With NHS England set to be abolished, a new 10-year plan to reform the NHS looming and a refreshed workforce strategy around the corner, the government is doubling down on its mission to overhaul the health service.
The chief nursing officer (CNO) for England, Duncan Burton, has told Nursing Times what he thinks the changes mean for the profession.
“I don’t think cuts are inevitable”
Duncan Burton
Since taking power, the government has initiated plans to reorganise the health system.
As part of this, prime minister Sir Keir Starmer announced earlier this year that NHS England would be scrapped, ending the NHS’s operational independence from the government established by the Health and Social Care Act 2012.
Ministers argued that frontline staff were “drowning in micromanagement” because of the bureaucracy and duplication created by having two organisations overseeing the NHS.
Asked whether dissolving the body was the right move, Mr Burton said: “I do think it is the right thing to do.
“Being back fully in the department of health is an important step for nursing. I think that change and that coming together is fundamental and a good thing for nursing.”
Through the reforms, expected to be completed within two years, around 9,000 job cuts are anticipated across the Department of Health and Social Care and NHS England.
Mr Burton argued that “bringing the organisations together and downsizing” was about making sure “we get enough resources to frontline nurses”.
“It’s the right thing, but it’s clearly a difficult time for many nurses who are directly affected by that,” he noted.
“One of my jobs is to do as much as I can to support those colleagues in their next steps and work.”
As part of the changes, Mr Burton has been tasked with reviewing the size of the “corporate” nursing workforce across integrated care boards and trusts to address variation in numbers between organisations.
Health unions have warned that cuts to non-patient-facing nursing roles show a lack of understanding of their contributions.
However, Mr Burton said: “I don’t think cuts are inevitable. I think this is essentially about providing the information to chief nurses and trusts, to ask… why there are variations.”
He further emphasised the importance of using “every pound wisely” and exploring “other ways of doing this differently”.
Amid the cuts and reshuffles, Mr Burton suggested that his position as CNO remained safe.
He said: “The secretary of state has made it very clear in parliament that there will be a chief nursing officer in the department of health.
“I think it’s a great opportunity to be right there in the centre of influencing government for the benefit of patients and the professions.”
Abolishing NHS England is part of a broader NHS shake-up taking place across the country.
Following a review last year by Lord Ara Darzi – which warned that the NHS was in a “critical condition” – the government pledged the “biggest re-imagining of our NHS since its birth”.
This includes reforms under three “big shifts”: moving care from hospitals into the community, shifting services from analogue to digital and moving away from sickness to prevention.
These three shifts will underpin the government’s forthcoming 10-year plan for the NHS, which will set out how the health service will evolve over the next decade.
Mr Burton praised the “enthusiasm” nurses and midwives had shown during the plan’s development.
“It’s been great, actually, to see the energy coming from the nursing profession to drive the development of the plan,” he said.
Moving care from hospitals to the community will require nursing input, explained Mr Burton, stating: “There are a huge [number] of opportunities for the profession to lean into that shift.”
He argued that nursing education must adapt to support this reform, with more placements in community settings.
“If we are really serious about making that shift, which we are, we have got to expose people to those opportunities out in the community,” he added.
It comes as the refreshed NHS Long Term Workforce Plan, due this summer, is also expected to focus on the community shift.
“I do not want any newly qualified nurse or midwife without a job”
Duncan Burton
Mr Burton added: “It’s important also that the new workforce plan reflects the ambitions of the 10-year plan and the models of care and the approaches that are going to be taken through that.
“Nurses, as the largest workforce in the NHS… will absolutely be core to that.”
The previous iteration of the workforce plan, which was published in 2023, included ambitious targets to expand the nursing workforce that have since been undermined by declining application rates to nursing and midwifery courses.
Even for those graduating, there is no guarantee that they will find employment.
Concerns are growing that financial constraints in the NHS and social care are leading to nursing vacancies being scrutinised or frozen altogether.
At the Royal College of Nursing (RCN) Congress 2025, newly registered nurses described being forced to look for employment outside of the profession, including in coffee shops, due to a shortage of jobs.
Responding to this, Mr Burton said: “I do not want any newly qualified nurse or midwife without a job.
“I do not want them working in a coffee shop. I want them doing the thing that they’ve trained to do for the last three or so years.”
Mr Burton said newly registered nurses must be supported to “find work across the whole range of services” available, including the NHS, social care and the independent and charitable sectors.
He added: “I’m doing everything I can in my power to make sure that those newly qualified nurses do find jobs and work.”
The central tenet of the NHS Long Term Workforce Plan is to create a more sustainable pipeline of domestically trained nurses.
It comes as, in recent years, the UK has heavily relied on overseas recruitment to plug workforce gaps.
Now, the tide has begun to change, with the UK government clamping down on international recruitment into the health and social care sector.
However, nursing leaders have warned that the government crackdown on net migration is creating a hostile environment for migrant nursing staff already in the UK and could “accelerate an exodus” of them.
The Nursing and Midwifery Council reported in December 2024 that there had been a 33% increase in the number of international professionals leaving the register.
Meanwhile, a survey published last month by the RCN warned that tens of thousands of overseas nurses were ready to quit working in the UK in search of better treatment, pay, conditions and career opportunities.
Mr Burton recognised “that it’s a particularly difficult time for international nurses”.
He said: “I would say to every single one of them, you are welcome. You are making a huge contribution.
“I’m incredibly grateful for those nurses coming from overseas, moving to the UK to provide care to the population in the UK, and they have now made this their home.”
“It’s a privilege to be able to work with people at some of the worst times of their lives”
Duncan Burton
While international recruitment would continue, it would be “much less than it has been previously”, Mr Burton explained.
For overseas nurses settled in the UK, Mr Burton emphasised the importance of pastoral support and career development.
International nursing and midwifery organisations have been leading in this space, and the CNO said he had “seen the significant work they do”.
These organisations had previously received funding from NHS England via the Florence Nightingale Foundation, but this ended in 2023.
The government had recently been called upon to plug this gap, but declined, citing the “difficult fiscal situation” it inherited.
Mr Burton said he recognised “the disappointment there will be among those associations”, adding: “We will continue to work with them and support them as much as we can do to continue to thrive and give voice to our international colleagues.”
Overall, Mr Burton appeared enthused about how nursing could be transformed over the next few years.
He said it was a “huge privilege” to be leading the workforce through this period of change: “For me, the privilege of being the chief nursing officer is to do as much as I can to support nurses to do what they are fantastic at, but also to give them voice nationally, to government and to the wider population as well.”
Echoing messages from his predecessors, Mr Burton said it was essential to “attract more people” into nursing.
He added: “When I go out and talk to most nurses across the country, [they] still love what they do, but obviously sometimes the conditions they work in are difficult.
“But we’ve got to, I think, present much more of a balanced picture of what it is to work as a nurse, the opportunities there are to work in so many different settings.”
Mr Burton described nursing as a fulfilling career that had “grown [him] as a person”.
“It’s a privilege to be able to work with people at some of the worst times of their lives, in some of the most difficult circumstances,” he said.
This power to help patients and families was the thing that Mr Burton said still drove him today, even as the country’s most senior nurse.
“Yes, it might be at a different scale now, but that ability to influence, change and enhance and improve patients’ lives and families’ lives… why would you want to do anything else?”
