Abolishing NHS England with no clear plan for cuts left uncertain future for patients and staff

14 May 2025

Govt called on to reduce tragic incidences of patient harm as jaw-dropping amounts paid out on clinical negligence claims.

Forthcoming staff cuts and NHS England’s (NHSE) abolition have caused great uncertainty for all involved with the health system. In a report on the Department for Health and Social Care’s (DHSC) Accounts 2023-24, the Public Accounts Committee (PAC) underlines its concern at the impact this uncertainty may have on patients and staff.

The Government announced that it would abolish NHSE and centralise its functions into the DHSC during the PAC’s 13 March 2025 evidence session. It has still not set out how this major structural and operational change will impact key services and targets to improve patient care. Other areas where government was unable to provide clarity to the PAC’s inquiry include:

The lack of a clear plan for how DHSC and NHSE will achieve significant headcount reductions, and the costs involved;
How the reductions fit in with the wider 10 Year Health Plan for the NHS;
How savings made from reducing NHSE staff costs help frontline services;
How the institutional knowledge of NHSE would be preserved following its abolition;
The scale of headcount reductions in the DHSC, and the geographical spread of the planned 50% headcount reductions in NHSE and across local Integrated Care Boards.

In the area of clinical negligence, the PAC is disappointed that huge improvements still need to be made to better protect both patients and public money. An astounding £58.2bn has been set aside to cover the potential cost of clinical negligence events in the latest accounts – the second largest liability across government after nuclear decommissioning. An astronomical 19% of money awarded to claimants in 2023-24 goes to their lawyers (£536m of the total £2.8bn paid that year), on top of the fees payable for the Government Legal Team. Behind these jaw-dropping figures lie many tragic incidents of patient harm, and the PAC is calling on government to set out a plan with clear actions to improve patient safety across the NHS, and in particular in maternity services.

As well as clinical negligence and severance payments, the report also highlights a lack of information provided by the DHSC in other key areas of interest to the PAC and Parliament. Its accounts contain no clear overarching narrative on social care, with a lack of clear data on productivity; prevention; digital and artificial intelligence; and palliative and end-of-life care.

Also scrutinised in the report is the development of a new site for high containment labs central to protecting the population against infectious diseases by UK Health Security Agency (UKHSA). The building of new facilities at Harlow has been poorly overseen, with a now over-decade long programme’s costs rising from an initial estimate of £530m to an eye-watering projected £3.2bn. No decision has yet been made on the future of the site on which £400m has been spent on development so far with little to show for it, and delays could risk leaving the nation without adequate protection against emerging new diseases. With time running out as current facilities near the end of their life, the report calls for UKHSA to urgently outline how it will ensure that the UK continues to have the infrastructure it needs to protect public health.

Chair comment

Sir Geoffrey Clifton-Brown MP, Chair of the Committee, said: “Our report shows a health system still under pressure on a number of fronts, pressure which will need strong decision-making from government to begin to be relieved. One significant decision, the abolition of NHS England, was announced whilst our Committee was questioning senior health officials. All those who work for NHSE deserve our ongoing gratitude for their efforts to safeguard the nation’s health. But it has been two months since government’s decision to remove what up until now has been seen as a key piece of machinery without articulating a clear plan for what comes next, and the future for patients and staff remains hazy.

“These changes also require 50% reduction in local health board staff, including frontline services such as health prevention, GP services and dentistry. These services are usually the first interaction a patient has with the NHS, so we will require further reassurance and clarity on how government intends these changes to play out on the local level.

“The fact that government has set aside tens of billions of pounds for clinical negligence payments, its second most costly liability after some of the world’s most complex nuclear decommissioning projects, should give our entire society pause. This is a sign of a system struggling to do right by the people it is designed to help. It must be a priority of the highest order for government to reduce tragic incidences of patient harm, and lay out a mechanism to reduce legal fees to manage the jaw-dropping costs involved more effectively.

“Our Committee has also returned with this report to the vexed question of new high containment labs at Harlow. Of all the projects to have been poorly overseen, the lack of clear direction on a critical piece of infrastructure designed to keep us all safe from infectious disease is particularly alarming. Our Committee will continue pressing government on this until it is firmly on track.”

Further information

Image: House of Commons