The NHS 10-year plan, published today, sets out the government’s plans to shake up the centre of healthcare by redesigning both its form and function.
A chapter in the plan titled A devolved and diverse NHS: A new operating model gives more details on the government’s plans to merge NHS England into the Department of Health and Social Care.
And it sets out a streamlined function where the centre of the system in Whitehall "will be smaller, more agile, and focused on developing strategic frameworks and building partnerships".
The plan says the first step towards achieving this will be to combine the headquarters of NHS England and DHSC. It says “the integration of teams will begin in the coming months and the process of abolishing NHS England will be complete within the next two years”.
The document says: "Today, power is concentrated in Whitehall, rather than distributed among local providers, staff and citizens."
It also says: “It was never a sensible proposition that an arm’s-length body would be responsible for resources amounting to nearly a tenth of the economy. Nor was it ever likely that having two central organisations would do anything other than concentrate more power in the centre.”
The plan says the government will “strip out duplication and bring many of NHS England’s functions into the department”. And it says the centre will get smaller – with its headcount to fall by 50% by 2027, and savings redirected to local systems.
“The major benefit will be the reduction in the burden that central bodies place on systems and providers,” the document says. “We will replace the culture of bureaucracy that has disempowered local leaders, through endless micromanagement, with proportionate and streamlined regulation and oversight.”
On the function of this new centre, the plan says: “Alongside setting strategy, its purpose will be to form partnerships with investors, industry, local government, employers, small or medium-sized enterprises (SMEs), voluntary organisations and trade unions.”
As part of this role, “there will be an explicit goal to make the NHS the best possible partner and the world’s most collaborative public healthcare provider and it will do more to create the conditions for local entrepreneurship, both inside and beyond the NHS, to support grassroots innovation”, the plan says.
The document says the centre will continue to have seven NHS regions, which will be responsible, alongside the national headquarters, for performance management and oversight of providers.
Working with integrated care board (ICBs), “they will oversee transformation at scale; ensure services are configured appropriately to deliver; and that structures, functions and incentives are implemented effectively”, the plan says.
It also says the regions “should support the national team in its assurance functions, but never duplicate them”.
As trailed last weekend, the plan will see more than 200 organisations scrapped, including Commissioning Support Units, Integrated Care Partnerships, the Health Services Safety Investigations Body, the National Guardian’s Office and Healthwatch England.
Healthwatch England will be brought into a reformed DHSC and the department will appoint a new national director of patient experience, responsible for overseeing the collection and publication of "more informed feedback from both patients and carers". The role will incorporate the functions of Healthwatch England, as well as the work on patient experience adopted by the patient safety commissioner.
The work of local Healthwatch bodies relating to healthcare will be brought together with ICB and provider engagement functions, while local authorities will take up local Healthwatch social care functions.
The plan also sets out reforms to the role and governance of NHS foundation trusts and integrated care boards.
The strongest foundation trusts will become “integrated health organisations” that have control over the whole health budget for a defined local population. The document says: "Our intention is to designate a small number of these IHOs in 2026, with a view to them becoming operational in 2027. Over time they will become the norm." DHSC will have responsibility for authorising the new IHOs.
ICBs will be instructed to be "strategic commissioners of local health services, responsible for all but the most specialised commissioning using multi-year budgets". Provider organisations will no longer sit on ICBs, while strategic authority mayors – or their delegated representatives – will replace local authority represenatives as ICB board members.
Another section of the document sets out plans for a national independent investigation into maternity and neonatal services. It says the national maternity and neonatal taskforce will be chaired by the health secretary to inform a new national maternity and neonatal action plan, produced with input from bereaved families.