Scrapping NHS England: A Reorg or a Real Redesign?

Another NHS reorganisation is coming. This time, NHS England is being scrapped, with its responsibilities absorbed into the Department of Health and Social Care (DHSC) over the next two years. 

The government’s reasoning? To remove a “layer of bureaucracy” and improve efficiency. 

But anyone who has worked with the NHS (or any large organisation) knows that simply moving the org chart around doesn’t fix real problems. 

The real question isn’t what the new structure looks like, it’s how well it’s designed to deliver better outcomes. 

And that’s where service design thinking comes in. 

The NHS England reorg at a glance

Before: A two-layered structure 

Until now, NHS England operated as an ‘arm’s-length body’, carrying out DHSC's health policy and funding priorities while maintaining a degree of operational independence. The division of labour looked like this:  

DHSC (Department of Health & Social Care) - Policy and Funding 

• Set national health policy and priorities 

• Allocated NHS budgets 

• Managed political engagement (parliament, ministers) 

NHS England – Operations & Delivery 

• Commissioned healthcare services (primary care, specialist services) 

• Managed NHS providers via ICSs (Integrated Care Systems) 

• Led digital transformation (NHS App, AI in healthcare) 

• Handled workforce planning 

• Provided a degree of independence from political decision making. 

Other bodies like NHS Improvement and Public Health England have been merged into NHS England in earlier restructures. 

After: A centralised DHSC 

With NHS England being absorbed into DHSC, its responsibilities will now sit directly under government control. 

What this could mean: 

Positive: 

• More direct control over policy and spending 

• Potentially faster decision-making (fewer layers of approval) 

Negative: 

• Less independence for NHS operations, with possible risk of political interference 

• Disruptions to digital innovation (previously led by NHS England) 

Wait and see: 

• The role of ICSs may change, as they take on more regional commissioning power 

• Will DHSC align with the re-established Government Digital Services organisation to define responsibility for digital transformation and inclusion guidance?

Why reorgs often fail: The missing service design approach

Reorganisations usually start with good intentions. Unfortunately, too many times they focus on internal structures rather than the end users of the service (in this case, NHS staff, patients, and partners). 

The biggest mistake? Assuming that moving responsibilities around automatically leads to better services. 

Service design tells us that real change happens when you: 

1. Start with the problem that triggered the reorg, not just vague goals like "efficiency." 
2. Define what success actually looks like, measuring outcomes. 
3. Design from the user’s perspective — how does this impact NHS teams and patient care? 
4. Test, iterate, and adapt, rather than assuming the new structure will work perfectly. 

A service design lens on the NHS England reorg

If this reorganisation was designed properly, it would answer questions like: 

1) What specific problems is this solving?

• If the issue is too many layers of bureaucracy, where exactly is the bottleneck? 

• If decision-making is too slow, what specific processes need to change? 

• If resources are wasted, what will be done differently beyond restructuring? 

Service design principle: Restructuring without understanding why the previous model didn’t work is just shifting inefficiencies around. Work needs to be done to try to anticipate where they may manifest. 

2) What does success actually look like?

• Is success cost savings, better patient care, or both? 

• How will NHS teams know if this change is helping or hindering their work? 

• Will there be clear, measurable improvements in response times, outcomes, or access to services? 

Service design principle: Define measurable outcomes, not just structural changes. A new structure isn’t progress if it doesn’t make life easier for NHS staff or patients. 

3) What unintended consequences might this have?

• Will centralising power in DHSC slow things down, rather than speed them up? 

• Will digital transformation and tech initiatives stall without a dedicated NHS England team? 

• Will SMEs and external partners find it harder to work with the NHS due to changing procurement routes? 

• Will DHSC deviate from and create an equivalent of the recently launched A blueprint for modern digital government - GOV.UK, or seek to adopt it for health and social care? 

Service design principle: Map out the entire ecosystem, including the impact on patients, providers, and suppliers, not just internal teams. 

4) How do we ensure continuity AND improvement?

• If NHS England’s staff and expertise are absorbed into DHSC, how do we retain the good while removing the inefficiencies? 

• How do we ensure contracts, partnerships, and innovation projects don’t get lost in the transition? 

• What’s the plan for iterating and adapting if things don’t work as expected? 

Service design principle: Change is a process, not a one-time event. Reorgs should have a test-and-learn approach rather than assuming the first attempt is the best. 

What this change means for SMEs working with the NHS

If your company provides services to the NHS, this reorg could mean: 

Positive: 

• New opportunities: If DHSC takes a more direct role in procurement, it could open up new contracts. 

• Devolved responsibility for implementing some of the good guidance NHSE has established around service standards, accessibility, language – assuming ICBs, Primary and Secondary care organisations have the budget to invest directly 

Negative: 

• Slower decision-making: During transition periods, budgets may be frozen, and buying decisions may stall. 

Wait and see: 

• Uncertain procurement pathways: If frameworks and decision-making processes shift, SMEs may need to adapt quickly. 

Final thought: How can this reorg avoid becoming just another shuffle?

Organisational change isn’t good or bad, it depends on how well it’s designed. 

It isn't just about restructuring; it's about reimagining how services are designed to create sustainable solutions and optimal experiences for both those receiving care and those delivering it.  

Beyond structures and responsibilities, culture plays a huge role in how well organisations function. NHS England and DHSC have evolved with different ways of working, different priorities, and different decision-making processes. 

A service design approach ensures that every aspect of a system: people, processes, and supporting infrastructure is aligned to achieve the right outcomes. It focuses on how change actually works in practice, rather than just how it looks on a flowchart. 

Instead of just asking, ‘How do we restructure NHS England?' a service design approach would ask: 

• How will NHS staff experience this change on the ground? 

• Where could unintended barriers emerge? 

• What does good look like, beyond efficiency savings? 

• How do we measure success in real patient outcomes, not just budgets? 

Service design helps organisations avoid the trap of ‘reorganising for the sake of it’ by focusing on the real needs of users and service providers. 

The challenge for the NHS, and for small to medium enterprises (SMEs) working with it, is ensuring that this isn’t just a reshuffling of roles but a true redesign of how healthcare is delivered.  

At Nexer, we help organisations navigate complex change using service design thinking. We’d love to start a conversation. Let’s explore how service design can help your organisation create meaningful change, not just structural shifts.