In his excoriating 2024 analysis of NHS performance for the new Labour government, surgeon Ara Darzi was clear: top-down reorganisation of NHS England and integrated care boards (ICBs) was “neither necessary nor desirable.”1 Ministers are now pursuing both.Claiming that the NHS was broken, Labour’s manifesto, unveiled in June 2024, promised to cut waiting times, by adding 40 000 more appointments a week, meet the referral-to-treatment target of 92% of patients being seen within 18 weeks, and double the number of cancer scanners. It also sought to rescue NHS dentistry, employ 8500 more mental health staff, reset relations between staff and government, deliver the new hospital programme, and ensure the “return of the family doctor.”2The pledge of more appointments is on track, but progress on treatment waiting times is far short of what is required to hit the target. Some progress has been made on providing more scanners, but there’s a…