NHS England Update

Statement

The following Statement was made in the House of Commons on Thursday 13 March.

“With permission, I would like to make a Statement on the future of NHS England.

Since coming into office, this Government have made big strides in fixing our broken NHS. Under the Conservatives, the NHS suffered years of industrial action, costing taxpayers billions and costing patients more than 1 million cancelled operations and appointments. We negotiated an end to the resident doctors’ strike within three weeks. We have delivered the 2 million extra appointments we promised in our first year, and we did it seven months early. After 14 years of rising waiting lists under the Conservatives, we are finally turning the tide, cutting waiting lists for five months in a row, cutting waiting lists through the winter pressures and cutting waiting lists by 193,000 so far and counting. We have agreed the GP contract with GPs for the first time since the pandemic—our first step to bringing back the family doctor—and we have delivered the biggest uplift in hospice funding for a generation.

However, there should be no doubt about the scale of the challenge ahead. We inherited an NHS going through the worst crisis in its history, so there is no time to waste. We inherited public finances with a £22 billion black hole, so there is no money to waste. The urgency of the crisis means we have to go further and faster to deliver better value for taxpayers and better services for patients—something the Conservative Party cannot even begin to speak to a record on.

The independent investigation into the National Health Service by the noble Lord, Lord Darzi, traced the current crisis back to the 2012 top-down reorganisation of the NHS by the noble Lord, Lord Lansley. The Darzi investigation said the reorganisation was ‘disastrous’ and a ‘calamity without international precedent’ that ‘scorched the earth’ for health reform,

‘the effects of which are still felt to this day’.

The Health and Social Care Act 2012 established more than 300 new NHS organisations, created a complex and fragmented web of bureaucracy and, to quote the Darzi investigation,

‘imprisoned more than a million NHS staff in a broken system’.

Today, we are putting the final nail in the coffin of the Conservatives’ disastrous top-down reorganisation of the NHS.

There are more than twice as many staff working in NHS England and the Department of Health and Social Care today than there were in 2010—twice as many staff as when the NHS delivered the shortest waiting times and the highest patient satisfaction in history. Today, the NHS delivers worse care for patients, but is more expensive than ever before. The budget for NHS England staff and admin alone has soared to £2 billion. Taxpayers are paying more, but getting less. We have been left with two large organisations doing the same roles, with an enormous amount of duplication.

It is especially in times like these, when money is tight, that such bloated and inefficient bureaucracy cannot be justified. However, even if the Conservatives had not left a £22 billion black hole in the public finances, the Prime Minister would still be announcing the changes he is today, because every £1 that is wasted on inefficient bureaucracy—in good times or bad—is £1 that cannot be spent on treating patients faster, nor can it be spent on fixing our crumbling schools, lifting children out of poverty or putting money back into people’s pockets. There is always a duty on Ministers to get as much value for taxpayers’ money as is possible, and I cannot honestly say that it is achievable with the way that my department and NHS England are set up today, nor can I say that the current set-up is getting the best out of the NHS.

I am sure Members will have heard their local NHS leaders complain about the top-down way in which the NHS is run. It is something I have heard for years. Now that I find myself at the peak of this enormous mountain of accountability, I do not just recognise the complaint; I agree with it. Front-line NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy.

In the Hewitt review, the former Health Secretary, my right honourable friend Dame Patricia Hewitt, reported that one local service was required to send 250 reports and forms to NHS England and the Department of Health and Social Care in a single month. That is time and energy that is not being spent delivering care for patients. The review also concluded that having two organisations doing the same jobs has led to

‘tensions, wasted time and needless frictional costs’.

Since coming into office I have sought to correct that, by building a one-team approach between my department and NHS England, working towards our shared mission of building an NHS fit for the future. Today, the Prime Minister has announced that we are turning one team into one organisation.

I acknowledge that there are talented, committed public servants working at every level of the NHS and my department, including at NHS England, who I have had the privilege of working with over the past eight months. The reforms we are announcing today are not a reflection on them. They have been set up to fail by a fragmented system that holds them back. The actions we are taking today will change that.

Work has already begun to strip out the duplication between the two organisations, and bring many of NHS England’s functions into the department. NHS England will have a much clearer focus over this transformation period. It will be in charge of holding local providers to account for the outcomes that really matter: cutting waiting times, and managing their finances responsibly. And it is tasked with realising the untapped potential of our National Health Service as a single-payer public service: getting a better deal for taxpayers through central procurement; being a better customer to medical technology innovators, to get the latest cutting-edge tech into the hands of staff and patients much faster; and being a better partner to the life sciences sector, to develop the medicines of the future.

