Think the abolition of NHS England doesn’t matter to Wales? Think again

James Downs, Mental Health Campaigner

The news that NHS England is being abolished hasn’t made much of a splash in Wales.

It’s easy to assume that decisions made in Westminster about England’s health service have little to do with us here. Health is devolved, after all. We do things differently in Wales.

But while Wales may have its own NHS structures and policies, we’re still deeply affected by what happens over the border.

The abolition of NHS England is not just an administrative reshuffle in another country.

It’s a moment that should make us stop and ask serious questions about the future of health and care in Wales – about who holds power, where decisions are made, the funding we are permitted, and whether we’re willing to take real control.

NHS England: A system that has failed patients

I have worked closely with both NHS England and the NHS Wales Executive, particularly in the area of eating disorders. My experience of NHS England is one of deep frustration.

Over several years, I was part of the implementation group for the Parliamentary and Health Service Ombudsman’s 2017 report on avoidable deaths from eating disorders.

Yet, by the time the group was shut down (and to this day, eight years later), not a single recommendation of the PHSO report has been fully implemented.

Worse still, patients with eating disorders on the ground have seen little, if any, improvement. In fact, in many instances, the accessibility and quality of care is deteriorating.

A lack of accountability

Earlier this month, I even received a formal apology from NHS England’s Chief Operating Officer and several senior staff working in eating disorders.

This apology wasn’t about services or systems, but about their conduct in meetings with me as an expert by experience.

It says a lot that while patients continue to suffer, senior professionals in NHS England have continued to fail upwards – being promoted into more influential roles, despite presiding over worsening conditions and a failure to act.

From my perspective, NHS England became a failing organisation, one where accountability was minimal, and progress was painfully slow – if it happened at all.

The system became bloated and clunky, with layers of bureaucracy that stifled innovation and responsiveness to population needs.

If its abolition clears the way for something better in England, I welcome that.

Why what happens in England matters to Wales

Some people in Wales may think the abolition of NHS England doesn’t concern us. But it does.

While our NHS structures are separate, our funding is not.

Health spending in Wales is tied to decisions made in Westminster through the Barnett Formula, which allocates money based on what England spends, not what Wales actually needs.

Wales has a distinct population, with different health needs shaped by our history.

Generations of heavy industry extracted vast wealth from our land and labour, leaving behind communities with some of the highest rates of chronic illness and poverty in the UK.

It’s as if our health was mined alongside our coal – and when the seams ran dry, we were left to pick up the pieces without compensation.

We also have an older population on average than England, with higher levels of ill health and disability.

This legacy still shapes our public health today, demanding a system that reflects our realities, not England’s.

Is health really devolved?

If the abolition of NHS England leads to public spending cuts and fragmented services in England – delivered by private providers, accountable to no one – we risk seeing public spending fall here in Wales, too, with no regard for our policy choices or population health priorities.

Our principles won’t protect us if we can’t fund them.

This is yet another example of Wales being overlooked in decisions made in England. Our health system’s future can still be undermined by choices we have no power over.

If we are to have a truly devolved health system in Wales, we need to ensure that power – and funding – cannot be pulled from under our feet by Westminster at a moment’s notice.

NHS Wales is different—and we need to make it work

In Wales, we’ve chosen a different policy path – at least on paper.

We moved away from the internal market model years ago, and we tend to talk less about competition and more about collaboration.

There’s a clearer emphasis on public service values in the rhetoric. But that doesn’t mean we’ve avoided the pitfalls.

Marketisation and privatisation are still realities here, particularly where services have been stretched beyond capacity – like in mental health and community care.

The difference is often more about how we describe the system than how patients experience it on the ground.

The creation of the NHS Wales Executive is a chance to move beyond this -to build something that works for Wales on our own terms.

Unlike NHS England, which became bloated and unaccountable, the NHS Wales Executive is still small enough, and new enough, to be shaped into something better.

We have an opportunity to make decisions faster, to co-produce policies that reflect our unique context, and to design services around the real needs of our population – not simply follow what happens elsewhere.

My view is that this is not the time to abolish the NHS Wales Executive. It’s the time to get it right.

We need to make sure it doesn’t repeat the mistakes of NHS England – layers of bureaucracy, distant leadership, and a lack of meaningful accountability.

Instead, it should stay close to the people it serves, be led by clear values, and act decisively in the interests of Wales.

It’s time for Wales to take control

The abolition of NHS England marks a moment of greater divergence between England and Wales on health.

We have the opportunity to lean into that difference and build a system here that is more equitable, more responsive, and more aligned with the values of social justice and public service that Wales often claims to stand for.

But that won’t happen by accident. It needs political will, it needs proper funding, and it needs an NHS that is held accountable for its outcomes.

And it needs us to stop waiting to see what England does before we act.

I see this divergence as a chance for Wales to take control of its own health and care future – not just in name, but in reality. It’s time to create a Welsh healthcare system that works for us, and is built by us – without strings attached.

James Downs is a mental health campaigner, researcher, psychological therapist and expert by experience in eating disorders. He lives in Cardiff and can be contacted at @jamesldowns on X and Instagram, or via his website: jamesdowns.co.uk