Good morning. It’s not often that a big policy story breaks without a drip feed of briefing in advance – but yesterday, Keir Starmer and his health secretary, Wes Streeting, concocted that rare thing: a genuine political surprise. “NHS England will be abolished,” the news alerts said – and once readers got past their initial anxiety that the entire health service had been wiped out for 57 million people, they will have found details of a change that is radical nonetheless.
In the vast bureaucracy of the NHS, NHS England was the supreme quango: an organisation of 15,000 people, responsible for a budget worth well over £150bn, with a list of responsibilities that only ever seemed to grow. Now it is being wound down, at the cost of 10,000 jobs, with the aim of bringing back under government control the execution of policies that will have a huge bearing on Starmer’s fate.
NHS England has only operated since 2013 – and most experts agree that then-health secretary Andrew Lansley’s reforms have been a failure. But with Streeting under huge pressure to deliver on his promises to improve the NHS, there are also those who ask whether yet another reorganisation will simply be a distraction, and note that the vaunted savings are basically a rounding error. For today’s newsletter, I spoke to Stuart Hoddinott, senior researcher at the Institute for Government, about the arguments for and against. Here are the headlines.
Five big stories
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Russia-Ukraine war | Vladimir Putin has said he has many questions about the proposed US-brokered ceasefire with Ukraine and appeared to set out a series of sweeping conditions that would need to be met before Russia would agree to such a truce. Donald Trump said that if Russia did not agree to a ceasefire it would be “a very disappointing moment”.
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US economy | The S&P 500, a key US stock market index, closed in “correction” territory – a drop of 10% on its recent peak - on Thursday as the volatility of Donald Trump’s trade wars rattled investors. Meanwhile, Trump threatened a new 200% tariff on European alcohol, in response to a 50% EU tariff on American bourbon imports.
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Lucy Letby | Police investigating the hospital where the nurse Lucy Letby worked have widened their inquiries to include gross negligence manslaughter by senior staff. Cheshire constabulary says it has expanded its inquiry into the Countess of Chester hospital despite growing questions around Letby’s convictions.
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UK news | A teenager has been sentenced to life in prison for murdering a 15-year-old girl after a row over a teddy bear in south London. Hassan Sentamu was 17 when he killed Elianne Andam by stabbing her in the neck outside the Whitgift Centre in Croydon, south London, in September 2023.
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AI | Peter Kyle, the science and technology secretary, has asked ChatGPT for advice on a range of work-related issues, a freedom of information request has shown. Experts say the fact the information was provided could open the door to similar information having to be disclosed across Whitehall.
In depth: ‘It is a surprising way to go about making policy’
Just a few days ago, NHS England staff were told that the government intended to cut the workforce in half – but not that the institution was going to be abolished. As recently as January, Wes Streeting had told the Health Service Journal that he had no interest in such a move: “I could spend a hell of a lot of time in parliament and a hell of a lot of taxpayers’ money … and not make a single difference to the patient interest.” That is exactly the opposite story to the one that he and Keir Starmer told yesterday.
“What’s changed? It’s very difficult to say,” Stuart Hoddinott said. “But regardless of whether this was always the plan or not, it looks rushed and chaotic. It is a surprising way to go about making policy for the largest public service in the country.”
What does NHS England do?
NHS England has been running the health service in England since 2013, created as part of widely criticised reforms made by then-health secretary Andrew Lansley. It is accountable to the Department of Health, and has control of the vast majority of its £192bn budget – 86% last year. It employs about 13,000 people.
There are equivalent bodies in Wales, Scotland, and Northern Ireland, but they are under devolved control, which means the UK government cannot abolish them. Broadly speaking, NHS England is an arms length body that oversees the NHS workforce, manages local bodies as they provide clinical services, tracks targets, and performs many other functions.
It has grown significantly, both in staffing and in function, since it was first created, with many more points of overlap with the Department of Health and Social Care (DHSC) than were originally intended.
“There was a period where the separation between policymaking in DHSC and implementation in NHS England was clearer,” Hoddinott said. “You now have a situation where what effectively happens is that DHSC hands the money over, NHS England decides how it is spent on the frontline, and then they come back to the department at the end of the year and say how much they’ve overspent by – and so DHSC becomes this strange intermediary to the Treasury. That isn’t how it usually works with government departments.”
What are some of the arguments for abolishing it?
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NHS England has expanded its functions and duplicated roles at DHSC, creating an unwieldy and confusing structure. This was the central argument made yesterday by Starmer, who said: “Is it a good idea for the frontline of the NHS to get rid of two sets of comms teams, two sets of strategy teams, two sets of policy teams, where people are basically doing the same thing? Yes, it is.”
