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Changes include NHS England being absorbed by the Department of Health and Social Care (DHSC) and cuts to other organisations.

This page will be reviewed regularly. It was last updated on Friday 5 September 2025.

Nationally

• We are involved with discussions between system and trade union leaders. We are advocating for nursing and members and are engaging with the Department of Health and Social Care and other affected organisations to represent the nursing specific viewpoint.
• We published a report which highlights the essential, strategic impact of nursing staff working in commissioning and oversight bodies, to protect against any risk to nursing functions within the context of cost-saving measures and reforms.
• Following the publication of the model Integrated Care Board (ICB) Blueprint, we wrote to the Chief Executive at NHS England. Read our full letter and the response from NHS England.
• We have highlighted in the media the importance of nurse leadership, input and insight across the health and social landscape:
  • 天美传媒, Every ICB must retain nursing expertise, RCN says
  • Health Service Journal, 

Locally

• We have recruited and trained more local RCN representatives in organisations affected by these changes.
• Our local RCN representatives and regional teams are meeting with employers in workplaces and advocate for members, nurses and the nursing profession.
• Our local RCN representatives are signposting members to information and advice to support.
• As proposals for change develop we are meeting with members in the workplace.

Expand the headings below for more information on each organisation.

The Department for Health and Social Care (DHSC) is a government department responsible for policy on health and adult social care matters in England and oversees the English National Health Service (NHS).

On 13 March 2025, Prime Minister Sir Keir Starmer announced that NHS England would be absorbed by the DHSC in part of a government bid to bring the health service “back under democratic control” of government ministers. Government has said cuts could be up to 50% across DHSC and NHS England.

RCN representatives continue to meet with managers in the organisation to advocate for our members and closely monitor the impact of these changes. 

Individual RCN support, advice and representation is available for members working in DHSC if needed.

NHS England (NHSE) is an executive non-departmental public body, sponsored by the DHSC. It is not a government department, but it delivers public services with funding from government. It has a wide range of statutory functions, responsibilities and regulatory powers supporting the NHS to deliver effective and high-quality care.

On 13 March 2025 Prime Minister Sir Keir Starmer announced that NHS England will be absorbed by the Department of Health and Social Care in part of a government bid to bring the health service “back under democratic control” of government ministers. Government has said cuts could be up to 50% across DHSC and NHS England.

We have been holding regular member meetings to provide updates and will publish future dates on the events page.

RCN Representatives continue to meet with managers in the organisation to advocate for our members and closely monitor the impact of these changes.

Individual RCN support, advice and representation is available for members working in NHSE if needed.

Integrated Care Boards (ICBs) are NHS organisations with responsibility for planning health services for their local population. There are currently 42 ICBs in England. ICBs manage the local NHS budget and work with local providers of NHS services, such as hospitals and GP practices, to agree how the NHS will contribute to integrated care strategy.

In March 2025, ICBs were told to cut their running costs in half by October – December 2025. This came on top of a reduction in running costs of 20 per cent over the past two years.

Subsequently, plans have been announced that 30 ICBs will cluster with neighbouring organisations. The remaining ICBs will retain their current footprints.

Currently there are no confirmed timelines for when organisational change will begin. Your RCN region and local representatives are keeping a close eye on developments and will update you as soon as more details are available.

RCN resources to support these changes have been developed and links can be found on this page.

Individual RCN support, advice and representation is available for members working in ICBs if needed.

Commissioning Support Units (CSUs) are free-standing NHS organisations that support Integrated Care Boards and other NHS organisations including NHS England with procurement, analysis and commissioning or business support activity. Four CSUs operate across England, and they are part of the NHS Business Services Authority.
 
In June 2025, staff working for CSUs were informed that CSUs would close, however, to-date there is no detail about how staff or functions that CSUs currently provide will be affected. The 10-year plan may indicate more detailed plans.
 
RCN representatives continue to meet with employers to advocate for our members and closely monitor the impact of changes.
 
CSU members are being supported collectively through member meetings, information and communications. Individual RCN support, advice and representation is available.

Arm's-length bodies (ALBs) are a specific type of public body that operates with a degree of independence from government departments. They are not government departments themselves, but they deliver public services and/or carry out public functions using public funding.  The Cabinet Office administratively classifies three types of ALBs: Executive Agencies, Non-Departmental Public Bodies (NDPBs), or Non-Ministerial Departments. Every ALB is sponsored and overseen by a Government Department and is accountable to their Department's ministers – there are 23 ALBs accountable to the Department of Health and Social Care.

The Cabinet Office has written to all government departments asking them to review their use of ALBs with the potential to close, merge or return some or all functions to government departments. The move is part of the government's drive to slim down the Civil Service, with a view to saving money and restructuring how the state works.

The Government has published Penny Dash's review of patient safety across the health and care landscape. The review has implications for a number of ALBs sponsored by the DHSC.

RCN representatives continue to meet with managers in the organisations where we are recognised to advocate for our members and closely monitor the impact of these reviews.

Individual RCN support, advice and representation is available for members working in ALBs if needed.