Sir Keir Starmer cast his decision to abolish NHS England – the world’s largest quango – as a bold strike against bureaucracy. The move is designed to cut waste, “shift money to the front line” and put the English NHS under democratic control. It is a declaration of intent from a prime minister who wants Labour not to be the party of bigger government but the party of smarter government. At least, that’s the theory. The reality, as ever, is more complicated.
This is less a grand health reform and more a strategic positioning exercise. The health secretary, Wes Streeting, the architect of this plan, is engaged in a delicate balancing act: convincing the Treasury that the NHS can stay within budget while simultaneously lobbying for more money that he knows the health service will inevitably require. The headline-grabbing cull of NHS England is useful – allowing Mr Streeting to claim that he is shifting cash from managers to patient care, a necessary concession when preparing to argue for more Treasury investment.
