Keir Starmer’s NHS Shake-Up: The Abolition of NHS England and the Future of UK Healthcare
In a controversial move, UK Prime Minister Keir Starmer recently announced the abolition of NHS England as part of a radical plan to bring the NHS under “democratic control.” The decision, confirmed in March 2025, marks one of the most significant NHS reforms and aligns with a Labour pledge to end what Starmer has referred to as ‘unelected bureaucracy’ running healthcare.
Since its 2013 creation under the Conservative Party’s Health and Social Care Act, NHS England has operated independently from direct government control, with internal decisions made on budgets, priorities, and commissioning services. Many critics, including Starmer, have asserted that this system led to a lack of accountability because of its internal administration, fragmented decision-making due to gaps between NHS England and the Department of Health, and the encouragement of those in need of urgent assistance to rely on privatised healthcare.
Starmer’s government claims that dismantling NHS England will instill democratic insight and ensure that health policy is an issue of government rather than external decision-makers. In place of NHS England, the Department of Health and Social care will take direct control, so ministers may now oversee daily NHS operations, budgets, and strategies. Local Integrated Care Systems (ICSs) will also gain more power, so that councils and mayors will have a say in regional policies l. A new NHS Accountability Board will be established, composed of healthcare experts, local leaders, and patient representatives to advise the government. These reforms aim to create a balance between centralised accountability and local flexibility, with the goal of ensuring a national standard. It is important to note that, as of now, these reforms only apply to England, rather than to other countries within the UK.
Supporters of these reforms argue that they will end regional disparities between postcodes and create more equal access to healthcare through the rejection of market-driven healthcare. These reforms will also supposedly reduce negative impacts of waiting lists and staffing shortages, ensuring that healthcare is more accessible. Critics warn that politicising the NHS and subjecting it to short-term political pressures may not be productive, and they are concerned it would stifle local innovation for better healthcare. The British Medical Association (BMA) has warned that sudden changes amid current strain on the NHS system may worsen conditions, but the outcomes of these reforms cannot yet be observed, as the changes are expected to be gradually implemented over a period of two years. While these reforms are controversial and ambitious, many hold out hope that they will encourage the formation of a better and more functional NHS, with changes – if successful – hopefully being implemented outside of England as well.
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The views and opinions expressed in this article are those of the author and do not necessarily reflect those of the wider St. Andrews Foreign Affairs Review team.
