Dr Richard Dune

30-06-2025

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After NHS England: What centralised control by the DHSC means for providers, ICSs, regulation, and compliance in England

In the intricate ecosystem of health and social care in England, few institutions wield more influence than the Department of Health and Social Care (DHSC). While regulators such as the Care Quality Commission (CQC) enforce standards, and providers deliver care, it is the DHSC that sets national strategy, allocates funding, oversees regulation, and now, following the abolition of NHS England, controls the delivery of NHS services.

As of 2025, the Labour government’s sweeping reform to dismantle NHS England has reshaped the landscape, placing direct accountability for the NHS and Integrated Care Systems (ICSs) under the control of the DHSC. For health and social care providers, this marks a fundamental shift in how the system is led, regulated, and managed.

In this blog, Dr Richard Dune explores the changing role of the DHSC, what the abolition of NHS England means in practice, and how providers can align with the Department’s priorities to remain compliant, proactive, and competitive in a politically re-centralised system.

What is the Department of Health and Social Care?

The DHSC is a ministerial department of the UK Government. It is responsible for:

• Setting national health and social care policy in England
• Funding and directing local and national delivery systems
• Sponsoring regulators, workforce bodies, and research institutions
• Overseeing adult and children’s social care strategy.

It is headed by the Secretary of State for Health and Social Care, who is supported by ministers of state and civil servants. The DHSC is accountable to Parliament and scrutinised by the Health and Social Care Select Committee.

While health and social care are devolved to Scotland, Wales, and Northern Ireland, the DHSC often sets the tone on:

• Workforce strategy and international recruitment
• Funding formulas and capital investment
• Cross-border service collaboration
• UK-wide regulatory oversight (e.g., MHRA, PSA).

Core responsibilities of the DHSC

The DHSC’s responsibilities can be grouped into five strategic areas:

• Policy development
• Funding and resource allocation
• System oversight and leadership
• Commissioning and contracting
• Public health and emergency preparedness.

Let’s discuss these in more detail below.

Policy development

The DHSC sets health and care priorities by developing legislation and long-term strategies. These include:

• Health and Care Act 2022
• Care Act 2014
• Mental Capacity Act 2005 and Liberty Protection Safeguards
• NHS Constitution
• Public health strategy (in collaboration with OHID and UKHSA).

Current policy priorities include:

• NHS performance recovery
• Social care reform
• Digital transformation
• Mental health access
• Prevention and health inequality reduction.

Funding and resource allocation

The DHSC oversees funding for:

• Integrated Care Boards (ICBs)
• Local authorities for adult and children’s social care
• UKHSA and OHID
• Innovation programmes (e.g., digital tech, AI pilots)
• Capital programmes, including hospitals, GP estates, and infrastructure.

It determines provider tariffs, monitors financial performance, and directly funds services now that NHS England has been abolished.

System oversight and leadership

The DHSC now directly manages:

• ICS and ICB performance
• NHS operational planning and delivery
• National initiatives such as the Elective Recovery Taskforce
• Delivery assurance through the new DHSC Delivery and Performance Directorate.

It also sets strategic direction for:

• The health and care workforce
• Digital health platforms
• Value for money in commissioning and procurement.

Commissioning and contracting

Though much commissioning remains local, the DHSC:

• Sets the national legal framework for NHS contracts
• Oversees mandates for ICSs
• Controls core performance indicators
• Intervenes in cases of failure or financial mismanagement
• Monitors compliance across all NHS and social care delivery bodies.

Public health and emergency preparedness

Through agencies like UKHSA and OHID, the DHSC is responsible for:

• Managing national health emergencies (e.g., pandemics)
• Coordinating infection prevention and health protection
• Addressing lifestyle and environmental health inequalities
• Data surveillance and preparedness via the Joint Biosecurity Centre.

Abolition of NHS England - What has changed?

In March 2025, the Labour government announced the abolition of NHS England, citing excessive bureaucracy, inefficiency, and a lack of ministerial accountability. NHS England’s functions are now under direct control of the DHSC, reversing key elements of the 2012 Lansley reforms.

Key aspects of the reform

Table 1 - Pre-2025 and post-2025 key aspects of the reform.

Why it matters

• Providers are now subject to more direct political oversight.
• Funding and planning decisions are centralised.
• There is potential for faster decision-making, but at the expense of reduced operational autonomy.
• Inspection frameworks and performance targets may become more closely linked to political mandates.

