The health secretary, Wes Streeting, has approved a major reorganisation of NHS England that will see around 18,000 backroom jobs cut. The move is intended to save £1bn a year for frontline care, though implementation is expected to cost at least that amount upfront. It is part of a high-stakes reform that could serve as a model for rebuilding public services without excessive tax rises, or risk becoming a significant setback for both Labour and the NHS.
Recent polling by the Health Foundation found that less than a quarter of the public in England were aware that waiting lists had fallen during Labour's first year in power, with more than a third believing they had continued to rise. Official figures show that 61.8% of patients are currently treated within 18 weeks of referral, and NHS executives have expressed confidence this could reach 65% by March, with a target of 92% by 2029 – a goal originally set and met under Tony Blair's government but missed for a decade.
The reform announcement was overshadowed by reports that a figure close to Prime Minister Keir Starmer accused Streeting of plotting a coup, just days before a planned speech on NHS reform. Streeting was forced to address the speculation during a pre-booked television appearance, while he also expressed frustration with resident doctors who are set to strike again, despite having received a 28.9% pay rise last year. He suggested that the British Medical Association has lobbied against doctors paying higher taxes while demanding increased state pay.
The reorganisation involves merging NHS England into the Department of Health and Social Care and cutting regional commissioning boards. The plan is designed to reduce headcount and devolve more power to well-performing hospital trusts, freeing them from central control. This approach is expected to be echoed across other government departments, as ministers seek to cut administrative costs and redirect funding to frontline services.
However, the gamble carries considerable risks. The upfront costs of the reorganisation are substantial, and the plans are proceeding against a backdrop of ongoing doctors' strikes, delayed social care reforms, and warnings of a busy winter for the NHS. Streeting's strategy depends on the cooperation of doctors, yet his confrontational stance toward the BMA may complicate matters. The outcome could determine not only the future of the NHS but also the political fortunes of the Labour government, as lower waiting lists are seen as a key measure of its success.
