by Jonathan Eida, researcher
Keir Starmer announcing the closure of NHS England is a good thing. The quango has been beset with failure for years with examples ranging from ballooning waiting times to a failure to digitalise and integrate nationally. The resignation of its chief, Amanda Pritchard, is the final nail in the coffin. Good riddance.
Quite clearly, the status quo wasn’t working. When an institution stagnates and calls for reform grow louder, every lever for change must be available. Perhaps the most significant problem with NHS England was its lack of accountability. Decisions were made by bureaucrats insulated from public scrutiny, with little more than the occasional parliamentary committee hearing to hold them to account. That simply didn’t cut it. Now, with the government back in control, taxpayers can finally hold decision-makers responsible.
The scale of NHS England’s failure is staggering. For 2024-25, its estimated outturn was £162.5 billion—yet as of January 2025, 7.4 million people remained stuck on waiting lists. While the COVID-19 pandemic contributed to the backlog, the NHS has failed to clear it in the years since. Productivity remains dire.
Healthcare productivity in 2023 was still significantly below the pre-covid levels. According to the Office of National Statistics, the healthcare productivity index in 2023 was 21.5 points below the 2019 level. This is a marked decline in healthcare productivity.
At a cross-party Health and Social Care Committee meeting in January, Amanda Pritchard claimed NHS productivity was improving at double the pre-COVID rate. Yet she provided no vision for how the NHS would actually improve efficiency or cut waiting lists.
The TaxPayers’ Alliance’s latest report on NHS productivity highlights a key issue: the underutilisation of high-value medical machines. Using Freedom of Information requests, the report found that expensive equipment across NHS trusts was not being used to its full potential.
Over four years—including pre-COVID, during the pandemic, and post-pandemic—the usage of MRI machines, CT scanners, and surgical robots was tracked. The results were alarming:
- MRI scans fell by 26 per cent (1,665 fewer scans) in 2020 compared to 2019.
- CT scans dropped 16 per cent (1,572 fewer scans) in the same period.
- Surgical robot procedures declined 34 per cent (73 fewer surgeries).
More concerningly, by 2022, two years after the pandemic began, usage still hadn’t rebounded to pre-COVID levels. More alarminably still, thanks to the protection of NHS England, those responsible could not be held to account at the ballot box.
Dr. Katharine Halliday, president of the Royal College of Radiologists, admitted that while scan numbers have risen since 2022, the NHS still faces "many of the same challenges." Simply, NHS England has not found the required solutions.
It is now the government’s responsibility to find and implement solutions. The government has taken back control of the health service from an unaccountable technocracy.
There are solutions to issues like the under utilisation of high value machines. Our report suggests trusts cooperate to share services allowing machines that are being under utilised to help clear waiting lists for machines that have a high waiting lists. This will require a level of integration across trusts that NHS England has repeatedly failed to achieve. Additionally, the report suggests that machines be utilised outside working hours for patients who are willing to have appointments at more unusual times. The government must stand up to any unions seeking to block an increase in the out of usual hours work, at least until the backlog is significantly cleared.
These straightforward reforms would improve efficiency, cut waiting lists, and deliver better value for taxpayers. With NHS England gone, the government will now be held to account. It has the power to fix the NHS—but will it? As Wales has shown we should perhaps be cautious, an NHS with more control from the government is performing even worse than NHS England. The abolishing of NHS England means Labour, and in particular Wes Streeting, will certainly hope to see improving outcomes before the country goes to the ballot box again in four years time.