That could certainly deliver a “much more agile organisation, more able to implement policy effectively” in the long term, Hoddinott said. “There are practical implications of the duplication – you can get conflicting guidance, clashes that slow down policymaking and reform, and more people in the centre means more demands for information. It is burdensome for those on the frontline.” Also worth noting is the argument from Starmer that this is not about a drastic reorganisation of the entire NHS – only the bureaucracy at the top of it. -
Money will be freed up to spend on frontline services instead of managers. This was an argument made by Streeting yesterday, who said that the changes would deliver “savings of hundreds of millions of pounds a year” that would help cut waiting times.
But this is more a political argument than a practical one, Hoddinott said: “The NHS budget is so enormous that this would be a drop in the ocean. It’s not even enough to clear the NHS provider trusts deficit,” which stood at £1.2bn last year. “The idea it’s going to release enormous savings just isn’t true.” He also questioned the idea that the NHS is overmanaged: “The problem is where the managers are. If you had more managers, but closer to the frontline than the centre, that would be more effective.” -
There will be greater accountability for the direction of the NHS. Starmer emphasised the return of management of the health service to “democratic control”. It can be very difficult for ministers to bring about rapid change as the system currently operates, Hoddinott said. “Wes Streeting is perhaps finding that there is a very long wait, if he says something to a civil servant, for it to get down the chain. He may not have as much power as he thought he did.”
In this piece, Denis Campbell reflects the view of Streeting’s camp: a sense of “a can’t-do mentality among senior people who, when asked what their plans are to address key challenges, respond by stressing how difficult they are to fix.”
What are some of the arguments against the move?
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The whole point of its creation was to limit political short-termism. “The NHS has some very long-term and diffuse goals, like improving population health outcomes, that can take decades,” Hoddinott said. “And it’s an incredibly complex organisation. The idea was to avoid the constant tinkering.” On the other hand, he noted, “it’s not like it’s been immune from that pattern in recent years – the churn with a new secretary of state or a new prime minister has been almost constant since 2016”.
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Its power should be devolved to local leaders, not sent up the chain to Westminster. One of the most prominent recent arguments made for the abolition of NHS England was that put forward by the thinktank Reform, which published a headline-grabbing report making the case last year. But central to that thesis was the idea that control of the budget should instead be devolved to local bodies, not held in Westminster. And the mood music yesterday pointed in the opposite direction. “We’ve also had the announcement that integrated care boards [which plan healthcare in specific areas] have to cut spending by 50%,” Hoddinott said. “That doesn’t suggest a massive shift in resources away from the centre.”
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The process risks drowning out the NHS’s many urgent priorities. Perhaps the most compelling case against the change: amid all the other NHS priorities Streeting has announced, and with a 10-year plan due to be announced in the summer, it is easy to see how the reforms could distract from measures that might have more immediate policy outcomes. “If you were designing the superstructure from scratch you would not do it this way,” Hoddinott said. “But we aren’t designing it from scratch. And there are real costs that come with doing it.”
As well as the vast project management task facing staff in NHS England and DHSC alike, there is also the fact that the change will ultimately need primary legislation to be enacted – and anyone who remembers the Lansley reforms will know how much time and energy that might absorb. “Any time you put legislation on the table, you know that it might be turned into a political football,” Hoddinott said. “It’s easy for that to bounce off in directions that you didn’t expect.”
What else we’ve been reading
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Orysia Lutsevych attempts to get inside the mind of Vladimir Putin in this column on how Russia could approach peace talks with Ukraine. “I think his agreement on a ceasefire will be driven by two factors: whether his country can stay in the fight for much longer and the terms of the arrangement imposed on Ukraine,” she concludes. Charlie Lindlar, acting deputy editor, newsletters
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Thinking about getting a tatt? Read this first, as the tattoo experts tell you everything you need to know before needle pierces flesh and you’re left with an indelible source of regret. Top tip: “You can’t go wrong with a rose, a skull or an anchor.” Toby Moses, head of newsletters
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Tom Garry caught up with Man City star Vivianne Miedema on settling in at the club after her high-profile move from Arsenal, and the state of the women’s game. “We’re always saying we’re proud in the women’s game that we’re very inclusive but somehow that is starting to slip away a bit,” the striker warns. Charlie
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Tilda Swinton is nothing if not predictably unpredictable – her latest film is The End, a post-apocalyptic musical set in the underground bunker of a billionaire. Xan Brooks talks to the film’s star and its writer-director Joshua Oppenheimer about the unusual project, and the real life Russian family that inspired it. Toby
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There seems to be no end to the global implications of Donald Trump’s reckless programmes of tariffs – Jasper Jolly hears how UK steelmakers are managing the “massive frustration” imposed on them by the US president. Charlie
Sport
Football | Bruno Fernandes’s treble and a late goal from Diogo Dalot gave Manchester United a 4-1 win to put them through 5-2 on aggregate against Real Sociedad. Meanwhile, Rangers beat Fenerbahce in a penalty shootout, Chelsea beat FC Copenhagen, and Tottenham won against AZ Alkmaar 3-2 on aggregate.
