NHS England: divorced, beheaded, died

Abstract

A butterfly flaps its wings in the Amazon, said the mathematician and meteorologist Edward Lorenz, and later a tornado rages thousands of miles away.1 By contrast, will the demise of NHS England, the behemoth “quango” that oversees the NHS, raise more than a flutter on the “front line” of clinical care? It’s hard to argue that NHS England was ever wanted or loved or that it delivered to expectations, but in a world at war on bureaucracy, of vanishing fiscal space and a need to grow defence budgets, every billion counts. However, redirecting funding to the so called front line is one of the official narratives for disbanding NHS England (doi:10.1136/bmj.r521).2 Cutting several thousand of the staff who run the overlapping bureaucracies of NHS England and the Department of Health and Social Care will save less than £1bn—a big number that nonetheless accounts for a tiny percentage of the NHS’s £192bn budget for the next financial year (doi:10.1136/bmj.r535).34 Whether the few hundreds of millions that might be subsequently released can have a direct impact on clinical care is hard to believe, but whether the opportunities outweigh the risks more broadly requires consideration. Andrew Lansley’s reforms of 2012 gave birth to the NHS Commissioning Board, which became NHS England, an arm’s length body in theory divorced from politics that would run the NHS. Malcolm Grant, chair of the commissioning board …