After decapitating NHS England’s leadership last week, Wes Streeting has announced he wants to abolish the entity that is NHS England (slowly).

The Department of Health in England has the power to take functions from NHS England starting tomorrow, but in practice it will take some time. High priority functions are likely to go first, which will be a way to tell the priorities of the new Department of Health in England.

NHS England itself can only be abolished by primary legislation, but it can be hollowed out into a shell of its former self by administrative decree. Going from the hundreds of functions today down to one last function is trivial under section 103(3) of the Health and Social Care Act 2022. It merely prevents the eventual last remaining final function of NHSE from moving. That last remaining function does not have to be material and can be new – it could be a webinar on progress since the Darzi Review and an annual report, and the legislative box is ticked for everything else to have moved. Going from one to zero requires primary legislation long after the Department of Health in England has taken over.

NHS England reaps what it sows. It is culturally fitting that the powers used by it to devour other public bodies will now be used to devour it.

NHS England’s cultural blindspot was that it was “the NHS” manifest, and that no one could do to it what it did to others. That blindspot leaves a few messes to clean up.

The loopholes in the National Data Opt Out used to be a long way from the Secretary of State’s view, whether the opt out implemented by NHS England does what Secretary of State said it should becomes a lot more testable. DH knows NHSE sells identifiable patient data, yet has never been forced to do anything about it. That luxury goes away.

Wes Streeting is also proposing a “patient passport”, a single central government owned health and care record run by the Secretary of State.  The initial indications from the Department of Health in England are that you’ll have no choice about having a central care record, there will not be any notification to you , let alone any choice. All your medical notes – the why of prescribing – are proposed to become the official property of Wes Streeting. 

The way Palantir has been implemented for the Federated Data Platform today has placed NHSE as a joint data controller over everything. Post-abolition that appears to be going to the Secretary of State – i.e. every data flow in Palantir for every hospital, ICS, and nationally, will now have political responsibility. 

The use of algorithms in FDP to prioritise/delay care would be a political act in law as well as in political terms.

Wes wants to run AIs over the records nationally and directly and push your behaviours via the NHS App. This prioritises politically driven health decisions over your own doctor’s clinical decisions about what care is usually best for people like you, and then your doctor discusses with you what you personally want to do. Such decisions have a habit of cutting through – Wes Streeting’s line on “Jabbing overweight people” has been in the BBC Newscast opening credits for months now.

The old NHS Digital and before that the NHS Information Centre existed for a reason – to separate the process of accessing your medical records away from political control.

The end state, of consolidating your entire medical record in one place, under the control of the government of the day, is a radical shift in the status of your medical notes. 

We’ll be here.