NHS England abolition shows ‘we have to take difficult decisions’, says Starmer – UK politics live

Here are some pictures from the Starmer event earlier. Jeremy Hunt, the former Tory health secretary, said that potentially this announcement could lead to “real transformation”. He told Streeting: Can I commend the boldness of today’s announcement. If the NHS is going to be turned around, it’s going to need radical reforms. If the result of today is to replace bureaucratic over-centralisation with political over-centralisation, it will fail. But if what happens today is that we move to the decentralised model that we have for police and for schools, it could be the start of a real transformation. Hunt also asked if this change would lead to the 100 or so central targets, making the NHS “the most micro-managed system in the world”, would be abolished. In response, Streeting suggested that he agreed with Hunt that political over-centralisation was a mistake. He said that he believed “democratic accountability matters, both in terms of patient outcomes and value for taxpayers money”. But he also said that recently he had annoyed by health leaders, and charities, by attacking “this fallacy that the secretary of state can or should just fire endless instructions into the system, as if a secretary of state, or for that matter an NHS England, could just pull some big levers and drive change in such a vast and complex system. This is a falsehood.” He went on: This over-centralisation has got to stop. And so for the future, it will be for the department and the NHS nationally to do those things that only the National Health Service can do, providing the enablers for the system as a whole. But what we are presiding over and embarking on is the biggest decentralisation of power in the history of our National Health Service, putting more power into the hands of frontline leaders and clinicians – but, even more fundamentally and transformationally, more power into the hands of patients. Simon Opher, the Labour MP for Stroud and a GP, asked if this change would reduce admin for doctors. Streeting said he did think that was the case. He also said he did want to “liberate front-line staff and managers to help them be more effective”. Alison Bennett, a Lib Dem health spokerson, asked if legislation would be needed for this reorganisation. She also asked for an assurance that it would not hold up the review of adult social care (a Lib Dem priority). Streeting said “much” of the reorganisation could be done without legislation. But there would need to be a bill, he said. And, on adult social care, he said he regretted the fact that start of the cross-party talks on this had been delayed. That was because of “practicalities on the part of a number of parties involved”, he said. He said he would be in touch soon to arrange the first meeting. Caroline Johnson, the shadow health secretary, told MPs that the Conservative party was in favour of “a leaner and more efficient state”. She went on: That means using resources effectively, reducing waste and preventing duplication – spending money where it is most beneficial … Therefore, we are supportive of measures to streamline the management, and we do not oppose the principles of taking direct control. But she said the Tories wanted assurances about the reorganisations would take place, and how targets met and standards maintained during this process. Streeting told MPs that many Tories had told him privately that they should have reversed the Andrew Lansley health reforms of 2012 that set up NHS England as the executive body in charge of the English health service, largely independent from central government. The reforms also introduced more competition in the provision of NHS service, in a manner that has been widely criticised on the grounds that it hindered necessary cooperation. Streeting said: I cannot count the number of Conservatives who have told me in private that they regret the 2012 reorganisation and wish they had reversed it when in office, but none of them acted. They put it in the too difficult box while patients and taxpayers paid the price, because only Labour can reform the NHS. Streeting says work has already started ending duplication between NHS England and the Department of Health and Social Care (DHSC). During the transformation period, NHS England will focus on “holding local providers to account for the outcomes that really matter, cutting waiting times and managing their finances responsibly”. He says that it will take two years to bring NHS England’s functions back into the DHSC entirely. He goes on: These reforms will deliver a much leaner top of the NHS making significant savings of hundreds of millions of pounds a year. That money will flow down to the front line to cut waiting times faster and deliver our Plan for Change by slashing through the layers of red tape and ending the infantilisation of frontline NHS leaders. In the Commons Wes Streeting, the health secretary, has just started making an announcement about the abolition of NHS England. He says the government is “turning one team into one organisation”. Keir Starmer took some questions from staff members before he invited questions from journalists, and in response to one of the first points raised, he also raised the point about NHS England duplicating work done by the Department of Health and Social Care (DHSC). He said: On the question of NHS England, amongst the reasons we’re abolishing it is because of the duplication. So if you can believe it. We’ve got a communications team in NHS England, communications team in the health department of government. Got a strategy team in NHS England, a strategy team in the government department … If we strip that out, which is what we’re doing today, that then allows us to free up that money to put it where it needs to be, which is