Over the next two years, NHS England will be brought into the department entirely. 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 front-line NHS leaders, we will set local NHS providers free to innovate, develop new and productive ways of working, and focus on what matters most: delivering better care for patients.

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. And this Government are proving that only Labour can be trusted to reform the state. The Prime Minister has committed to cutting the number of quangos. Today, we are abolishing the biggest quango in the world.

I am delighted that Sir James Mackey will be leading the transformation team, as the chief executive of NHS England. Jim has an outstanding track record of turning around organisations, balancing the books, driving up productivity, and driving down waiting times. He is putting in place a new transformation team to drive change, and alongside Dr Penny Dash as the incoming chair, I am delighted to have such a capable leadership team of radical reformers to lead NHS England with me through this transformation.

I also take this opportunity to place on record my heartfelt thanks to Amanda Pritchard, who has shown an outstanding commitment to our National Health Service over her decades of service—which I know remains undiminished. She has also been a rock of enormous support, not only in the past eight months, but also in the past few weeks as we have worked together with Jim preparing for this change. I also place on record my thanks to her deputy Julian Kelly, who is one of the most outstanding public servants of his generation, along with the rest of the leadership team departing at the end of the month. They deserve our thanks and best wishes for the future.

Change is hard. There will always be cautious voices warning you to slow down. However broken the status quo is, there will be those who resist any change away from it. But we should be in no doubt: we inherited a National Health Service going through the worst crisis in its history. Patients are waiting unacceptable lengths of time for an operation, a GP appointment or an ambulance. This Labour Government will never duck the hard yards of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for us when we need it.

The Prime Minister has set an enormously ambitious target for the NHS: to cut waiting times for operations from up to 18 months to a maximum of 18 weeks by the end of this Parliament. That will require us to go further and faster than even the last Labour Government achieved, but patients in our country deserve nothing less. The reform the Prime Minister is setting out today will mean fewer checkers and more doers. It will cut through the complex web of bureaucracy, and devolve more resources and responsibility to the front line, to deliver better value for taxpayers’ money and a better service for patients. It will set the NHS up to deliver on the three big shifts needed to make the service fit for the future: from hospital to community, analogue to digital, and sickness to prevention.

The NHS is broken, but it is not beaten. Together, we will turn it around. I commend this Statement to the House”.

15:58:00

My Lords, no one can really disagree with the intention to reduce unnecessary duplication between the NHS and the Department of Health and Social Care, so these Benches welcome these proposals where they ensure value for money for taxpayers and free up money from bureaucracy to spend on front-line services. One of the many things that many medical staff have complained about is the amount of paperwork. We hope that these reforms and better investment in technology will reduce the time spent on administration. Although administration can be tedious, it provides much-needed data to monitor the level of services and, we hope, to improve patient care. But these changes need to be judged on more than just money; they must make sure that the patient remains at the centre of the conversation when we talk about our system of health and care. We have had many reforms over the years, and whether these reforms are the right ones can be judged only on what comes next. My noble friend Lord Lansley, who has been much maligned recently, has written that the lesson he learned from the 2012 reforms is that his Government, and subsequent Governments, delivered only one part of the intended reforms—creating NHS England—but did not always intervene when NHS England sought to block other reforms, such as clinically led local commissioning, competition and choice, choice of large-scale commissioning support organisations, tariff reform, “any qualified provider”, and an annual mandate from the Government and Parliament to the NHS, with accountability through the NHS outcomes framework. This, he believes, is what led to the centralised, bureaucratic system that the Government are trying to reform. Whether noble Lords agree with my noble friend or not, surely the lesson is to have an overall plan for reform and to intervene when a bureaucracy is a barrier to further reform. For this reason, noble Lords look forward to the publication of the 10-year plan. I wonder, at this stage, whether I can tempt the Minister to say whether she is any closer to giving us a date for that 10-year plan. I suspect that these reforms have to be seen in conjunction with the 10-year plan, and cannot be seen in isolation. Given these lessons, where clinical leaders are calling for greater autonomy from centralised control in order to offer better care for patients at a local level, how do the Government intend to balance centralisation to the DHSC with empowering clinicians and giving them autonomy at a local level? They are better equipped to know what services are needed locally. I know from my experience of organisational change that it is often not enough to change structures if the organisational culture does not also change. I will give your Lordships an example. I had an operation in Brussels a few years ago, and when I came back to the UK I wanted to have my annual check-up. I contacted a GP and eventually got a double appointment: an ECG at a local health centre, and a consultant phone call a week later. I thought that this was really good and modern. The ECG went smoothly and, a week later, I got a phone call from a junior doctor in the consultant’s office. It was clear that he had not seen the ECG, so I asked him, “Have you seen the ECG?” He said, “No”. I asked, “Can I tell you exactly what time, what day, and where it was, then you can call me back and we can discuss it?” He refused, and said, “I’ll just make a new appointment, including a new ECG”. I wonder what it is in the system that incentivises this sort of behaviour, rather than making that phone call and saving taxpayers an awful lot of money. Although these changes will save money, which is welcome, can the Minister provide clarity to the House on how these reforms will drive efficiency and cultural change within the health service, and ensure that we improve care, with patients at the centre? One of the key challenges your Lordships will be aware of when dealing with the NHS is the lack of willingness to own mistakes and accept responsibility. The NHS needs to be better at taking responsibility when targets are missed and things go wrong. Can the Minister assure your Lordships that the new structure the Government propose will have clear lines of responsibility, redress and transparency? Will it allow noble Lords, other politicians and people throughout the country to understand how the NHS is governed, who is responsible for what and how it operates? I look forward to hearing from the Minister, and I hope that we can work constructively, on a cross-party basis, to improve patient outcomes and our system of health and care.

