NHS CEO might not report to health secretary

The new NHS chief executive may soon report to a senior civil servant rather than the health secretary, HSJ understands.

The downgrade of the NHS CEO role is among several proposals being considered by national officials as they seek to finalise their target structure for the abolition of NHS England, senior sources said.

Another proposal, HSJ understands, is that staff in regional teams, who are currently NHSE employees, could be “hosted” by local NHS organisations, rather than become civil servants as part of the Department of Health and Social Care.

A year ago, the DHSC issued a “proposed top-level structure for the transformed DHSC” to staff, saying there would be “three permanent secretaries – including the DHSC permanent secretary, the NHS CEO and the chief medical officer”.

HSJ understands that this model – which echoed the “three at the top” configuration in the department in the years to 2012 – was agreed between NHSE, the DHSC and 10 Downing Street. As permanent secretaries, all three would report to the health and social care secretary.

But several senior national officials are now growing concerned that this agreement is being undermined by separate proposals being developed by DHSC officials.

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Source: HSJ, 16 June 2026