Staff shortages, obesity and an ageing population all pose deep questions for which structural reorganisation has no answer

On Thursday, Keir Starmer pledged to streamline the “flabby state” and take on a “cottage industry of blockers and checkers” to deliver better outcomes for citizens. The centrepiece of the prime minister’s intervention was an announcement that he would be abolishing NHS England, merging it into the Department of Health.

NHS England was created in 2012 by the then Conservative health secretary, Andrew Lansley, as part of his ill-judged, expensive structural “reform” of the NHS. Its purpose was to put the day-to-day operational management of the NHS at arm’s length from ministers, supposedly insulating it from the short-termism that afflicts governments of all colours. Since 2012, it has swelled through multiple mergers, and today oversees a huge range of functions for the English NHS, including allocating funding, sharing good practice, coordinating national programmes such as vaccination and screening, planning around future staffing, and negotiating contracts such as the price the NHS pays for medicines. In practice, research suggests that since 2012 ministers have retained a significant degree of political control over the NHS, and rightly so.