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue? The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture. Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board? Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House? Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made? Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed? Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

My Lords, I am grateful to both Front Benches for their reflections and their support for the direction of travel, in certain areas. I am pleased to see the noble Lord, Lord Scriven, in his place and I wish him a full recovery. I note that the noble Lord, Lord Kamall, welcomed the moves on value for money, freeing up from bureaucracy and the need to put the patient at the centre. I am glad that he did that, because that is exactly what this is about: better services and cutting duplication. It is probably worth my reflecting on the sentiments expressed in the other place by my right honourable friend the Secretary of State for Health and Social Care when he referred to the question of why we are doing this. The independent investigation by the noble Lord, Lord Darzi, was called for by this Secretary of State not long after we came into government and discovered a situation beyond what I think anyone had anticipated. The noble Lord, Lord Darzi—this relates to the point that the noble Lord, Lord Scriven, made about evidence—traced the current crisis back to the 2012 top-down reorganisation of the NHS and the establishment of NHSE. He stated that it had “imprisoned more than a million NHS staff in a broken system”. There are twice as many staff working in NHS England and the Department of Health and Social Care today as there were in 2010. In 2010, the NHS was delivering the shortest waiting times and the highest patient satisfaction in history. When we came into government last year, it was the exact opposite: the longest waiting times and the lowest patient satisfaction in history. You can add that up: taxpayers pay more, and they get less. We have been left with two very large organisations. I see that there are some former Ministers from the department in the Chamber today, which I am glad about. I will not speak for them, but they might also reflect that they will have noticed duplication and layers of bureaucracy that have stifled the progress and the patient treatment, patient focus and patient experience that we all seek to improve. The noble Lord, Lord Kamall, talked about the need for us all to coalesce around the interests of the patient, with which I certainly agree. Over the next two years, the intention is to bring NHS England into the department entirely. That will make significant savings of millions of pounds a year. To noble Lords who have raised some questions about whether the money will flow down to the front line, I say that it will cut waiting times faster and deliver our plan for change. The matter of staff came up, and I will come back to that. I acknowledge that there are talented, committed public servants who work at every single level of the NHS and the Department of Health and Social Care, including NHS England, with whom I have had the privilege of working over the past eight months under this Government. I was previously a Minister in the department in the last Labour Government. This is about the system, not the people. I say that to reassure those who are employed both at the department and in NHS England. The noble Lord, Lord Scriven, asked some important questions about staff reductions and when redundancies would potentially take place. There are currently 19,000 staff across NHS England and DHSC; across both, we are looking to reduce the overall headcount by 50%. Conversations have already begun with the trade unions on this change, and we will of course continue to engage with them throughout the process. As the noble Lord, Lord Scriven, rightly observes, abolishing NHSE—a non-departmental public body—will require primary legislation, so we are working with the usual channels to ensure that we have an appropriate legislative timetable to allow us to do things in a timely way, while safeguarding what is an ambitious legislative programme that has already been set out. We are already getting on with the job immediately, which also answers the point raised by the noble Lord, Lord Scriven, about bringing NHSE back into the department. The noble Lord, Lord Kamall, raised a very good point about the need for better understanding, clear lines and transparency. One of my learnings since we announced the abolition of NHSE was that, unfortunately, some members of the public thought that meant we were abolishing the NHS. I would like to reassure anybody in this Chamber or outside it that we are not doing that at all: we are committed to the National Health Service, as we have always been throughout our history as a party, and we will continue to strengthen it. However, what that said to me relates to the point the noble Lord made. People do not care about structures, and why should they? What they are interested in—and I completely endorse this—is what it does for them. Can they get that appointment? Can they get that treatment? Can their child get access to dentistry, or whatever it is? That is what people want. Actually, this is a tremendous opportunity to be clearer and more straightforward about what those lines are, and I certainly look forward to doing so. The noble Lord, Lord Kamall, is right about the need for a change in culture, and I think that applies to a whole range of issues. This measure has been considered and, as I explained, was born through experience and evidence. It will fit as part of the 10-year plan, to which the noble Lord, Lord Kamall, referred, and I thank him for that. On when that will be published, I will say only that I hope the noble Lord will not feel he is kept waiting for much longer. I am very grateful to everybody who gave input to the consultation—the biggest one ever in the history of the NHS. The noble Lord, Lord Scriven, rightly asked for a number of details about impact; there will, of course, be a full impact assessment with the legislation. He asked particularly about improvements overall, which is what we seek. Currently we have two organisations, many layers and duplication. I cannot think of one organisation that can boast all that—I do not say boast in a positive way—and say it is at its most efficient in delivering for whoever the service users are. All of it will translate to improvements on the front line, which is what we are talking about. As I mentioned, as I often do, earlier in Questions, we believe that decision-making locally—done in the interests of the local population, with their involvement and reflecting their nature—is crucial. Noble Lords will be aware that, on the advice of the report by the noble Lord, Lord Darzi, we reduced the numbers of targets in the planning guidance from 32 to 18, to free up local areas to better meet the local requirements. Again, we see the direction of travel. The noble Lord, Lord Scriven, asked about senior management and severance packages. Of course, I cannot comment on individuals, but I emphasise that, in the cases of those who announced their resignation, it was just that, so all the normal arrangements would apply. I hope we can continue to work together to improve the structure, support the staff and, most importantly, keep patients at the centre, so that they see improvements from this change and the recognition that two organisations are duplication and this needs to change.

