November 2025 has brought a flurry of announcements, actions, and arguments that reveal not just the state of the NHS—but the state of our national priorities.

As someone who has spent decades in public service, I see echoes of past missteps and fresh risks in what’s unfolding now.

Reform or Retreat? The Abolition of NHS England

The government’s decision to abolish NHS England by 2027 is being sold as a bold reform. Power will shift to Integrated Care Boards (ICBs), which are expected to lead localised, prevention-first systems. The rhetoric is familiar: cut bureaucracy, empower communities, save £1 billion a year.

But I’ve seen this play before. Structural upheaval without operational clarity rarely delivers. The promise to reinvest savings into frontline care is welcome—but the mechanism is fragile. ICBs are being asked to do more with less, while losing many of the very staff who hold institutional memory and local insight to carry through the changes.

We must also ask: who will scrutinise the outcomes? Parliament, the National Audit Office, and the Care Quality Commission must not merely observe—they must interrogate. Reform without accountability is not reform. It is risk.

Redundancy at Scale: 18,000 Jobs Cut

Up to 18,000 NHS administrative roles are being eliminated—many within NHS England and ICBs. The Treasury has authorised a £1 billion overspend to fund generous redundancy packages, with some staff reportedly receiving up to 24 months’ salary.

This is not just a financial gamble. It’s a human one.

ICBs are expected to halve their management headcount, risking disruption to commissioning, safeguarding, and service integration. There is no national workforce plan for redeployment—despite obvious gaps in digital, data, and community care.

If the reforms falter, will we rehire those we’ve just paid to leave? Or will we repeat the cycle of churn and regret? MPs and watchdogs have warned that Wes Streeting’s reform proposals bear “chilling echoes” of HS2 failures, citing unfunded plans and poor governance practices.

Junior Doctors’ Strike: A Symptom of Deeper Malaise

From 14–19 November, junior doctors staged a five-day strike over pay. While I respect their right to protest, I must challenge the premise.

After receiving 29% pay increases over the past three years, the current claim feels disproportionate—especially when most professionals, including doctors, progress through structured pay bands as they gain experience and maturity.

The strike risks delaying care, straining colleagues, and undermining public trust. But it also exposes a deeper issue: we are training thousands of doctors who cannot get jobs. Some leave the profession. Others go overseas. It is a tragic waste of talent, compassion, and public investment.

A Nation of Trained Healers—Left Idle

This is the paradox that haunts me: we have the people who want to deliver care, and we deprive them of the chance to do so.

More doctors mean better health, less sickness, fewer sick days, and higher tax receipts.

Investing in medical employment is not just ethical—it’s economically sound.

Yet we ration opportunity, fragment training pathways, and export our best minds.

We are, in effect, subsidising the health systems of other nations while our own citizens wait months for appointments. That is not stewardship. It is abdication.

Compare this to Australia and Canada, where structured workforce planning ensures that medical graduates transition into employment with clear pathways and national coordination. The UK must learn from these models—or risk losing its own.

Mental Health: The Quiet Casualty

Amid winter pressures, mental health services often suffer first. Waiting lists grow, community teams shrink, and crisis care becomes reactive rather than preventative. Reform must not neglect this domain. Mental health is not a luxury—it is a foundation.

Flu, COVID, and the Winter Wall

This winter may be one of the worst in recent memory. Flu cases are rising early, COVID remains in circulation, and RSV threatens vulnerable groups. ICU admissions for flu are already above seasonal norms. The UK Health Security Agency warns of a “triple threat” that could overwhelm hospitals.
Staff absences due to illness and burnout compound the crisis.

And yet, we cut staff, delay care, and argue over pay—while the virus does not wait for policy debates or budget cycles.

Euan Blair’s Warning: AI or Doom Loop?

Euan Blair, founder of Multiverse, recently warned that the NHS faces a “productivity doom loop” unless it rapidly adopts AI and retrains its workforce. His partnership with Palantir aims to accelerate digital transformation across NHS systems.

This coincides with the rollout of the Palantir Foundry platform, now being embedded across NHS trusts. While the promise of data-driven care is real, the risks are equally stark: opaque governance, vendor lock-in, and a lack of digital literacy among frontline staff.

Without robust data governance and patient consent frameworks, digital transformation risks undermining trust.

I agree that technology must serve care—but it cannot replace it.

Stewardship or Surrender?

We must not confuse cost-cutting with care. True reform demands clarity, compassion, and accountability. The NHS deserves nothing less. If we are to honour the legacy of public service and the trust of patients, we must act not with haste—but with wisdom.

Sources:

• BMJ – Why is NHS England being abolished?
• The King’s Fund – NHS reform and redundancy risks
• National Voices – ICB funding cuts and accountability
• Gunnercooke LLP – Legal implications of NHS structural reform
• The Guardian – MPs warn of HS2-style NHS risks
• BMJ – Junior doctors strike and pay context
• OECD – Health workforce planning comparisons
• NHS Confederation – Mental health winter pressures
• UKHSA – Flu and COVID winter surveillance
• Health Service Journal – Palantir rollout and AI warnings