Following Prime Minister Sir Keir Starmer’s recent announcement that NHS England (NHSE) will be dismantled, discussions have emerged about whether this restructuring could improve patient safety within the NHS. NHSE, which has been responsible for overseeing the health service’s daily operations, has long faced criticism for exerting excessive control over NHS trusts, limiting their ability to address challenges or highlight successes. Health Secretary Wes Streeting described the decision as a way to empower frontline NHS leaders, ending what he called the "infantilisation" of healthcare management.

For many, NHSE has been viewed as more of an obstacle than a solution when it comes to patient safety. It has often been accused of prioritizing the NHS’s reputation over transparency and accountability. Major patient safety scandals—including cases involving maternity care failures in Shrewsbury, Telford, East Kent, and Nottingham—only came to light after relentless campaigning by affected families who turned to the media when other avenues failed. For example, an independent review of maternity services at East Kent Hospitals University NHS Trust found that at least 45 babies could have survived with better care between 2009 and 2020. Despite being aware of concerns as early as 2013, NHSE failed to recognize the trust as a significant problem, and its attempts at intervention did not lead to the necessary improvements, allowing preventable deaths to continue.

Many families affected by such failures have expressed relief at NHSE’s abolition. Helen Gittos, who lost her daughter Harriet in 2014 due to inadequate care, stated that NHSE had been a barrier rather than a force for positive change. She criticized its ineffective response to repeated reviews of maternity services, suggesting that the organization had not fully absorbed the lessons from past reports.

NHSE has conducted hundreds of independent investigations into patient care, spending millions in the process. While some families have found these reports valuable, there has been widespread frustration over NHSE’s reluctance to act on findings. A recurring issue in patient safety scandals has been a culture of secrecy and resistance to patient engagement. Unlike individual NHS trusts, which make board papers publicly available ahead of meetings, NHSE historically withheld its documents until after meetings had taken place—only recently shifting to publishing them just hours in advance, which critics argue still limits transparency.

Long-time patient safety advocate Peter Walsh highlighted NHSE’s reluctance to prioritize patients’ interests. He pointed to the maternity review at Shrewsbury and Telford NHS Trust, which recommended independent advocates for families. However, NHSE attempted to reframe the role by making these advocates its own employees—an approach that critics said undermined their independence and reflected NHSE’s desire for control.

It remains unclear whether dismantling NHSE will lead to improved patient safety. Some experts warn that in the short term, the transition could create setbacks. The UK once had a globally respected body dedicated to patient safety—the National Patient Safety Agency—but it was disbanded in 2012 and absorbed into NHSE. Paul Whiting, chief executive of Action Against Medical Accidents, stressed that patient safety must become a central focus of the government’s long-term NHS strategy to restore public trust.

Professor James Walker, who previously led the Healthcare Safety Investigation Branch, views the restructuring as a significant opportunity to enhance patient care. However, he emphasized the need for a cultural shift within the NHS, moving away from rigid structures and restoring empathy in healthcare. Instead of adhering strictly to bureaucratic frameworks, he argued, the NHS must refocus on genuinely helping patients.

As discussions continue, the full impact of NHSE’s abolition remains uncertain. However, many see this as a crucial moment to reshape the NHS with patient safety as a priority.