Another reorganisation of the NHS could do more harm than good, warns a leading health think tank, as calls grow to scrap NHS England. The Nuffield Trust says abolishing the organisation would create damaging disruption whilst failing to tackle the root causes of the health service's struggles – chronic underfunding, severe staff shortages, and the mounting social care crisis.
NHS England, established in 2013 as the NHS Commissioning Board and rebranded in 2019, oversees the day-to-day running of England's health service. It sets strategic direction, supervises local integrated care boards (ICBs), and manages the NHS budget. However, the Nuffield Trust's analysis suggests that dismantling the organisation would likely trigger a period of instability, pulling vital resources and attention away from frontline patient care.
Dr Sarah Scobie, Deputy Director of Research at the Nuffield Trust, points to the track record of previous NHS reorganisations – often costly and disruptive affairs that failed to deliver promised improvements. The report emphasises that the health service's challenges run much deeper, stemming from inadequate long-term investment and persistent difficulties recruiting and retaining staff across all healthcare professions, from GPs and nurses to allied health professionals.
Rather than another structural shake-up, the think tank calls for practical solutions that directly benefit patients and staff. These include developing a sustainable long-term workforce plan with proper funding for training and retention, investing in social care to ease hospital pressures, and improving integration between health and social care services. Such measures, the Nuffield Trust argues, would deliver far more tangible benefits than yet another large-scale reorganisation.
The report stresses that stable, well-resourced leadership remains crucial for steering the NHS through its current difficulties. Instead of dismantling existing structures, the Nuffield Trust suggests focusing efforts on empowering local systems whilst maintaining effective national oversight and strategic planning. This approach, they believe, offers a clearer route to improving patient outcomes and overall health service efficiency.
The context is stark: the NHS faces unprecedented demand, with waiting lists for routine care remaining stubbornly high. The latest NHS England data shows 7.54 million people were waiting for routine hospital treatment in April 2024, including 309,300 patients waiting over 52 weeks. Tackling these figures, alongside pressures in A&E departments and GP surgeries, requires strategic stability rather than disruptive change, the Nuffield Trust concludes.