NHS overhaul must boost local control and tackle funding gap, says CIPFA

13-03-2025

“The government’s decision to abolish NHS England and return central leadership and control to Whitehall continues the rollercoaster of organisational restructuring, which has seen national, regional and local bodies come and go over the past 30 years.

“Reducing bureaucracy and duplication to prioritise scarce funding for frontline operations is welcome. It will be crucial that increased centralisation does not conflict with the government’s stated desire to empower local leaders. Local systems need autonomy and accountability to deliver better patient outcomes.”

In response to the Department of Health and Social Care, NHS England and The Rt Hon Wes Streeting MP’s announcement of changes to NHS England, CIPFA’s CEO Owen Mapley said:

“The NHS has undergone multiple restructurings in recent years, and these latest changes come at a time of huge operational and financial pressures. It is essential that attention is not diverted towards management structures and legislative changes but rather towards frontline improvements.

CIPFA hopes that a system traditionally characterised by ‘command and control’ uses these changes to truly empower local system leaders rather than simply change who they report to.

“Integrated Care Boards have long had the potential to join up local services, centred around a community-first approach to patient care in local systems. But different parts of those systems continue to face fragmented approaches to reform. CIPFA welcomes the commitment to devolve a greater proportion of resources and responsibilities to the frontline and urges the government to fully seize this opportunity to enhance local autonomy and accountability.

To be truly effective, these reforms must align with the local government devolution agenda, fostering both cross-government and truly place based approaches that drive the critical shifts from hospital to community-based care, analogue to digital, and treatment to prevention.

“While redirecting ‘hundreds of millions of pounds’ in savings to the frontline is a positive step, it falls short of addressing the NHS’s financial sustainability challenge—which the first round of financial planning revealed could be a deficit of approximately £7bn overall for 2025/26.

“We reiterate our call for a comprehensive review to determine the true scale and root causes of this financial pressure. The NHS funding and financial framework must be adapted to address these challenges and place the system on a sustainable long-term footing.”

Notes to editor