Restructuring NHS England: Will hindsight show this to be a bold move or missed opportunity? 

The government’s proposal to integrate NHS England into the Department of Health and Social Care (DHSC) has been framed as a way to cut bureaucracy, drive efficiency and create a more joined-up system.  

It follows years of structural shifts, funding debates and pandemic aftershocks – and comes at a time when both patients and professionals are under immense pressure. 

From our vantage point at Future Care Capital, the question isn’t whether change is needed. The question is what kind of change this will turn out to be – and whether it will truly enable innovation and improve patient outcomes or simply shift the furniture. 

Change in search of purpose? 

As The King’s Fund recently outlined, this is a move that has been years in the making. NHS England, NHS Digital and Health Education England have already been brought together. What’s now proposed is the absorption of these structures into DHSC, in what some are calling a return to greater ministerial control. 

The intention is to simplify. But as those in the system know, structure alone doesn’t solve problems. Without a clear plan – a narrative that tells us what this change is for, and how it will improve care – this could become another missed opportunity. 

We need clarity. Not just on who reports to whom but on what innovation will look like in this new configuration and who will be empowered to lead it. 

Innovation depends on more than structure 

At FCC, we exist to support innovation in health and care – the kind that breaks down silos, enables learning, and delivers better care for patients and communities. But we also know innovation doesn’t just happen because a new structure is put in place. 

Innovation needs space. It needs backing. It needs a system that can identify and remove barriers, not simply pretend they are not there. 

If this restructuring enables that – if it creates clearer accountability, faster decision-making and better routes for new ideas to scale – then good. Let’s make the most of it. But if it creates ambiguity, weakens local agency, or disrupts momentum, it risks doing more harm than good. 

Waiting on the 10-Year Plan 

This is also happening in the shadow of the much-anticipated NHS 10-Year Plan, which is still to be published. That plan is expected to outline strategic priorities for the next decade, including how we tackle workforce shortages, improve integration and use technology more effectively. 

Any structural reform must be understood in that wider context. We should not judge this change solely on efficiency or politics but on whether it sets the system up to deliver against the vision and values that the 10-Year Plan (hopefully) sets out. 

We will be watching closely – and contributing where we can – to ensure innovation isn’t lost in translation. 

Our view 

We are not nostalgic for old structures, nor reflexively suspicious of new ones. Change can be powerful but only when it’s clear what the change is for. 

What we hope to see is a system that: 

• Makes it easier for innovation to be identified, adopted and scaled 

• Supports collaboration across health and social care, not just within one part of it 

• Creates clarity and accountability, not confusion or duplication 

• Puts patients, professionals and outcomes at the heart of the system — not structure for structure’s sake 

If the reorganisation of NHS England helps achieve that, then it will be more than justified. If not, we may look back at this moment as yet another reform that changed the form but not the function. 

Let’s hope it’s the former.