The abolition of NHS England (NHSE), the transfer of its functions into the Department of Health and Social Care (DHSC), and the proposed halving of Integrated Care Boards (ICBs) mark a watershed moment for the NHS. Ministers argue this streamlining will remove duplication and bureaucracy. But without explicit protection and elevation of nursing leadership, these reforms risk compounding an already critical crisis in the profession – with serious consequences for patient safety, public health, and NHS effectiveness.
Within NHSE and ICBs, nurses have led work that doesn’t make headlines but keeps people safe and services running. Safeguarding vulnerable adults and children, ensuring the health and protection of looked-after children, overseeing infection prevention and control at scale, managing continuing healthcare and the quality of care placements, building workforce capability, and ensuring high professional standards – these are not optional extras.
Reforms must create, not diminish, space for strategic nursing leadership. Reintegration of the Chief Nursing Officer (CNO) into the DHSC’s core leadership team is a real opportunity – but only if it comes with genuine influence and a mandate to speak for the profession at the highest level of government. Nursing must be embedded in all decisions on policy, commissioning, quality, workforce, and digital transformation. General practice nursing in particular needs dedicated leadership at ICB, regional, and national levels to address long-standing challenges in recruitment, retention, and development.
Structural reform is undeniably necessary. The health and care system has become increasingly complex, with duplication, overlapping responsibilities, and an excessive emphasis on activity metrics and financial efficiency, often at the expense of clinical outcomes and meaningful measures of impact. However, pursuing reform through a narrow, cost-driven lens – one that overlooks the expertise and contribution of nursing – carries significant risks. Many aspects of nursing work, such as safeguarding, public health, and care quality oversight, are not easily captured by conventional performance data, yet they are essential to patient safety and system integrity. These functions must not be lost or diminished in the drive for simplification.
As the Government pushes forward with reform, it must listen to nurses and nursing leaders. Cuts without clarity will not deliver safer or more effective care. The real opportunity lies in designing a system that recognises and harnesses the full value of nursing — not just at the bedside, but in the boardroom, in commissioning, in strategy, and in shaping the future of integrated care. Strip that away, and we all pay the price.