the front line. One person who knows a lot about this subject is Starmer’s own director of strategic communications, James Lyons. Before joining the No 10 team, Lyons was head of communications for NHS England. And another person who may have advised Starmer on the NHS England/DHSC duplication problem is Chris Wormald, the new cabinet secretary. He was as previously permanent secretary at DHSC. Q: NHS England has a big presence in Leeds. What do you say to people worried about their jobs? Starmer says there are always consequences of decisions. If people just focus on those, they will always be in a “defensive crouch” and nothing will ever get done. He goes on: Is it a good idea for the front line 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. And it’s very difficult for me to look at people who desperately need the NHS, haven’t got the treatment that they want, at the speed they want, through no fault… [and] say I could do something about it, and I don’t think this duplication is very sensible, but I’m not going to do it. That is what’s gone wrong in politics, which is an unwillingness to take difficult decisions. And that’s why we end up where we are. So we have to take difficult decisions. Obviously, the people in NHS England are hugely qualified, highly skilled, doing a fantastic job, and we will work with them in relation to what comes next. Of course we will, because I believe in dignity and respect at work … I’m not abandoning anybody in this. But I can’t look people in the eye who say I want a quicker appointment and say I could do something to help you, but I’m not going to do it, because I’m somehow fearful of making a difficult decision. I’m not going to do that. Haven’t done that in politics, I’m not going to start now. And that is the end of the Q&A. Just as he’s leaving, Starmer says how much he likes the Reckitt offices, which he describes as “modern” and “open”. He says he would like to do an office swap. This place is better than Downing Street, which is a “rabbit warren of dark rooms, half of them underground”. Asked about the ship collision off the Yorkshire coast this week, Starmer says the cause has yet to be established. He pays tribute to all those who responded. Q: [From Christopher Hope from GB News] Will you scrap woke diversity and inclusion policies? That is what GB News viewers want. Starmer says the government want to ensure money is well spent. He goes on: We’re not slashing our commitment to equality and important issues like that. Nobody would expect that, but we are making sure we’re stripping away what is unnecessary. Q: And how do you feel about the prospect of sending British troops to war with Russia? Starmer says the point of deterrence is to avoid war. He says he is working with other countries to ensure that a peace deal for Ukraine would last, because Ukraine was defended. Starmer is still taking questions at the Q&A. He refers to the NHS England as an example of his approach to solving problems. My reaction, as it is to all things, is to just get on and change it. Lots of people walk around the problem many, many times and do massively brilliant rhetorical speeches about them, and change nothing. I tend to look at the problem, poke it, prod it, and then just change it. And that’s what we’re doing today. And the Department of Health and Social Care’s press release quotes And it quotes Wes Streeting, the health secretary, as saying: This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history. When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline. NHS staff are working flat out but the current system sets them up to fail. These changes will support the huge number of capable, innovative and committed people across the NHS to deliver for patients and taxpayers. Just because reform is difficult doesn’t mean it shouldn’t be done. This government will never duck the hard work of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for you when you need it. The Department of Health and Social Care has just put out a press released about the abolition of NHS England headlined: World’s largest quango scrapped under reforms to put patients first Explaining what is happening, it says: NHS England will be brought back into the Department of Health and Social Care to put an end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients. By stripping back layers of red tape and bureaucracy, more resources will be put back into the front line rather than being spent on unnecessary admin. The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability. As Lord Darzi’s independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system. The current system also penalises hardworking staff at NHS England and the Department of Health and Social Care who desperately want to improve the lives of patients but who are being held back by the current overly bureaucratic and fragmented system. Q: [From Sky’s Beth Rigby] You promised at the election there would be no austerity. But with the benefit cuts, and these civil service job cuts, it is going to feel like austerity. Starmer says there will be no return to austerity. But he defends the need to reform welfare. Q: Do you hope to get US tariffs removed? Do you think President Trump can be trusted? Starmer says he is disappointed to see tariffs going on UK steel. But he says he “strong view” is that it would be better to have a trade deal with the US that would cover tariffs, so they would be removed. He says a trade deal is being discussed now. Starmer is now taking questions from journalists. Q: [From the BBC’s Chris Mason] How soon can you turn this around? Starmer says he is frustrated. He cannot recall a time when internation instability was having as much impact at home. He says he is not saying “it’s the fault of somebody else”. He is not blaming civil servants, he says. He has tried to analyse