MPs have raised concerns that the government’s major structural reforms to the healthcare system are “replicating poor practices” seen on the HS2 and New Hospital programmes, and will lead to wasted effort.
In a new report published today, the Public Accounts Committee said the major changes, namely the absorption of NHS England into the Department of Health and Social Care and Integrated Care Boards being ordered to cut costs by 50%, are being made without ensuring there is funding in place to pay for the changes.
It said the government has also failed to conduct impact assessments or take other steps to safeguard value for money. And it said much greater emphasis should be placed on producing an impact study to accompany these large changes.
The report warns these changes, “especially the planned cuts to local health boards, could have a significant negative impact on patients and on the workforce through the level of uncertainty they create”.
The MPs noted that previous reports PAC has published have highlighted the risks to value for money raised by sudden policy changes that are not supported by sufficient funding and planning.
In 2023, PAC reported that the decisions made by DHSC in planning the New Hospitals Programme could not be justified as no supporting documentation existed.
And in a September 2025 report on governance and decision-making on major projects, it found that announcing projects or programmes too early, or where the design of the proposed changes are immature, presents serious threats to governance.
The report seeks confirmation from DHSC that it will not announce unfunded commitments, and asks the department to set out the likely costs of planned redundancies and the absorption of NHS England.
Clive Betts MP, deputy chair of the Public Accounts Committee, said: “Alarmingly, in the government’s approach to the absorption of NHSE and 50% cuts to local health boards, we are now seeing chilling echoes of past failures on HS2 and the New Hospital Programme.
"Our committee has long established that large, unfunded commitments, without plans for delivery, while good at generating headlines, can only end one way. We hope the government can provide reassurance as part of this inquiry that it can come forward with the underpinning detail that can marry its ambitions to reality.”
Speaking at the NHS Providers annual conference last week, the health secretary, Wes Streeting, announced he was giving ICBs the go ahead and the funding for voluntary redundancy programmes that will see overall headcount drop by 50%
He also said DHSC is on track to absorb NHS England within two years and confirmed the two bodies' combined headcount will be halved.
‘Serious risk’ of missing health mission milestone
The report also warns that NHS England has missed several post-Covid recovery targets by a significant margin and that DHSC is at "serious risk" of failing to meet its key pledge to fix the NHS.
The MPs found that:
The report says these failures were “driven in part by NHSE’s and the government’s flawed approach to improving its own services”. It said £3.24bn in spending – most of which paid for new surgical hubs and diagnostic centres – was approved by government “without sufficient focus on what exactly its funding would deliver and without any focus on outcomes for patients”.
The MPs said freeing up more outpatient appointments could have made the most difference as the vast majority (80%) of elective care pathways end through such an appointment, but NHSE “had no credible plan to achieve this, failing to secure meaningful engagement from clinicians to do so”.
The report warns that DHSC will need "get a grip" on the recovery programmes when it takes them over from NHSE or there is a "serious risk" of failing on its pledge to treat 92% of patients within the statutory standard of 18 weeks by 2029, the key milestone the government has set in this parliament for its health mission: build an NHS fit for the future.
A DHSC spokesperson said: “This government inherited a broken NHS, with waiting lists soaring and elective services in dire need of modernisation. This report focuses on the previous government, and we have taken immediate and robust action to tackle waiting lists and modernise elective care.
“For the first time in 15 years, waiting lists are falling. Through record investment and modernisation, we’ve cut backlogs by more than 230,000 and smashed our target for additional appointments, delivering more than five million extra.
“Health service productivity is up 2.7% on last year – and just last week, we pressed ahead with halving the headcount of NHSE and DHSC, saving billions to reinvest into the frontline and patient care.
“We’re delivering the change the NHS is crying out for – while slashing wasteful spending to ensure maximum value for taxpayers.”