Thousands of NHS staff in England are set to lose their jobs after a deal was struck with the Treasury allowing the health service to overspend this year to cover the cost of redundancy payments.
The agreement paves the way for around 18,000 administrative and managerial roles to be cut, as NHS England, which oversees the health service, is brought back under the Department of Health and Social Care.
Local Integrated Care Boards (ICBs), which plan regional services, will also see their head counts slashed by half.
The one-off bill for the shake-up is expected to reach £1 billion. NHS leaders had asked for additional funding, but the Treasury refused, instead permitting a temporary overspend to cover pay-offs. Officials said the move was a “pragmatic step” that will allow the NHS to save money in future years.
A government source insisted the deal does not involve new money beyond what was already pledged, an extra £29 billion a year above inflation by 2028–29.
‘Too many layers of bureaucracy’
Health Secretary Wes Streeting defended the move, insisting it would streamline management and put more resources into patient care.
Speaking on BBC Breakfast, Mr Streeting said:
“Patients and NHS staff have told me the health service has too many layers of management, too many layers of bureaucracy. People want to see the front line prioritised, and that is exactly what we’re doing.”
Later, addressing health leaders at the NHS Providers’ Conference in Manchester, he will tell them:
“I want to reassure taxpayers that every penny they are being asked to pay will be spent wisely. We’re now pushing down on the accelerator and slashing unnecessary bureaucracy, to reinvest the savings in front-line care.
“It won’t happen overnight, but with our investment and modernisation, we will rebuild our NHS so it is there for you when you need it once again.”
According to the government, the reforms will eventually raise £1 billion a year to improve patient services. Officials claim that each £1 billion saved in administrative costs could fund around 116,000 hip and knee operations.
NHS leaders call it a ‘pragmatic step’
Daniel Elkeles, chief executive of NHS Providers, described the move as “a pragmatic step that means planned redundancies can now go ahead.”
He added:
“It reflects the flexibility of a three-year settlement, allowing some funding to be brought forward in order to generate future savings to go into front-line care.
“However, we must recognise the position of staff affected by these changes, people who have offered commitment and service to the NHS, who face a very uncertain future.”
Unions warn of ‘false economy’
But unions have condemned the redundancies, warning they could damage vital services.
Patricia Marquis, of the Royal College of Nursing, said:
“Front-line services need more investment, but to do this off the backs of making thousands of experts redundant is a false economy.
“Expert registered nurses working across NHS England and ICBs don’t just run vital public health programmes and oversee care programmes for the vulnerable, they connect the NHS and social care services with one another. To imply these are administrators shows a complete lack of understanding of their roles and how they contribute to patient care.”
NHS overhaul reignites debate over control
NHS England was created under Andrew Lansley’s 2012 reforms to keep day-to-day operations at arm’s length from ministers. But critics, including former health secretary Jeremy Hunt, have since described it as a “bureaucratic monster” that “stifles innovation”.
Some NHS trusts have reportedly had to complete up to 250 forms a month to satisfy both NHS England and the health department, a symbol, many argue, of excessive red tape.
However, the reforms will also hand ministers far greater control over the running of the health service, something previous governments tried to avoid.
While Labour criticised the Conservatives for repeatedly reorganising the NHS, its own major restructuring now comes with significant political risk. Many inside the health service have warned that the changes could cause disruption and distraction at a time when hospitals are already struggling with record waiting lists and staff shortages.
As the reforms begin to take shape, one thing is clear, the NHS is entering another turbulent chapter, with thousands of staff set to pay the price in the hope of a leaner, more efficient system.
Do you work for the NHS? Are you affected by these cuts, or facing redundancy? We want to hear from you. Tell us how the changes are impacting your team and your patients. Email us at this newspaper or share your story in confidence.
