LONDON — In a speech Thursday, Starmer made a surprise announcement that NHS England was to be scrapped.
That definitely does not mean the abolition of Britain’s National Health Service, which offers free health care to all, is funded through taxation and payroll deductions, and is so popular that it was once likened by a senior government minister to a national religion.
What will go instead is one administrative level within the larger health system.
NHS England was created in 2013. The agency works with the government to agree on funding and priorities for the health service, but it is separate from the health ministry, called the Department of Health and ocial Care.
What’s the point of scrapping NHS England?
The agency employs around 15,300 people. How many of those jobs will be eliminated and how many will transfer to the Department of Health, which employs 3,300, is unclear. But the health secretary, Wes Streeting, said in Parliament on Thursday that “hundreds of millions of pounds a year” would be saved and that he aimed to reduce the overall head count by 50%.
The government argues that having two separate structures, which date from an ill-fated reform of the health service in 2012-13, is wasteful and means that some tasks are duplicated.
“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,” Starmer said Thursday. “We are duplicating things that could be done once.”
Unraveling the current structure will not be quick, and the transition is expected to take about two years.
Nor is the history of changing the health service a happy one. A former Conservative minister, Andrew Lansley, oversaw the creation of NHS England as part of an overhaul of the health service that was widely criticized and has been gradually undone. The announcement Thursday is effectively the last nail in the coffin for the “Lansley reforms.”
Starmer said that the changes would restore “democratic control” to the management of the health service and that savings and efficiencies made by scrapping NHS England would free up resources for patient care. After years of underfunding, the country’s creaking, overstretched health care system badly needs investment: The waiting list for medical procedures currently exceeds 7 million.
Is there a broader agenda here?
Yes. The government says it wants to slim the size of the state and deliver services more efficiently. It argues that the number of civil servants increased under the last government, run by the Conservatives, because of extra tasks needed during the COVID pandemic and as a result of Brexit.
For some, the move has echoes of the cost-cutting in the United States by Elon Musk’s so-called Department of Government Efficiency or of the cutbacks implemented by Argentina’s president, Javier Milei.
In Britain, a government-linked think tank, Labour Together, has proposed plans to reshape the state. The project has been nicknamed by some outside the organization as “Project Chain Saw,” but the prime minister’s office this week rejected that characterization of its policies. Instead, Starmer has talked about “an agile and productive state.”
With resources scarce, public services overstretched, and the government under pressure to raise military spending, there is renewed pressure to find savings.
That said, what’s envisaged in Britain looks more like gentle pruning than the widespread lopping of jobs envisaged across the Atlantic.
Are there risks for the Labour government?
Cutting duplication in the delivery of the health service is unlikely to be too contentious with voters. And Starmer is a center-left leader who believes in the power of the state and who has spoken of the support his family received when he was young and his mother was sick.
But the government is also planning broader changes to the welfare system to try to reduce the number who are of working age but outside the workforce, estimated to be around 11 million.
That could mean reductions in welfare payments, including to disabled people, and some Labour lawmakers are anxious about the potential impact.
They worry about a repeat of the cuts that followed the financial crisis, which were introduced by the Conservative-led coalition government that came to power in 2010. That belt-tightening led to stark reductions in public services. On Thursday, Starmer was at pains to stress that under his leadership, there would be no return to “austerity.”
This article originally appeared in The New York Times.
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