NHS England to go is Keir being unreasonable?

[43percentburnt]

I don’t work for the NHS but have friends who do (and are increasingly looking at leaving - in some cases to move abroad).

https://www.bbc.co.uk/news/live/cx29lrl826rt

Is the removal of NHS England a good thing? Or is this a Labour gimmick?

To include an Aibu for Keir -

Yes Keir - you are being unreasonable

Or

Good job Keir, please get rid of NHS England - you are NOT being unreasonable

Not everyone in NHSE is a “manager”? My husband is a band 5, his job is highly stressful and actually does mean something. Really disappointed in a lot of the rhetoric in this thread - NHSE is not entirely made up of “lazy managers” getting paid “cushy” £60k+ salaries. 7500 people at least are going to lose their jobs, people seem to be almost gleeful about that.

Sorry to hear that @someonethatyoulovetoomuch

I think he's doing the right thing... although I obviously have sympathy for anyone who is going to lose their job.

That's the problem with voluntary redundancy: the people who stay are the ones who know they have a good deal and are unlikely to get a job elsewhere! The people who leave are the smart ones who will take the money and know they will get a job somewhere else in a few months' time.

I've worked in the NHS for nearly 20 years (for a provider). NHSE is, in my view, a total waste of time and money. Its total abolition is long overdue. It does very little of irreplaceable value, and much of what it does do is duplicated elsewhere.

My concern is for the good people working there, some of whom are former colleagues. I hope that they aren't feeling too unsetlled, and trust that compulsory redundancies will be kept to a minimum. I would hope that a mixture of not replacing those who naturally leave, combined with a voluntary redundancy process and redeployment elsewhere in the NHS will keep forced job losses (and redundancy costs) down.

I agree with it.

I also think that whatever form the restructure takes, all staff need to be office based. If doctors, nurses and midwives can't work from home, then the 60k a year middle managers need to be in an office having a 30 minute lunch too. I know people who 'work' for NHSE from home and they take the absolute piss, doing every school run, putting washes on etc. And of course, nothing gets done.
I'm a frontline NHs worker and it boils my piss,.

I don’t care who manages it as long as it works.

I've worked in acute Trusts, community Trusts, and commissioning up to Director level before walking out in disgust at the poor calibre of people with whom I was expected to work. The problem with most NHS management not directly involved in front line delivery is that no fucker ever actually does anything unless there's both a clear direction from a politician - preferably a Labour one, even under Conservative rule - and a step-by-step instruction on how to do it, so they can never be held to account for their own decisions. And even then, if they don't like it they'll still bend over backwards not to do it.

Taking away the day to day direction from what's now the DHSC meant even less actually got done; NHS England just added in another layer of moribund bureaucracy.

Amanda Pritchard dug her own grave appearing at several Parliamentary committees over this winter when it became clear that absolutely nothing was getting done. I'm actually surprised nobody asked her "what do you do all day long?" The Public Accounts Committee described her and her deputy as 'complacent' and lacking any kind of dynamism. The Health Select Committee described her answers as 'lengthy and diffuse' - code words for BS and waffle. Here's a nice article about it: https://www.theguardian.com/society/2025/jan/29/complacent-health-chiefs-in-england-lack-drive-to-transform-nhs-say-mps

Ultimately, the entire management culture in the NHS is just plain wrong, but this is a bloody good start.

I hope it’s a good thing. I can’t take much more of Starmer, I truly loathe the man.
They need to whittle down the manger numbers in the whole of the Civil Service too while they are saving money.

Clearly you can't have large organisations run with no managers and admin, are frontline clinical staff supposed to also organise the catering, cleaning, finance, HR, legal, etc, etc. It derails constructive discussion when the knee jerk 'sack the overpaid managers' crew turn up in every debate. I thought Darsi gave a balanced view saying that the problem isn't too many managers but too few in the right parts of the system to be effective. Abolishing duplicated non patient facing roles seems a sensible start.

I've been involved in similar reorganisations in the public sector before and people in the 'abolished roles' tend to pop up again in the new structures, elsewhere in the larger organisation or in closely associated organisations so the skills aren't necessarily lost.

I agree with this. I read an analysis quite a long time ago that said actually the NHS is under managed, not over.

