The National Health Service (NHS) England is set to undergo its most dramatic restructuring in over a decade, with half of its workforce facing redundancy.

The overhaul will see staffing levels plummet from 13,000 to approximately 6,500, as entire departments are disbanded to cut costs and eliminate “duplication” with the Department of Health and Social Care (DHSC).

The scale of the layoffs has left many NHS England employees “in shock and awe,” far surpassing the previously announced 2,000 job losses aimed at saving £175 million. This restructuring will also impact the DHSC, albeit to a lesser extent, as it aligns more closely with NHS England from April onwards.

The changes grant Health Secretary Wes Streeting significantly more influence over NHS England, the body responsible for overseeing the operational performance of the country’s healthcare system. “These changes represent the biggest reshaping of the NHS’s national architecture in more than a decade,” stated Matthew Taylor, chief executive of the NHS Confederation, which represents NHS trusts across England.

Outgoing NHS England chief executive Amanda Pritchard informed staff of the massive restructuring via email, making it clear that Streeting had spearheaded the initiative. She revealed that he had tasked her successor, Jim Mackey, and incoming NHS England chair, Dr. Penny Dash, with leading the “radical reform” of the organization.

Pritchard’s announcement comes just two weeks after confirming her resignation, following prolonged discussions with Streeting. She will officially step down at the end of the month.

Leadership Shake-Up Sparks Concerns

A “formal change programme board” or “transition team” comprising officials from both NHS England and the DHSC has been established to oversee the downsizing efforts. The board, co-chaired by Dash and Alan Milburn, a former Labour health secretary appointed as the DHSC’s lead non-executive director, will spearhead the restructuring.

“As part of this, they will be looking at ways of radically reducing the size of NHS England that could see the centre decrease by around half,” Pritchard confirmed, acknowledging that the news would be “very unsettling” and cause “uncertainty and worry” among staff.

The leadership shake-up extends beyond Pritchard. Julian Kelly, NHS England’s deputy chief executive and finance chief, along with chief operating officer Emily Lawson and chief delivery officer Steve Russell, will also step down this month.

“They feel it is the right time to move on and allow a new transition team, led by Jim, to reshape how NHS England and DHSC work together,” Pritchard explained. National medical director Professor Sir Stephen Powis also announced his departure last week, adding to the wave of exits.

For many within NHS England, the changes have sparked deep concerns. “People here have been expecting change over the last couple of weeks but not as much change as is now apparent. They feel baffled, unnerved and fearful,” one NHS England staff member disclosed. “The speed at which Emily Lawson, Julian Kelly and Steve Russell are going is bewildering,” they added.

Government Seeks Greater Control Over NHS

Streeting has been vocal about his ambition to exert greater control over NHS England, which has functioned semi-independently since former Health Secretary Andrew Lansley’s 2012 reforms — one of the most significant overhauls in NHS history.

Last month, it was revealed that thousands of NHS England jobs were on the chopping block, with further leadership cuts expected. Mackey, set to take over as chief executive, has signaled that additional senior leadership reductions are imminent.

Mackey and Pritchard recently cautioned NHS leaders that the organization faces a potential £6.6 billion budget overspend in the 2025/26 financial year. They emphasized the need for “a fundamental reset of the financial regime” to “get a grip of this situation” and restore stability.

The restructuring represents a critical turning point for NHS England, with both staff and the public closely watching how these sweeping changes will shape the future of the nation’s healthcare system.