The UK Government’s decision to dissolve NHS England and return control to ministers marks a bold shift in health governance. Framed as a move to restore democratic accountability, the change is positioned as a fix for inefficiency and duplication. Health Secretary Wes Streeting has called NHS England “the biggest quango in the world” and pledged to cut red tape, reduce costs and redirect savings to frontline care.
But the real test isn’t structural, it’s about communication. Reform on this scale demands more than policy. It requires trust, clarity and a shared vision. With thousands of NHS roles, including communications professionals, facing redundancy, the system risks losing the very people who have long been its voice during crisis, change and innovation.
The rationale for reform is clear: overlapping responsibilities between NHS England and the Department of Health have slowed decision-making and blurred accountability. Labour’s ambition for a leaner, delivery-focused state underpins the move. Yet the absence of a published long-term NHS strategy, and the lack of detail on how countless functions like commissioning and public health campaigns will be absorbed, remains unclear.
This uncertainty has not gone unnoticed. The Public Accounts Committee has raised concerns in their recent report, about the lack of clarity on safeguarding services and demanded a detailed plan. Meanwhile, local leaders and clinicians are asking who will ensure coordination and consistency once NHS England is gone.
There’s a sharp irony. Just as the system needs to explain itself better than ever, its capacity to do so is being dismantled. Communications teams are not a luxury, they are essential infrastructure. They help patients navigate services, support digital transformation and build public confidence.
This is where the real challenge lies for Wes Streeting - not just managing transition but narrating it. The DHSC must communicate with clarity, empathy and intent. That means recognising staff concerns, handling redundancies with compassion, painting a tangible vision for reform and treating clinicians and local NHS staff as co-owners of change. Crucially, DHSC must rebuild its own communications function, leaner, yes, but not fragmented or weak.
The success of this reform depends not on structure alone, but on execution. They need to plan it well, staff it effectively and communicate it with both skill and a long-term vision. If the DHSC gets it right, this could be the beginning of a more responsive, integrated and patient-focused NHS. If it gets it wrong, it risks making the system leaner only on paper while in practice, slower, weaker and more brittle. Communications will not just carry this reform. It may just decide its fate.
Benjamin Waldmann, senior account director