what the problem is. Starmer is now talking about NHS England. He says it was a mistake for the last Conservative government to make it more independent of central government. (He is referring to the Andrew Lansley reforms.) He goes on: I don’t see why decisions about £200bn of taxpayer money on something as fundamental to our security as the NHS should be taken by an arm’s length body, NHS England. And I can’t, in all honesty, explain to the British people why they should spend their money on two layers of bureaucracy [NHS England and the Department of Health and Social Care]. That money could and should be spent on, nurses, doctors, operations, GP appointments. So today, I can announce we’re going to cut bureaucracy across the state, focus government on the priorities of working people, shift money to the front line. So I’m bringing management of the NHS back into democratic control by abolishing the arms length body NHS England. That will put the NHS back at the heart of government where it belongs, free it to focus on patients – less bureaucracy, with more money for nurses. That is a big announcement, that goes way beyond what we were expecting Wes Streeting to announce later today. (See 9.48am.) But what this will mean in practice is not clear. Starmer is now talking about regulatation, and giving examples of where he thinks it has gone too far. l give you an example. There’s a office conversion in Bingley, which, as you know, is in Yorkshire. That is an office conversion that will create 139 homes. But now the future of that is uncertain because the regulator was not properly consulted on the power of cricket balls. That’s 139 homes. Now just think of the people, the families, the individuals who want those homes to buy, those homes to make their life and now they’re held up. Why? You’ll decide whether this is a good reason because I’m going to quote this is the reason ‘because the ball strike assessment doesn’t appear to be undertaken by a specialist, qualified consultant’. So that’s what’s holding up these 139 homes. And if you put that in these contexts, people across Britain are frustrated. They don’t think politics works for them. It doesn’t deliver on its promises. How can you justify that in such circumstances that parts of the state see their job as blocking the government from doing the very things that it was elected to do? Starmer says the figures just out this morning showing waiting lists down for the five month in a row. (See 9.53am.) He says he is committed to reforming public services, and says he has always believed in the power of government. There was a good example of government at its best last summer, he says. When we had those terrible riots … what we saw then, in response, was dynamic. It was strong, it was urgent. It was what I call active government, on the pitch, doing what was needed, acting. But for many of us, I think the feeling is we don’t really have that everywhere all of the time at the moment. Starmer explains what he thinks is going wrong at the moment, using some of the language briefed in advance. (See 9.35am.) The state employs more people than we’ve employed for decades, and yet look around the country; do you see good value everywhere? Because I don’t. I actually think it’s weaker than it’s ever been, overstretched, unfocused, trying to do too much, doing it badly, unable to deliver the security that people need. I believe that working people want an active government. They don’t want a weak state. They want it to secure our future, to take the big decisions so they can get on with their lives. So we don’t want a bigger state, a more intrusive state, an over-expanding state, a state that demands more and more of people as it itself fails to deliver on core purposes. Starmer says AI will enable civil servants to work more effectively. He stresses that he is “not about questioning the dedication or the effort of civil servants”. Starmer switches to Ukraine. Without peace in Ukraine, the UK will face more economic insecurity, he says. He says Russia is menacing the UK. And the UK will not be strong if its energy supply is threatened by Putin, he says. If your energy security is exploited by Putin you’re not strong. If one in 80 young people are not in education or work, you’re not strong. If you lose control of your public finances, you can’t build your industries. So that is the test of our time, the goal of my Plan for Change – national security, for national renewal. Keir Starmer speaking about civil service reform at an event in Yorkshire. He is at the Reckitt HQ. He starts by saying that at the election Labour promised change. The Conservatives claim Keir Starmer is “not serious” about civil service reform. In a statement released last night in response to the overnight preview of Starmer’s speech, Alex Burghart, the shadow Cabinet Office minister, said: Labour is not serious about getting Britain growing. The prime minister has no plan to reform the civil service or cut public spending. Thanks to his budget the size of the state will reach a staggering 44% of GDP by 2030. Meanwhile businesses are being strangled by Rachel Reeves’s taxes and Angela Rayner’s red tape. The decision not to classify Axel Rudakubana as a terrorist following the Southport murders was right because it would be unhelpful to stretch the definition of terrorism to cover all extreme violence, Jonathan Hall KC, the UK’s terror watchdog, has concluded. Rachel Hall has the story. The Times today is running a story saying that Peter Kyle, the science secretary, “has described himself as a ‘disruptor’ with similarities to Elon Musk or Dominic Cummings” because he wants to use AI to modernise the delivery of public services. As explained on the blog yesterday, the government is now in favour of “disruptor” politics. But, an in interview with LBC, Kyle was keen to clarify