Ministers aiming to abolish NHS England may need to create a new public body to employ highly paid regional staff, delaying promised reforms.

A year and a half after former Prime Minister Sir Keir Starmer pledged to scrap the £200bn-a-year arm’s-length body, regional managers remain on higher pay scales than civil servants, complicating the transition.

Health service leaders, including Sir Ciarán Devane of the NHS Alliance, warn the uncertainty is harming patient care and urge a temporary quango via a “special health authority” to resolve the deadlock.

The stand-off centers on regional staff paid up to 25% more than civil service equivalents, preventing their transfer to the Department of Health and Social Care. Proposed amendments to the Health Bill seek to enable this workaround, but delays risk missing the April 2027 deadline.