Tennis | Jack Draper has booked his place in an ATP Masters 1000 semi-final for the first time after defeating American Ben Shelton in straight sets at the BNP Paribas Open.
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Horse racing | Frankie Dettori, one of the most successful and popular racing figures of recent decades, has said that he is “saddened and embarrassed” at being forced to file for bankruptcy having failed to resolve a dispute over unpaid tax with HMRC.
The front pages
“Streeting scraps NHS England in ‘high-stakes’ push to improve care” – that’s the Guardian’s splash, while the Daily Mail enthuses “Finally! patients to be put before NHS bureaucrats!” The i says “NHS revolution: Streeting seizes control of £192bn health service to force change” and the Financial Times has “Starmer axes NHS England in big health service revamp”. The Metro calls it “Starmer’s shock NHS takeover”. “Put the knives down” – the Mirror leads on the sentencing of Elianne Andam’s murderer. Unsurprising news in the Times – “Putin backs ceasefire in Ukraine but on his terms” – and the Express – “Putin: I will agree truce but only on my terms” – and the Daily Telegraph – “Peace on my terms, warns Putin”.
Something for the weekend
Our critics’ roundup of the best things to watch, read, play and listen to right now
TV
Adolescence | ★★★★★
A Wanted Man was, and remains, the most devastating and immaculately scripted and played series I have ever seen – as close to televisual perfection as you can get. There have been a few contenders for the crown over the years, but none has come as close as Jack Thorne and Stephen Graham’s astonishing four-part series Adolescence, whose technical accomplishments – each episode is done in a single take – are matched by an array of award-worthy performances and a script that manages to be intensely naturalistic and hugely evocative at the same time. It is a deeply moving, deeply harrowing experience. Lucy Mangan
Film
Sister Midnight | ★★★★☆
Radhika Apte plays Uma, a woman who has arrived in Mumbai to start life as a housewife after an arranged marriage, the groom having gone on ahead to where he has already established himself in what is to be their modest marital home. All alone, with nothing but her feelings of boredom and resentment and rage, Uma begins to lose it – she hears noises, she has hallucinations regarding birds and goats, which are represented in stop-motion animation. Or are they real? Peter Bradshaw
Game
Wanderstop (PC, PlayStation 5, Xbox) | ★★★★★
Cosy is often a kind of code for twee, low-stakes domestic adventures where drama is eschewed in favour of repetitive tasks intended to generate comfort, or imitate lightning-in-a-bottle resource management sims such as Stardew Valley or Animal Crossing. So when faced with Wanderstop, a colourful game in which a fallen warrior trades in her fighting life for managing a tea shop, I was hesitant. But Wanderstop’s cosy and cute exterior belies something much richer and much cleverer than I have seen in quite some time. It is a masterpiece in a cute disguise – offering the player a place worth visiting, staying and paying attention to. Sarah Maria Griffin
Music
Annie and the Caldwells: Can’t Lose My (Soul) | ★★★★★
Traditional gospel has been having something of a moment, thanks to a series of archival releases, 21st-century artists – most notably the Harlem Gospel Travelers – and sampling: 70s tracks by Pastor TL Barrett have been plundered by Loyle Carner and Kanye West, whose album 2019 Jesus is King was similarly packed with gospel interpolations. Even so, a band releasing their debut album and playing hip European festivals 40 years into their existence is undoubtedly peculiar. The climate might be welcoming, but this wouldn’t have happened had Annie and the Caldwells not been exceptionally good at what they do, and Can’t Lose My (Soul) underlines just how good that is. Alexis Petridis
Cartoon of the day | Ben Jennings
The Upside
A bit of good news to remind you that the world’s not all bad
A woman who lived to the age of 117 had genes that were keeping her cells “younger”, a study has shown. Maria Branyas Morera, who was the world’s oldest living person before she died in Spain last August, had attributed her longevity to “luck and good genetics”. And it seems she might have been on to something.
A study of Branyas’s microbiome and DNA reportedly found that the genes she inherited allowed her cells to feel and behave as if they were 17 years younger than they actually were, and her gut microbiota mirrored that of an infant.
Researchers at the University of Barcelona, who began conducting the study before Branyas’s death, hope their findings will prove useful to those developing medications and treatments for age-related illnesses. They said her case helps to “challenge the perception that [ageing and sickness] are inexorably linked”.
Bored at work?
And finally, the Guardian’s puzzles are here to keep you entertained throughout the day. Until tomorrow.
