Briefing Paper P035 - Government NHS White Paper Proposals: Review of Arms Length Bodies


As part of its work Hastings Voluntary Action have produced this briefing - as part of a series on the Governments NHS White Paper.

Reducing Costs/Increasing Efficiency

Over the next four years the Government is committed to reducing NHS administrative costs by more than 45% and to simplifying and reducing radically the number of NHS bodies.

The Principles of the Review

  • devolution to the frontline: functions will only be exercised at a national level where it makes sense to do so;
  • the number of arm’s-length bodies will be kept to a necessary minimum.

The scope of each arm’s-length body will be clearly defined and each arm’s-length body will be subject to triennial reviews to provide a regular assessment of the need for functions to continue and to ensure the organisations deliver value for money for the taxpayer;

  • arm’s-length bodies will be expected to collaborate and co-operate to ensure that duplication of activities, for example licensing and inspections,
  • and data collection is minimised and unnecessary burdens and costs to the NHS are reduced;
  • setting policy is the role of the Department of Health not arm’s-length bodies, although arm’s-length bodies will often have a role in policy development and implementation determined by the Department of Health;
  • business support functions will maximise economies of scale while meeting the support needs of individual arm’s-length bodies. Budgets will be benchmarked and managed down to ensure efficiency;
  • in the interests of greater transparency and accountability, arm’s-length bodies will be expected to publish performance information and benchmarking data online;
  • where appropriate, arm’s-length bodies will be expected to exploit commercial opportunities, for example outsourcing or divestment, to
  • maximise commercial discipline across the sector.

The initial Results of the Review

The assessment of arm’s-length bodies means that, subject to Parliamentary approval:

  • six of existing bodies have a clear future as arm’s-length bodies, albeit operating in the most cost effective and efficient way: Monitor, the Care Quality Commission, the National Institute for Health and Clinical Excellence, the Medicines & Healthcare products Regulatory Agency, the Health and Social Care Information Centre and NHS Blood & Transplant;
  • the functions of two of our arm’s-length bodies will be transferred to other organisations to achieve greater synergies where appropriate: the Human Fertilisation and Embryology Authority and the Human Tissue Authority. Further work is required to examine in greater detail the practicalities involved and we propose that they remain as independent arm’s-length bodies in the short term, with the aim that their functions will be transferred by the end of the current Parliament;
  • two of arm’s-length bodies will be abolished as statutory organisations and their functions will be transferred to the Secretary of State as part of the new Public Health Service: the Health Protection Agency and the National Treatment Agency;
  • there are four arm’s-length bodies which we propose to abolish from the sector; the Alcohol Education Research Council, the Appointments Commission, the National Patient Safety Agency and NHS Institute for Innovation and Improvement;
  • one arm’s-length body will be moved out of the sector to operate on a full-cost recovery basis: the Council for Healthcare Regulatory Excellence;
  • one arm’s-length body will have its function transferred to an existing professional regulator: the General Social Care Council;
  • two arm’s-length bodies will be subject to a commercial review by industry experts to identify potential opportunities for greater efficiency through outsourcing, divestment and contestability and/or employee ownership: NHS Litigation Authority and NHS Business Services Authority.

A New Public Health Service

The Government propose to support the cross-government public health strategy through the creation of a new Public Health Service directly accountable to the Secretary of State, to integrate and streamline existing health improvement and protection bodies and functions, with an increased emphasis on research, analysis and evaluation. As a part of that development the Government intend to abolish the Health Protection Agency and the National Treatment Agency for Substance Misuse as statutory organisations and transfer their functions to the Secretary of State as part of the Public Health Service. The critical functions of the National Treatment Agency for Substance Misuse which support the local delivery of drug treatment services would be integrated into the Public Health Service. It is believed by the Government that this move would tackle the dependency problems of individuals, and address the entire range of issues which users face. The full recovery of drug users back into society, housing and employment will provide significant benefits to all.

Further information

A full downloadable copy of the consultation paper can be found via the Department of Health website:-

Responding to the Consultation

Responses to the questions in this consultation document should be sent to or to the White Paper Team, Room 601, Department of Health, 79 Whitehall, London SW1A 2NS by 11 October 2010.

Group Support: