A Power Shift in the NHS: What Amanda Pritchard’s Resignation Tells Us About Wes Streeting’s Vision

The resignation of Amanda Pritchard as NHS England’s chief executive is more than just a usual leadership change—it signals a significant power shift within the UK’s healthcare system. With Health Secretary Wes Streeting pushing an ambitious agenda of reform, Pritchard’s departure highlights the friction between established NHS leadership and the Government’s drive for increased ministerial control across departments.

Streeting’s Move to Centralise NHS Authority

Pritchard’s decision has been framed as a voluntary resignation rather than a sacking, but it comes against a backdrop of growing Government discontent with her performance. House of Commons committees raised concerns about her “drive and dynamism” to implement the changes envisioned by Streeting. Her resignation suggests a return to pre-2012 NHS structures, where the Department of Health had more direct control over NHS operational decisions. This potentially reduces the autonomy of NHS England.

Previously, Streeting laid out "three big shifts" for the health service, which included references to a new relationship between the Department of Health and NHS England. This could pave the way for enhanced political oversight, empowering ministers to have greater influence over NHS management decisions. This move may enhance government accountability for NHS performance, but it also raises concerns about the erosion of politically insulated health governance. When long-term thinking and data-driven decision-making is needed to make meaningful steps forward, this insulation can be essential.

An NHS CEO With a Private-Sector Background?

While James Mackey has been appointed as interim CEO, there will need to be a permanent replacement which will likely be amenable to the wishes of the new Health Secretary. There are indications that the government may recruit from outside the NHS to bring a more disruptive approach to NHS management.

This strategy is not without precedent—various NHS reforms have included private-sector methodologies—but the success of this approach has been mixed. The key challenge will be whether a leader without a real background in the unique circumstances of the NHS can effectively navigate the pressures of the publicly funded and often politically charged healthcare system.

Streeting’s High-Stakes Reform Agenda

Streeting is under pressure to deliver immediate improvements. His proposed reforms centre on:

• Reducing waiting lists through efficiency measures and better resource allocation.

• Shifting towards preventive and community-based healthcare rather than reliance on hospitals.

• Developing a long-term NHS strategy, with the upcoming 10-year NHS plan expected to be a cornerstone of his tenure.

While these objectives are broadly supported, the methods to achieve them could prove controversial. Increased Government control over NHS England could lead these long-term aims being ignored in favour of short-term political wins; this would undermine the health service's independence and ability to implement the longer-term strategies the Government is saying it wants.

Challenges for the Next NHS Leader

The next NHS chief will face a mountainous to-do list. They will need to manage an overstretched workforce, with high staff turnover and burnout remaining critical issues despite pay deals being reached shortly into this Government. Given the drive for reform, they will be crucial in balancing these political pressures with operational realities to ensure reforms do not lead to drops in patient care. A big part of their role will be rebuilding public trust - a survey conducted by Ipsos in early February 2025 revealed that 75% of UK residents fear being neglected in hospitals or experiencing delays in ambulance services. This faith in the health service could be further eroded if NHS England is perceived as too politically controlled, a danger which the Government need to caution against.

The Verdict: A Defining Moment for the NHS

Pritchard’s resignation is a turning point in NHS governance. A more centralised, ministerial-driven NHS could lead to faster reforms and greater accountability. However, if political interference undermines operational efficiency, it risks short-term thinking, more bureaucratic inefficiencies, and inevitable public backlash.

The next NHS chief will play a decisive role in shaping this transition. Whether the new leadership will embrace Streeting’s vision—or clash with it—will determine the trajectory of the NHS for years to come.