NHS England: Why world's biggest quango is being axed

The biggest quango in the world is to be scrapped.

That is how the government unveiled the move to bring NHS England, which runs much of the health service in the country, back under the control of the Department of Health and Social Care (DHSC).

With more than 14,000 staff, it is around four times the size of the DHSC itself.

But that is only because in recent years NHS England has absorbed Health Education England, which oversees staff training, and NHS Digital, which is responsible for data collection and technology.

NHS England also plays a role in organising some key frontline services, including GPs and specialist hospital care, while overseeing the day-to-day running of the health service alongside distributing the money made available by ministers.

Much of this will now fall under the control of the health department. But not all. Expect some to be devolved down to regional health boards.

Nonetheless, it is expected to lead to half of the jobs at the two organisations going – around 9,000 roles.

That is expected to save at least £500m. While the sum sounds a lot, it is around 0.25% of the health budget. The respected King's Fund think-tank has called it a "drop in the ocean" that will not go very far on the frontline.

But this is also about reducing bureaucracy – something that can't really be measured in numbers.

In his address to the House of Commons, Streeting cited one organisation that was having to fill in 250 forms in one month to satisfy both the health department and NHS England.

Reacting to the announcement on Thursday, former health secretary Jeremy Hunt told the BBC NHS England has become a "bureaucratic monster" that stifles innovation.

And talk to those doing the work in hospitals and other frontline services, one of the most common complaints is that NHS England was incredibly controlling, even requesting individual NHS trusts ask for permission for something as mundane as granting media interviews.

But make no mistake this is also about control. It was a point made clear by Prime Minister Sir Keir Starmer when he set out the plan, which could take two years to fully implement.

He said it was only right that a democratically-elected government was in charge of day-to-day running of the health service.

Quangos - "quasi-autonomous non-governmental organisations" - are set up by government to oversee regulations and operate independently from politicians.

NHS England was created as part of the 2012 reforms introduced under former Tory health secretary Andrew Lansley.

The idea was to free the health service from political meddling – with ministers instead setting the wider strategy, but stepping back from getting involved on a daily basis.

In the years afterwards NHS England has exercised that independence. This was most notable under the leadership of Sir Simon Stevens, who challenged and pressed the Theresa May government into increasing funding.

In the late 2010s, after Lansley had left government, Conservative health ministers privately expressed frustration that the single-biggest part of their brief was outside of their control.

As soon as Streeting took charge at the DHSC last summer, it was clear he felt the same and NHS England was on borrowed time.

On Monday it was announced half of the roles at NHS England would go – and that came after the current chief executive, Amanda Pritchard, and a number of her top managers announced they would be stepping down.

But given Labour, in opposition, was critical of the Tories messing around with NHS structures, embarking on its own reorganisation comes with significant risk. The public are understandably asking what difference this will make to services.

The government says it will help it improve services and reduce waiting times – and, given that is one of its top priorities, there will be no hiding place now.