Ben Howlett
Chief Executive, CuriaBen Howlett has worked with the NHS for over 15 years and has previously chaired numerous Parliamentary groups on health, including rare diseases and stroke
As the dust begins to settle on the Government’s announcement to dissolve NHS England, the real work begins – not in Westminster press briefings, but in deciphering what this means for how the NHS is funded, governed, and ultimately delivered across the country.
In March 2025, Prime Minister, Sir Keir Starmer confirmed what had long been rumoured: NHS England, the organisation that has overseen healthcare delivery for over a decade, is to be abolished. What replaces it is still taking shape, but the implications are already becoming clear. The early signs point to an NHS that will either be completely managed by the centre or one that is steered by a smaller number of powerful regional commissioning bodies.
From speaking with senior officials, what is becoming clear is that steering an organisation from the centre that employs one of the largest workforces in the world is a daunting prospect. Intended for Curia Health, Care, and Life Sciences Research Group members and public sector officials, this opinion article and report is based on an educated assessment.
Financial Flows
This is not simply another bureaucratic shuffle. Behind the headlines lies a deeper transformation of how money will move through the system – and how decisions will be made about what gets funded, where, and by whom.
The context is as important as the reform itself. The forthcoming June Spending Review is expected to offer only a modest 2 per cent real-terms increase in day-to-day health spending. This comes at a time when NHS providers are forecasting a collective deficit of £787 million for this financial year, with some projections for 2025/26 suggesting this could balloon to £6.6 billion. With 7.4 million people waiting for treatment and public expectations high, the pressure on the Government to do more with less is intense.
A Return to Regional Health Authorities?
What’s emerging in response is not a fully centralised NHS – nor a return to localism – but something in between: a regional model. Think 7 to 12 regional commissioning
authorities, likely based on NHS England’s former regions, absorbing the responsibilities of the current 42 Integrated Care Systems. These regional authorities would become the new financial gatekeepers, receiving allocations directly from the Department of Health and Social Care (DHSC) and distributing them to provider collaboratives and delivery teams within their footprint.
Proponents argue this shift could bring strategic clarity, economies of scale, and more consistent access to services. By reducing the number of budget-holding organisations, the Government hopes to streamline procurement, standardise commissioning processes, and ensure that national priorities – whether it’s prevention, digital transformation, or waiting list recovery – are delivered with greater efficiency.
Is this the End for Place-Based Autonomy?
But this transition comes with risk. Local flexibility could be lost if funding decisions are too remote from the communities they affect. Larger regions may dilute attention to specific inequalities, unless carefully designed safeguards are put in place. And restructuring itself will bring administrative costs and potential disruption just as the system is struggling to stabilise.
What does this mean in practice? In the short term, local delivery teams may find themselves operating within narrower financial envelopes. Place-based autonomy may shrink unless regions are explicitly empowered to devolve resources. New funding formulas will be needed – ones that account not just for population size but for real patterns of need and demand.
Still Many Questions
The longer-term picture is still evolving. Capital investment beyond 2025/26 remains uncertain, with current planning assumptions advising systems to expect 80 per cent of their current allocation in future years. And operational pressures – from staffing to service reconfigurations – will continue to drive difficult decisions at the frontline.
At the Health, Care and Life Sciences Research Group, we’ve provided our members with an educated assessment of these developments: what they mean for financial flows, governance structures, and local delivery. While none of these changes are yet final, the signals are strong, and the direction of travel is clear.
For those seeking a deeper understanding – whether you’re working in NHS leadership, industry, academia, or policymaking – our full member briefing offers insight into what’s coming, what’s at stake, and how best to respond.
To access the full analysis and become part of our member Health, Care, and Life Sciences Research Group, contact Partnerships Director Ben McDermott at ben.mcdermott@chamberuk.com.