During the two-year transition period, NHS England continues to support performance oversight, although its functions are being gradually phased out.

DHSC and the NHS - A redefined relationship

With NHS England now gradually being dismantled, the DHSC will lead:

• Waiting list reduction efforts
• Workforce strategy, including the NHS Long-Term Workforce Plan
• Digital and data strategy, including DSCRs and NHS App integration
• Performance oversight for all NHS Trusts and ICSs
• Quality and improvement frameworks, in conjunction with the CQC and NICE.

This centralised model means ICSs must now operate with tighter alignment to national goals, and providers will feel greater top-down influence.

DHSC and local authorities

The DHSC continues to fund and steer local authority commissioning, including:

• Social care (domiciliary, residential, community-based)
• SEND services and safeguarding
• Public health via OHID and ring-fenced budgets.

Key instruments include:

• Adult Social Care Reform White Paper
• Market Sustainability and Fair Cost of Care Fund
• Health and Wellbeing Boards are increasingly linked to ICSs at the Place level.

Although councils retain statutory responsibility, the DHSC now plays a more active role in guiding workforce policy, commissioning priorities, and sustainability planning.

The DHSC and professional regulation

Regulatory bodies such as the NMC, GMC, HCPC, and GDC remain independent, but the DHSC:

• Commission reviews (e.g., Kark Review, Paterson Inquiry)
• Sets reform agendas (e.g., digital revalidation, fitness to practice updates)
• Sponsors the Professional Standards Authority (PSA)
• Approves regulatory changes and new registration categories.

It also sponsors the Care Quality Commission (CQC), which is tasked with aligning inspection methodologies to DHSC priorities.

How the DHSC strategy shapes provider compliance

Even if providers don’t interact with the DHSC directly, its decisions affect:

• CQC’s inspection framework (SAF and Fundamental Standards)
• Training and CPD mandates
• Safeguarding and workforce governance policies
• Contractual expectations from ICBs and LAs
• Digital transformation requirements (e.g., interoperability, cybersecurity).

Understanding the DHSC’s evolving priorities helps providers:

• Anticipate change
• Secure funding
• Adapt training and quality systems
• Avoid non-compliance.

Arms-length bodies sponsored by the DHSC

The DHSC oversees over 15 arms-length bodies (ALBs), including:

• Care Quality Commission (CQC)
• Medicines and Healthcare Products Regulatory Agency (MHRA)
• National Institute for Health and Care Excellence (NICE)
• Health Research Authority (HRA)
• Human Fertilisation and Embryology Authority (HFEA)
• Human Tissue Authority (HTA)
• NHS Business Services Authority (NHSBSA)
• NHS Resolution
• NHS Counter Fraud Authority.

These ALBs support a range of areas, including medication safety and research ethics, as well as digital standards and clinical effectiveness.

DHSC priorities in 2025 (Under the Labour Government)

The current administration has prioritised:

• Cutting NHS waiting lists, especially in elective care
• Expanding mental health services, particularly for young people
• Social care workforce reform, including pay and conditions
• Primary care reform, emphasising continuity and local accountability
• Digitisation and AI in care, including mandated use of DSCRs
• Tackling health inequalities, with a focus on prevention and early intervention
• Reducing bureaucracy through centralised delivery and streamlined contracts. 

For providers, this means greater scrutiny, but also opportunities to engage in funding, pilots, and transformation initiatives.

Final thoughts

The DHSC is no longer just a policy department. In 2025, it is the nerve centre of NHS delivery, holding the reins of operational planning, workforce management, performance monitoring, and funding.

Providers must now adapt to a more centralised, politically accountable system, where DHSC decisions directly shape their inspection, compliance, and commissioning environment.

Understanding the DHSC and aligning with its agenda is no longer optional. It’s the key to surviving and thriving in England’s evolving healthcare system.

Translate national policy into local practice with ComplyPlus™

At The Mandatory Training Group, we understand the complexities of DHSC policy, inspection requirements, and compliance obligations. That’s why we created ComplyPlus™, a digital compliance and governance platform designed to help providers stay ahead of change.

With ComplyPlus™, you can:

• Access editable, DHSC-aligned policies and procedures
• Track staff training, CPD, and revalidation across your workforce
• Monitor CQC and ICB compliance metrics in real-time
• Align audits and QI reports to the Single Assessment Framework (SAF)
• Receive alerts and guidance on policy and regulatory updates.

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