16:18:00

My Lords, I apologise again for my wonky voice. My noble friend the Minister and I are veterans of running the NHS, when we were both Ministers in the last Labour Government. I am a veteran of leading the Opposition against the Lansley reforms when they came to the House; I spent two years of my life on them. It is worth reminding the Liberal Democrats that they were party to putting that legislation on the statute book, so we hope they will help to remove it in a positive fashion. This was a huge piece of legislation—as somebody said, it was so big it could be seen from space —and over the years wasted billions that could have been spent on front-line services. As a veteran of my local CCG and a non-executive director of my local NHS hospital, I value this announcement. I hope that the people who help to run the hospital of which I am non-executive director—the Whittington—who are brilliant managers in difficult circumstances, will be freed up to do their jobs better and more freely. I ask my noble friend the Minister: what is the timescale—

Question.

I am just asking the question. What is the likely timescale for when investment might be released? I am thinking particularly about technology and investment in infrastructure, as a non-executive director of a hospital, a large part of which is still a Victorian build.

I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission. We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change. We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.

My Lords, the point is well made about duplication, bureaucracy and excessive cost. Can the Minister give us an assurance, though, that we will not move from excessive bureaucratic centralisation to political centralisation? There are few politicians who are clinicians, sophisticated managers or financiers. This is the largest employer in the world, with extraordinarily dedicated and talented individuals concerned. They will not be happy to think that they will be organised on the whim of whoever is the latest Minister. The right reverend Prelate the Bishop of London used to be the Chief Nursing Officer—there are many people who have worked at high levels in the NHS. We need to be confident that there will be an evidence-based, rational system at some distance from party-political considerations, because the viciousness of health debates about hospital closures, boundaries and other matters knows no bounds. We do not want by-elections to become involved in non-party-political matters. The noble Lord, Lord Waldegrave, and even the noble Lord, Lord Clarke, and I, were very happy with an NHS executive which was part of the department. However, the role of the chief executive was not the same as the role of the Secretary of State. I hope the Minister can give us some assurance.

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time. This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. In the announcement made by the right honourable Secretary of State for Health in the other place, there was particular emphasis on identifying that in this period of transition, NHS England will focus on ensuring that local providers are better able to cut waiting times and to organise their finances appropriately. But NHS England has many other functions beyond those two important ones, and they will need to be delivered in what is a substantial transformation in reabsorbing NHS England into the Department of Health and Social Care. What reassurance can the Minister give your Lordships’ House that functions such as the recently integrated Health Education England function into NHS England, the NHS Digital function and many others, are going to be properly supervised and delivered during this period? They are as essential, in many ways, as delivering on waiting times and organising finances.

