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The jobs cull from the government’s radical restructuring of the NHS will be at least twice as big as previously thought, with other parts of the health service now being downsized too.
The staff shakeout caused by NHS England’s abolition and unprecedented cost-cutting elsewhere will mean the number of lost posts will soar from the 10,000 expected to between 20,000 and 30,000.
Many thousands more people who work for the NHS’s 42 integrated care boards (ICBs) in England will see their roles axed, as well as the 10,000 working for NHS England and the Department of Health and Social Care (DHSC) who have already been earmarked to go. ICBs, regional health service bodies which oversee groupings of NHS trusts, employ 25,000 people between them.
Sir Jim Mackey, NHS England’s incoming new chief executive, has told the ICBs to cut their running costs by 50% by the end of the year. “Given ICBs employ 25,000 people, that means that half of them are going to go,” a senior NHS official said. That could lead to 12,500 posts being lost.
In addition, Mackey has also ordered the 220 NHS trusts that provide care across England to cut the number of people working in corporate services, such as HR, finance and communications. That could lead to thousands more officials losing their jobs, insiders say.
Mackey passed on the grim news to ICB and trust leaders in phone calls and meetings this week. He outlined the NHS’s need to undertake budget cuts on a huge scale as part of a “reset” of the service’s finances to help it avoid overspending by the £6.6bn in 2025-26 that initial estimates said was likely.
Mackey, who is succeeding Amanda Pritchard on 1 April but already making key decisions about the NHS’s future, told service bosses that the prospect of such a massive deficit had “scared the living daylights” out of government ministers, the Health Service Journal (HSJ) reported.
Senior figures running ICBs say the order to halve their running costs will make it impossible for them to undertake the full range of their activities, which include funding vaccination programmes, offering blood pressure checks and improving children’s dental health. ICBs have recently finished reducing their budgets by 20% as part of a previous round of cost-saving.
“Operationally, this could be a disaster – 50% on top of what some ICBs have already done is huge. There will definitely be job losses,” said one ICB official.
“In our ICB we have no more ‘fat’ to trim. It’s very difficult to see how, if implemented in a blanket way, this doesn’t lead to service cuts.”
Julian Kelly, NHS England’s outgoing deputy chief executive, told the Commons public accounts committee on Thursday that ICB staff being cut by half was part of the wide-ranging reorganisation of NHS England that Keir Starmer and Wes Streeting, the health secretary, unveiled on Thursday in an announcement that few insiders knew was coming.
Kelly told the cross-party committee, which scrutinises government spending, that reducing NHS England’s staffing by 50% would save £400m a year and that if the staff budget for the 42 ICBs was subjected to a similarly brutal cut that would save a further £750m a year, once the programme of job losses was complete. He did not indicate how many posts could go.
The sheer scale of budget cuts Mackey is pursuing is causing consternation across the NHS. One leader told the HSJ that the size and speed of the cut to ICB running costs was “terrifying” and would cause chaos for the service.
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The loss of so many experienced staff could threaten both the service’s drive to improve treatment waiting times and Streeting’s plans to overhaul how it operates through “three big shifts”, ministers have been warned by Matthew Taylor, the boss of the NHS Confederation and the former head of the Downing Street policy unit under Tony Blair.
“NHS staff are digesting the news that NHS England will cease to exist in two years. But the bigger issue is the 50% cut not only to central capacity but to systems [ICBs] and trust corporate services,” Taylor told the Guardian.
“As well as leading to thousands of redundancies, the danger is that the scale of change and insecurity will distract organisations from the daunting task of achieving recovery and reform in the context of an unprecedented financial squeeze.”
Matt Barrow, a national officer with the FDA union, which represents many DHSC staff, said: “Stopping duplication is one thing but a 50% cut to staffing following the merger of NHS England and the Department of Health and Social Care goes way beyond that.
“Ministers, of course, have the democratic right to determine the size of the state but you cannot make cuts of this scale without consequences. If you are cutting staff, there won’t be enough people to do the same amount of work and ministers will have to decide what they want to stop doing.”
