Upon taking office, this Government organised the biggest national conversation about the future of the NHS in its history, with events involving over 4,000 staff and members of the public and 1.9 million visits to our Change NHS website, where 250,000 experiences and ideas for change were shared. We heard a unanimous message: no-one defends the status quo. Staff and patients are crying out for desperately needed change. Since the 2012 reorganisation of the NHS we have seen worse care for patients, at soaring costs, leaving taxpayers paying more but getting less. In 2010, we spent below the OECD average on healthcare and achieved above-average outcomes. Today we spend the average and achieve worse outcomes. The size of the centre has doubled over this same period. The NHS today accounts for 38 per cent of day-to-day Government spending – a figure projected to rise to 40 per cent by the end of the decade – crowding out investment which could tackle the wider social determinants of ill health. That is unsustainable. As Lord Darzi’s independent investigation into the NHS in England found, the NHS is in a ‘critical condition’. Public satisfaction is the lowest it has ever been, millions are waiting for treatment, and the health of the nation is deteriorating. The NHS stands at a historic crossroads and the choice is stark: continue like this, making tweaks to an increasingly unsustainable model, or take a new course and reinvent the NHS through transformational change that will guarantee its sustainability for generations to come.

This Government is serious about delivering this transformational change for staff and patients through the ambitious shifts set out in the 10 Year Health Plan. A key component of this change is a more efficient and effective centre. We will simplify the NHS and remove layers of unnecessary bureaucracy, which will allow us to reinvest more into the frontline, so patients receive safe, timely care and are heard and listened to. This change is no reflection on the tireless work of professionals across the centre who have had to battle against this red tape for too long – the new leaner, more efficient, more focused centre we are building will not just work better for patients and NHS staff, but for employees of the new centre as well.

The Government’s ambition is to reduce staff numbers by up to 50 per cent across the Department of Health and Social Care (DHSC), NHS England (NHSE) and integrated care boards (ICBs). These reductions will be made by March 2028, with around 18,000 posts abolished and more than £1 billion per annum saved by the end of the Parliament. This is enough to fund an extra 116,000 hip and knee operations.

We are looking to remove duplication, cut bureaucracy and fundamentally change the role of the centre in the health and care system to empower the frontline. This will mean that posts that are removed are ones that are no longer needed. As such, there is no intention to cover these roles with consultants as they will no longer exist. For staff that will be impacted by this reduction in posts we are offering support in each respective organisation.

One of the core rationales for this transformation programme is to better fund and support the NHS. We know that many staff currently working in DHSC, NHSE and ICBs have relevant experience, many of them having formerly held clinical and care roles. We would encourage staff to continue to bring their expertise to bear in supporting the NHS through direct frontline roles.

We will not directly be cutting any investment to the NHS or frontline services but will give more power and autonomy to local leaders and systems. The savings made will more than offset the cost of redundancy payments. We will make every penny count from the £29 billion funding boost for the NHS announced at the conclusion of Phase 2 of the Spending Review.

Furthermore, these reductions are only part of our wider programme to reform healthcare and deliver the 10 Year Health Plan. Alongside this transformation we are:
• reinventing the NHS foundation trust model, enabling some trusts to take on responsibility for a wider range of services as integrated health organisations
• transforming the role of ICBs so they are fully focused on strategic commissioning and building a Neighbourhood Health Service in their areas
• devolving responsibility for directly commissioning services out into ICBs so decisions are made closer to the communities they serve

As such, the Government cannot halt the financial and service changes needed to reform the NHS. However, it is only right that with such significant reform, we commit to carefully assessing and understanding the potential impacts. Ongoing assessment is part of the reform programme and will help ensure our decisions focus on improving patient care. The Government is committed to transparency and will consider how best to ensure the public and parliamentarians are kept informed as the programme progresses.

Department of Health and Social Care