The UK government has announced a dramatic restructuring of England’s healthcare system that will see NHS England – the body responsible for overseeing the country’s health service – abolished.
The move, revealed in March 2025, signals a return to direct ministerial control of the NHS under the Department of Health and Social Care (DHSC) and is being presented as a bid to streamline services, cut bureaucracy and refocus on frontline care.
Why now?
The government’s rationale for the decision centres on efficiency. Ministers argue that the current system has become overly complex, with NHS England acting as a “disastrous” intermediary that introduced unnecessary administrative layers. A recent review commissioned by the DHSC found that the arms-length structure hindered effective decision-making and accountability.
The Secretary of State for Health and Social Care, Wes Streeting, speaking at the announcement, said: Work has already begun to strip out the duplication between the two organisations and bring many of NHS England’s functions into the department. NHS England will have a much clearer focus over this transformation period. It will be in charge of holding local providers to account for the outcomes that really matter: cutting waiting times and managing their finances responsibly.
“This reform is about restoring clarity and accountability in the leadership of our health service. We are removing duplication and ensuring the NHS can focus on what matters most- delivering excellent patient care. These reforms will deliver a much leaner top of the NHS, making significant savings of hundreds of millions of pounds a year.”
What will change?
Under the new structure, NHS England’s functions will be absorbed back into the DHSC. The department will take on direct responsibility for managing the NHS, marking a significant shift in the governance of the health service. A dedicated transition team, headed by a newly appointed chief executive, will oversee the merger. The process is expected to take up to 24 months to complete.
Impact on workforce
One of the most controversial aspects of the reform is the scale of expected job losses. Sources close to the transition plan suggest that as many as 9,000 roles within NHS England could be cut as part of the restructuring. While the government insists the move will allow resources to be redirected to frontline services, unions and staff groups have already voiced concern about the impact on morale and capacity during the transition period.
Refocusing on frontline care
Ministers are keen to emphasise that the ultimate aim is to boost patient care by reducing administrative drag. The government has pledged to reinvest savings from the restructuring into hospitals, GP surgeries and community health services, promising a more responsive and less fragmented NHS. However, health experts have cautioned that such a sweeping change could bring significant disruption at a time when the NHS continues to face rising demand, workforce shortages and post-pandemic recovery pressures.
What’s next?
The coming months will see the formation of the transition team, stakeholder consultations, and the gradual handover of functions. Parliamentary scrutiny of the decision is expected, and many will be watching closely to see how the reforms are implemented – and whether they deliver the promised improvements in patient outcomes.
For patients, the short-term impact may not be immediately visible. But, for staff across the health service, the changes signal a period of uncertainty – and potentially opportunity – as the NHS enters a new era of centralised oversight.
What could this mean for digital transformation in the NHS?
The dismantling of NHS England raises important questions about the future of digital transformation across the health service – an area that has gained increased momentum in recent years, from the rollout of shared care records and virtual wards to AI-assisted diagnostics and electronic prescribing.
NHS England has played a key coordinating role in setting the digital agenda nationally, aligning local systems with central priorities, managing large-scale digital investment programmes, and ensuring consistency across regions. It has also been instrumental in distributing capital for digital infrastructure, defining technical standards, and working with NHS Digital (now part of NHS England) to deliver flagship programmes like the NHS App and Federated Data Platform.
With NHS England being dissolved, some of these responsibilities are expected to be absorbed by the Department of Health and Social Care, while others – particularly financial and implementation responsibilities – are likely to be devolved further to Integrated Care Boards (ICBs) and NHS Trusts.
Opportunities and Risks
For those involved in delivering digital health solutions, the impact of this transition could be significant. While some see this as an opportunity for greater regional autonomy and innovation, others warn of increased fragmentation and inconsistent adoption if central coordination is weakened.
Key implications include:
- Devolved commissioning power: ICBs and Trusts may gain more control over which digital tools and platforms they invest in. This could allow for more tailored solutions to meet local needs but may also lead to duplication, inefficiencies, or a lack of interoperability without strong national oversight.
- Shifting leadership: The abolition of a central administrative body raises questions about who will lead in setting national digital strategy. If responsibility reverts to DHSC, there may be a risk of digital transformation becoming overly politicised or losing momentum during the transition.
- Impact on national programmes: Initiatives such as NHS England’s “What Good Looks Like” digital maturity framework or the Unified Tech Fund may need to be restructured or rehomed within new governance arrangements.
- Vendor landscape disruption: Suppliers – especially SMEs and health tech innovators – often rely on clarity around funding routes, governance structures, and decision-makers. The reorganisation could introduce uncertainty into procurement cycles and approval pathways, at least in the short term.
A new era of local digital leadership?
In the longer term, the shift could empower regional bodies to lead digital transformation more flexibly, using their intimate understanding of local system challenges to commission the right tools and technologies. But, success will depend heavily on whether DHSC can establish clear, effective mechanisms for national coordination, digital standards, and best practice sharing – without the administrative machinery of NHS England.
This reform may signal a broader philosophical change in how digital progress is pursued: less top-down leadership and more distributed management. For digital leaders in ICBs and Trusts, it could mean greater responsibility – but also a critical need to collaborate across regions to avoid digital siloes and ensure that transformation is truly joined-up.