The Future of NHS England: What We Know to Date

Uncertainty is emerging whether the NHS England can realistically be abolished within the next two years, a key pledge outlined in July’s 10-Year Health Plan.

In a staff briefing last week, NHS England chief executive Sir Jim Mackey sought to calm nerves, saying there was no longer a “rush” to transfer the employment of NHS England staff to the Department of Health and Social Care. The transition, he explained, would not be a “big, dramatic overnight thing” as many had assumed.

“The downside is, it’ll take a bit longer,” he told staff. “The upside is – and especially if we can resolve the voluntary redundancy situation – we work through this in a more thoughtful, organised and controlled way over the next couple of years.”

Behind the shift in tone lies a growing recognition that the path to dissolution is more complex than first imagined. Officials close to the process say three factors have forced a rethink.

First, Treasury resistance to additional funding in 2025-26 has limited the ability to finance voluntary redundancies, stalling the pace of restructuring. Second, senior figures are increasingly concerned that a major organisational overhaul could divert critical energy away from the immediate challenge of improving NHS performance and stabilising finances. And third, legal advice is believed to have raised red flags about transferring NHS England staff to the DHSC before Parliament has even debated the bill required to formally abolish the body.

What was once a defining feature of the government’s reform narrative: a bold plan to simplify and centralise oversight, is now showing signs of slowing under its own weight. For those within the system, the question is shifting from when NHS England will cease to exist to whether the political will remains to see the process through.

The broader consequence is uncertainty at a time when the NHS can least afford it. With performance targets slipping, budgets under pressure, and winter approaching, the national leadership’s focus on structural reform risks coming at the expense of operational recovery. Sir Jim’s message of patience may buy time, but it also signals a quieter admission that the road to reform will be longer, and harder, than promised.