivity—if she is any doubt about the results, she should look at the fact that despite winter pressures, NHS waiting lists have fallen five months in a row.

Once again, we get the facile points about my right hon. Friend Alan Milburn, who is the lead non-executive board member for my Department. I honestly do not know why he bothers to pay for a mortgage; he lives rent-free in the Conservatives’ heads. They need to move on. By the way, just for the record: Alan Milburn has a record on the NHS that the Conservatives cannot even begin to touch.

The shadow Minister asks about confidence. I am delighted to be introducing a new transformation team. Different leadership challenges require different leadership skills. As I say, I have been really pleased to work with Amanda Pritchard for the past eight months, including on this transition; people should have no doubt about the confidence I have in her skills, talents and abilities, and I think she has a lot still to contribute to our NHS. We do not need to ask about confidence in the Conservative party; it is reflected in the scarce numbers on the Opposition Benches.

What is the lesson from Wales? The lesson is that when there is a Conservative Government in Westminster, the national health service suffers in England, Wales, Scotland and Northern Ireland. That is why we are creating a rising tide to lift all ships. I am sure we will see improvements across the United Kingdom. SNP Members, who are not in their place, do not have any excuses now. As I said before the election, all roads lead to Westminster, and the biggest funding settlement since devolution began is going down the road to Holyrood. There are no hiding places there for the SNP. If people want real reform of the NHS in Scotland, they should vote for Scottish Labour under Anas Sarwar and Jackie Baillie.

People can see here in Westminster the difference that new leadership provides. The shadow Minister laughably referred to new leadership in the Conservative party. Well, it is certainly leaner and meaner, but it is the same old Conservative party. The only thing that the Conservatives have shrunk is their own party. The only jobs that they have laid off are those of their poor party staff. The only thing that they are capable of changing—[Interruption.] Well, come to think of it, I do not think that there is anything they are capable of changing. Instead they look over their shoulder at a party leader who cannot even manage a five-aside team, let alone a country. The Conservatives are just so diminished as a party. I appreciate that it must be so painful for them to watch a Labour Government doing the things that they only ever talked about: reducing bloated state bureaucracy; investing in defence; reforming our public services; and bringing down the welfare bill. The public are asking: “What is the point of the Conservative party?” I bet they are glad that they chose change with Labour.