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Seventeen months ago …
March, 2025…
Severe wet weather triggered multiple regional flood-warnings across the UK… just thought I’d cheer-up the gardeners!
I digress. Seventeen months ago…
…in March 2025,
… with a policy that has no electoral mandate, the workforce not consulted, the impact not published and the operating model, not yet ready…
… the DH+ started muddling through abolishing NHSE and folding it into into the DH++.
A couple of days ago, staff were invited to an upcoming ‘engagement session’…
…a two-and-a-half-hour workshop to; ‘help shape our new DHSC’.
Bear in mind this is the abolition of a statutory, national organisation, the transfer of its powers and responsibilities…
… chalk-n-cheese, oil and water, two very different cultures, and…
...a workforce reduction on an unprecedented scale. A Labour government will slash up to 18,000 jobs across DH+, NHSE and ICBs, with no actual budget for redundancy.
Probably, the biggest administrative workforce reduction the NHS has seen.
The NHS is dismantling its national headquarters, redistributing statutory functions, trying to keep a health service running at the same time, and...
... now sending half the workforce to Leeds. Which half? Dunno…
You might expect a programme of this size to begin with a settled ‘shape’. A blueprint. An operating model . Anything, explaining what the new organisation is for?
How it’ll be structured, where responsibilities sit, how decisions will be made and who’ll be accountable.
Well… there ain’t one.
The staff invitation says the Target Operating Model will describe the high-level shape of the department… ‘when published’.
When published?!
Abolition was announced in March 2025. The combined DH+ and NHSE workforce is supposed to be halved by March 2028…
…roughly 580 days.
The Next ~240 days is the high-pressure window. The DH++ is targeted to legally begin operations and absorb NHSE functions by April 2027, following the passage of parliamentary legislation.
To add to the uncertainty, the text of the Bill itself is under heavy fire and is unlikely to emerge unscathed.
Voluntary redundancy schemes have already been run.. Fizzled out? Dunno.
People gone. Yet staff are still waiting to see the organisation they may, or may not, be working in.
Relationships are strained. Morale is fragile. Institutional knowledge, gone.
The Government’s own equality impact-assessment warns of disruption caused by losing experience and failing to align ministerial decisions with operational reality.
Over the horizon comes trahlah … an online 'workshop' to discuss; respect, curiosity, connection, habits and behaviours.
The invitation is explicit; this is not a formal consultation, a transition briefing or a session about HR, pay or role matching.
In other words, it excludes everything people most need answers to.
People facing the largest upheaval of their working lives will be allowed to discuss how to ‘feel supported’... but not whether they’ll have a job.
People will be permitted to talk about ‘confidence’... but not who will make decisions.
People can explore ‘culture’... but not the structure in which that culture is supposed to exist.
A meeting to discuss TUPE and Terms and Conditions was diarised and then cancelled.
Honestly, you couldn’t make it up.
When the centre doesn’t know the answer, it repeats the question, and calls it engagement.
This is more than culture, it’s immiscible culture.
… the Civil Service advises ministers, protects propriety and develops policy….
… the NHS turns policy into beds, staff, appointments, treatments and safe care every day.
Management theorist Elliott Jaques developed the idea of the ‘requisite organisation’. His argument was…
‘… managerial roles exist at different levels of complexity and time-horizon.
The person occupying a role must have the judgement, experience and cognitive capacity appropriate to that level of work.
When the complexity of the job exceeds the capability of the person doing it, the organisation becomes dysfunctional.’
It’s clear… the entire leadership system has been given a task beyond its collective experience.
What’s needed are decisions.
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What remains national?
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What goes to regions or ICBs?
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What operational independence survives?
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Who has the final say when ministerial urgency collides with clinical reality?
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What work stops when thousands disappear?
Without answers to those questions, the workshops are merely displacement activity…
… something visible to do while the difficult problems have no solutions and the architectural work is still on the drawing board.
You cannot remove thousands of people, then decide how the organisation will work.
This is not shaping a new department.
It is a redundancy programme with breakout rooms.
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