I believe NHS England is responsible for commissioning services so who will do that? It allocates & distributes funds to the CCGs - that's pretty essential
Also social care are terrible at running anything. It's very unclear what this move does other than create mass redundancies

This means more political control of the NHS. I'm very very wary of this - more use of healthcare as a political football

I agree with the fact that demonising "management" is unfair. You need backoffice staff - HR, admin etc to make the front end work well. Especially for a large system handling patient data and making huge financial decisions. But, I think the reforms brought in by Landsley were a mistake and complicated the buerocracy. That doesn't mean the people whose jobs came from that were wasting time/not working/lazy. And you would want staff layoffs only when necessary (as opposed to the slash and burn make them all afraid fiasco over the pond). But reforming the NHS in a meaningful way is probably a good idea. It won't by itself save loads and loads of money because actually the "spend" on bureaucracy/admin makes up a much much smaller percentage of total costs than it does in fully privatised systems like the US. But it should be a move in the right direction.

Hopefully any redundancies can be managed so that as much as possible it mostly involves not replacing retirees etc rather than P45s. And I really feel for anyone working there at the moment as it must be stressful. But I don't think removing some of the layers is a bad thing in itself.

The other thing I would say is that if it involves removing some higher paid positions those people are usually better placed to find alternative employment than most just because "high responsibility" positions look good on a CV and there is often private sector demand for managers.

Thats a good point actually. Its easy to say "they are just moving staff around" but if its moving people out of duplicated work into filling needed gaps thats a good thing.

Heath is 99.99% devolved. What Kier is doing won’t impact on the NHS in Wales and Scotland.

It’s not about headcount though, it’s about skills. You can’t just move anyone into any role.

Friends who work in NHS say that pre-trust status there were less suits, so anything that gets rid of those will be good. I think (and I am not that informed tbh) that more management and suit hires in hospital should have NHS training/backgrounds, e.g. ex-nurses, medics etc. who understand how these decisions at mid-level impact down to the patients.

I don't think it means the activities of NHS England are being abolished, they are being reabsorbed into the Dept of Health and Social Care and I assume that many of the staff will move across. It's where there is duplication that redundancies will arise, eg, comms, policy, etc. I don't see how anyone could argue that two different organisations setting policy is a good use of resource - or source of clarity in setting direction.

I see the logic totally , although obviously sorry for those who will lose jobs. In non public service in a company of this size , any department that was effectively so it seems duplicating efforts and causing slowness in a system would not still be there

No, it is actually putting everything back to how it was before 2012 by returning the functions of NHSE back to DHSC. NHSE is already ultimately accountable to Parliament and to the Secretary of State for Health and Social Care.

My experience of NHSE was that the staff have better pay and conditions than those elsewhere in the NHS. There were lots of teams with definite duplication that completely existed in silos. There are also a lot of clinical advisors, which were very well paid. Not saying they didn’t do a good job, but they tended to have the full repertoire of their own admin staff so they were quite costly but fairly untouchable because they are senior clinicians, and not the much maligned NHS managers.

I think a lot of people will just filter into regional roles. In about 15 years these organisations will too become costly and bloated, and will be centralised into one organisation to save bureaucracy and money.

NHSE was originally created to put some distance between Ministers and NHS problems as politicians were tired of always being accountable for front line problems so an autonomous body was felt to be helpful. Over time, this didn't work. The other Lansley reforms were also intended to put primary care front and centre as research showed that patients disproportionately 'trusted' GPs more than hospitals so GPs were to be put front and centre then cynically that trust was to be broken when primary care was to be further under-funded. That did succeed, unfortunately.

There developed enormous duplication and fighting between the Department and NHSE.

As an aside, when bodies in the system get 'abolished' then the activities are almost inevitably done by another body and usually by the same people (ex-PCT staff still working in the same activities years later).

As another aside, independent international research generally shows the English NHS system is relatively lightly managed and performs well when funding and the age profile of the population is taken into account)

I know health is devolved but the overall funding envelope is predominantly determined centrally and the performance of the four nations is arguably comparable with some spectacular deficiencies in NI waiting lists aside.

The main issue with the NHS performance results from long-standing under funding with periodic but unplannable increases in funding to adequate before the taps are turned down again.

Removing NHS England adminsitrative activities and integrating the duplicated activities into the Department will probably help if delivered adequately well though any savings will, at best, make a small contribution to the chronic underfunding and ageing of the population, involving and order of magnitude of £!00s of millions?

Although the most expensive care is delivered in acute hospitals at the end of life, the under-funding is probably worst in primary care - it will be interesting if any funds get preferentially directed to primary care or if it will get stuffed into acute which is differentially better funded than primary care and who, post-COVID, are increasingly shovelling inappropriate work back to primary, IME.

The skills are duplicated though. There are people in NHSE doing the same role as people in DHSC. This has been the case since NHSE was set up in 2012/13.

I trust economics and financial experts to take decisions on interest rates far more than politicians, who may or may not be competent and knowledgeable in this area.

As a PP asked, regarding employment terms and conditions, it used to be that Departmental staff are on civil service terms and even non-clinical NHSE staff are on NHS terms.