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.

My Lords, I declare my interest as indicated by the noble Baroness, in that I am a former government Chief Nursing Officer. Following on from the noble Lord’s point, this is a very significant change not just to the NHS but to its workforce. We know from looking back that when there is a reorganisation of the NHS, attention and funds are distracted away from the front line and patient care. The announcement came on the same day as the publication of the NHS staff survey results, which highlighted that only 31% felt that there were enough staff to enable them to do their job, and that 45% felt unwell due to work-related stress. What action will the Government take to make sure that there is not a management distraction, through this reorganisation, away from the front line and patient care in particular? How will staff be supported during this transition, not least those who, I suspect, fear that their jobs are now under threat?

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult. It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients. On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

My Lords, I am very conscious that a number of noble Lords want to get in. Can all keep their questions brief? I will take the Liberal Democrat contribution first and then Labour.

My Lords, I will be brief. With such a strong emphasis in the Statement on reducing duplication and bureaucracy, can the Minister say what consideration is being given to fusing NHS England’s regional offices with the remaining ICBs that come within their geographical area? It strikes me that there is scope for savings there.

All of this will be looked at by the transformation team, because it is a considerable change. I thank the noble Baroness for that contribution, and I will ensure that it is heard.

My Lords, can my noble friend the Minister kindly confirm that the role of the Chief Nursing Officer for England will migrate to DHSC?

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.

As a former Health Minister, I too welcome this move, but the devil is in the detail. The point made about the NHS regions is completely right: that is another layer which will stop hospitals being freed up in the way the Secretary of State said he wants to happen. There is the question of whether lots of merged entities will be demerged again. As we all know, it is the uncertainty which hits productivity in the meantime, when people are naturally worried about their jobs. I would really like to press the Minister on when we will see the detail behind the plan. When will it be produced, and when can we give the staff the information they need, so they know their position? Until that happens, the uncertainty will, unfortunately, hinder productivity and stop the changes we all want to see happening.

I understand that point and the noble Lord’s wish for dates, which I am not able to give him, as I am sure he will appreciate. These reforms are not about front-line staff losing their jobs; we are talking about people employed directly by the department and the NHS. The noble Lord referred to the Secretary of State, and I would add that other arm’s-length bodies also need to be leaner than they are today. I understand the problem, and we are going to work very closely with staff organisations, but it is not a neutral situation. Staff are suffering from box-ticking, duplication and red tape, which prevents them doing their job properly. Their morale is not good in this case—in any case. We do not want to add to that, but we do want to give them hope for the future.

After the transformation team has completed its work, who will take over the duties that the noble Lord, Lord Kakkar, referred to in his question?

That will be declared in due course, once the work has been completed.

My Lords, I spent yesterday morning at the women’s health department in Mile End hospital—I know the Minister is a great champion, and I highly recommend a visit. What will the NHS England update mean for the women’s health strategy, and, specifically, for NHS England’s commitment to eliminating cervical cancer by 2040?

It will not affect commitments to women’s health. As we have said, women’s health remains a priority. The noble Baroness will know that there are some 600,000 women already on the gynaecology waiting list; that is far too long for women to wait. Women’s health hubs are part of the solution, and I continue to champion those with the integrated care boards.

My Lords, I am delighted to support the direction of travel towards patients first. I wonder if there are savings to be made. We can concentrate on the gap in social care, where I suspect much of the NHS is so interdependent. Social care is so badly funded, and we need to do something there.

As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.

My Lords, since NHS Digital was merged with NHS England, NHS England staff have been running absolutely critical data and digital infrastructure. During this period of uncertainty, we are bound to be in danger of losing some staff with expertise that is difficult to replace. What are the Government doing to make sure that these jobs are absolutely safeguarded and that this expertise is not lost?

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.

My Lords, I congratulate the Government on removing a powerful and unelected body—the world’s largest quango. What the Government have done is so important democratically, given that the Secretary of State says, “The buck stops here”. However, it is not a silver bullet. There is no NHS England in Wales—my neck of the woods—and the buck stops with the Senedd, but the Welsh health service is in a terrible state, with wastage of money, red tape, bureaucracy, and smoke and mirrors about where money is being spent. Does the Minister agree that that can happen even when the buck, apparently, stops with the politicians?

I am not sure if that was a question about politicians or Wales. We work very closely with the devolved Governments, as the noble Baroness will be aware. On her point about politicians, we take our responsibilities very seriously. That is why we have recognised the problem and are acting.