what this meant. Asked if he wanted to be seen as a disruptor like Musk or Cummings, he replied: I aspire to be a disruptor in a positive way that takes people with us and excites people for change. The issue about disruptors and disruption – in the past, it’s been used in a fearful way, in a threatening way, in a way that actually creates circumstances where people are fearful of change. In Keir Starmer as prime minister, you see somebody who wants to lead positively through change, but yes, be assiduous and be determined in delivering the outcome. The headline hospital waiting list figure for England has fallen for the fifth month in a row, PA Media reports. An estimated 7.43m treatments were waiting to be carried out at the end of January, down from 7.46m at the end of December, NHS England figures show. This is the lowest figure since April 2023. But 6.25m patients were estimated to be waiting for treatments at the end of January, up slightly from 6.24m at the end of December. The two figures are different because some individuals are waiting for more than one procedure. The waiting list hit a record high in September 2023, with 7.77m treatments and 6.5m patients. There will be two Commons statements today at about 11.30am, after business questions. First Wes Streeting, the health secretary, will give an update on NHS England, where about half the HQ workforce is being cut to avoid duplication with the work done by the Department of Health and Social Security. And then Stephanie Peacock, a culture minister, is making a statement about the plans to celebrate the 80th anniversaries of Victory in Europe day and Victory over Japan day. Good morning. All prime ministers, sooner or later, get frustrated when they realise that the central government machine isn’t as effective as they would like. They arrive thinking that if they tell their officials to do something, it will happen, and they find out that it’s not that simple. When talking about this, they normally combine their criticism of the system with comments about how the individual civil servants with whom they work personally are excellent. Keir Starmer has arrived at this stage more quickly than some of his predecessors and this week there have been a series of announcements about shaking up Whitehall. Pat McFadden, the Cabinet Office minister, has said measures will be taken to ease out officials who are under-performing. On Tuesday Starmer told cabinet that the government should be taking more responsibility for decisions, and not outsourcing them to regulators. And today Starmer is going to say that the state has become “bigger, but weaker”. Ahead of the speech (or mini-speech – No 10 are billing it as an intervention, not a proper, set-piece policy speech), Starmer has published an article in the Daily Telegraph setting out his thinking. Starmer says he is only interested in making the state more effective, and does not care if it gets bigger or smaller. We need to go further and faster on security and renewal. In such uncertain times, people want a state that will take care of the big questions, not a bigger state that asks more from them. We need to be operating at maximum efficiency and strength. I believe in the power of the state. I’m not interested in ideological arguments about whether it should be bigger or smaller. I simply want it to work. I saw the state at its best in our response to the riots last summer. It was dynamic, strong and urgent. But for the most part, that’s not the state that most people will recognise. And he says the state has become “overcautious” and “flabby”. He cites planning policy as an example. I heard from a family business owner in Wales that builds homes for first-time buyers. During the consultation delays and the lengthy planning application, the cost of resources went up. The regulations held him back for so long that he lost the site. Business unable to grow because of red tape. Families unable to buy because an overcautious flabby state got in the way. As Rowena Mason reports in her preview, Starmer is also going to use the speech to say artificial intelligence (AI) should be doing more work currently done by civil servants. According to the extracts released by No 10 in advance, Starmer will argue that civil service reform should be shaped by the mantra: No person’s substantive time should be spent on a task where digital or AI can do it better, quicker and to the same high quality and standard. Starmer will be taking questions. Obviously reporters will want to question him about the growing Labour revolt over the proposed sickness and disability benefit cuts, but hopefully someone will ask if this mantra should apply to politicians too. You would not want AI running the control (I presume?), but most ministers who turn up on the morning interview programmes to regurgitate the No 10 line to take could easily be replaced by an AI bot. Here is the agenda for the day. 9.30am: Jonathan Reynolds, the business secretary, takes questions in the Commons. 9.30am: NHS England publishes its latest monthly performance figures. 10am: Helen Whately, the former care minister, gives evidence to the Covid inquiry as part of its module looking at PPE procurement. After 10.30am: Lucy Powell, the leader of the Commons, makes a statement on next week’s Commons business. Morning: Keir Starmer is doing a Q&A in Yorkshire where he will deliver a short speech about reforming the state. Noon: John Swinney, Scotland’s first minister, takes questions at Holyrood. Early afternoon: Kemi Badenoch is on a visit near Glasgow where she is expected to speak to reporters. And at some point today Shabana Mahmood, the justice secretary, is holding a meeting with the Sentencing Council to discuss the guidelines that Mahmood claims would implement “two-tier” justice. 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