Abolishing NHS England won’t work without greater decentralisation, IEA responds to PM speech
14 March 2025
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Lifestyle Economics
Economics
14 March 2025
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17 March 2025
Responding to the Prime Minister’s speech on public sector reform Tom Clougherty, Executive Director of the free market think tank the Institute of Economic Affairs, said:
“The Prime Minister is right to say that big, intrusive, and ever-expanding government is not working. Bureaucracy is strangling Britain’s economic dynamism. Welcome as today’s announcements are, however, they should only be the start of a much bigger programme of reform and liberalisation.
“Abolishing NHS England, for example, could be a good move. But if it simply translates to the Department for Health and Social Care trying to run everything itself, it won’t do any good. We need greater decentralisation and more bottom-up initiative-taking.
“Increasingly, the government is getting its rhetoric right. But its actions haven’t quite caught up. The British state is overloaded and that hurts both public services and the private sector. Changing structures might help, but ultimately government just needs to stop doing some things altogether.”
IEA Editorial Director Kristian Niemietz said:
“The abolition of NHS England is not as radical a measure as it may sound, given that the organisation has only been around for less than a decade and a half. Its existence has always been a bit of an anomaly. NHS England was created as part of the Lansley reforms of the early 2010s, which saw a reorganisation of the NHS’s internal commissioning process. Most NHS commissioning functions were transferred to so-called “Clinical Commissioning Groups” or “CCGs”, which were local bodies led by GPs.
“This created a potential conflict of interest, since GPs are also healthcare providers in their own right, so we would not necessarily want them to commission services from themselves, or mark their own homework. Hence, NHS England was created as a separate commissioning board for primary care and some specialised care services, alongside some oversight functions.
“The Prime Minister is right to say that big, intrusive, and ever-expanding government is not working. Bureaucracy is strangling Britain’s economic dynamism. Welcome as today’s announcements are, however, they should only be the start of a much bigger programme of reform and liberalisation.
“Abolishing NHS England, for example, could be a good move. But if it simply translates to the Department for Health and Social Care trying to run everything itself, it won’t do any good. We need greater decentralisation and more bottom-up initiative-taking.
“Increasingly, the government is getting its rhetoric right. But its actions haven’t quite caught up. The British state is overloaded and that hurts both public services and the private sector. Changing structures might help, but ultimately government just needs to stop doing some things altogether.”
IEA Editorial Director Kristian Niemietz said:
“The abolition of NHS England is not as radical a measure as it may sound, given that the organisation has only been around for less than a decade and a half. Its existence has always been a bit of an anomaly. NHS England was created as part of the Lansley reforms of the early 2010s, which saw a reorganisation of the NHS’s internal commissioning process. Most NHS commissioning functions were transferred to so-called “Clinical Commissioning Groups” or “CCGs”, which were local bodies led by GPs.
“This created a potential conflict of interest, since GPs are also healthcare providers in their own right, so we would not necessarily want them to commission services from themselves, or mark their own homework. Hence, NHS England was created as a separate commissioning board for primary care and some specialised care services, alongside some oversight functions.
“Abolishing NHS England is not an exercise in bureaucracy-slashing. The government has not identified any particular functions of NHS England it want to eliminate. It appears as if they are just transferring these functions from a semi-independent arms-length body to the Department of Health itself, in which case, it would be just the latest episode in a long series of NHS reorganisations.”
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