100,000 NHS JOB CUTS MUST BE STOPPED

Shockingly, more than 100,000 NHS staff are poised to lose their jobs as a consequence of the Government’s ’10 Year Plan’ and ‘financial reset’. The plan includes abolishing NHS England, halving Integrated Care Board (ICB) running costs, and forcing trusts to reduce corporate growth. This is a fundamental attack on the NHS.

Claims that these cuts will reduce waste and improve efficiency are disingenuous. In reality, this is not just about reducing bureaucracy and duplication (corporate and administrative roles are already understaffed) as trusts are now being forced to cut clinical roles in order to balance the books. One chief executive of a large hospital trust said it was looking to shed 1,500 jobs, some 5% of its workforce, including doctors and nurses. Job losses are happening now and right across the country, and not simply confined to the Department of Health and Social Care (DHSC), NHS England (NHSE) and ICB. This is despite the NHS vacancy rate standing at 6.7% in March this year, with major shortages across nursing, midwifery, GPs, anesthetists, radiologists, and more.

Analysis by the Guardian newspaper suggests many  trusts are considering reducing their workforce by 3–11%. Applied across approximately 1.37m trust staff, this equates to 41,100 to 150,700 potential losses. In addition, around half of NHSE’s 15,300 staff, plus around 12,500 ICB staff (the likely consequence of a 50% cut in running costs), and some DHSC posts will go. 

Job losses could easily exceed 100,000 when combining central and trust-level cuts.

It is very difficult to see how this could possibly improve productivity, increase patient flow through hospitals, reduce waiting lists and increase appointment volumes. It seems that the lesson of the disaster at Mid Staffordshire hospital has been forgotten, where the leadership were more focused on meeting financial and performance targets than providing safe, compassionate care.

The Government has not carried out any formal impact assessment of the abolition of NHS England on service delivery, patient safety, or financial resilience. The King’s Fund and Nuffield Trust warn that  job cuts in senior management will cause disruption, loss of expertise, and delays in service improvement. Lord Darzi’s advice has also been ignored. His report warned ‘The Health and Social Care Act of 2012 was a calamity without international precedent. By dissolving the NHS management line, it took a scorched earth approach to health reform, the effects of which are still felt to this day’.

Frontline accounts from NHS staff already describe chaotic implementation timelines and a lack of guidance, creating an environment of uncertainty and low morale. Redundancy costs for job losses in NHSE, ICB and in corporate services at Trust level could be over £2 billion. With no central funding for this, ICB are pointing out that bearing the cost is incompatible with their current financial plans and work programme. 

Alan Milburn in 2016. Photograph: Richard Gardner/REX/Shutterstock

All of this has to be understood in the context of overall government thinking on the future of the NHS and the real ambition of the Ten Year Plan for Health. Wes Streeting’s mentor, Alan Milburn, (New Labour’s privatising Health Secretary and a key influencer behind the plan), made clear his perspective in a recent podcast interview with the Health Foundation (read the transcript, or listen here). He stated that we should no longer think about healthcare being the NHS, but more an ‘ecosystem’ of private providers, tech companies and the public sector. 

All this means a healthcare system delivered less by people and more by technology, or in other words, with less salaried workers. 

Milburn’s  vision is that the healthcare system will be transformed through a combination of the power of data analytics, AI, genomics to predict risk of illness, wearable monitors and surgical robotics. 

This also opens up massive opportunities for private companies, many of which had representatives advising on the formulation of the plan. The ambition to have a reduced workforce is spelled out, and it seems probable that some of those who lose their jobs will be driven into an expanding private health sector.

Taken as a whole, the plan literally spells the end of the NHS as we know it as a centrally managed, publicly funded, publicly accountable, publicly delivered and universal healthcare system.

What it means instead is a hugely diminished NHS, even more over stretched and understaffed than it is now, with more room for private companies employing workers in less well paid and less secure jobs. Partnership with businesses will mean more private companies soaking up taxpayers money by providing controversial and untested technologies which, together with digital exclusion, will likely lead to an even greater increase in health inequalities over time. 

These 100,000 job cuts must be fought tooth and nail.

That around 100,000 individuals now risk unemployment with severe impacts to their families and to the local economy in which they work is unconscionable. Compared with industry as a whole, the NHS is under-managed and loss of senior management staff at a time of huge reorganisation can be expected to have a negative impact on patient services. Clinical staff are currently under huge pressure from covering for unfilled posts and further loss of staff will undoubtedly make this worse as well as hinder any possible recovery in NHS performance. This jeopardises key promises in Labour’s manifesto and represents a considerable political risk.

The Ten Year Plan sets out what changes the Government would like to see happen in healthcare, but with little on how these are to be achieved. 

The assault on jobs is an attack on the NHS as a public service and can only lead to disaster. 

We must emphasise that if the NHS (based on its founding principles) is funded to succeed, it is still by far the best model available. 

KONP calls on the government to fund the NHS in relation to need, address the social determinants of health rather than be seduced by technological fixes, and rebuild public health. It should bear in mind that if the NHS fails, the economy will fail, and take inspiration from the ambition of the Attlee government which built the NHS despite facing huge economic problems. We cannot have good health care without well trained and supported staff in adequate numbers. We therefore call on our allies in the trade unions, in parliament and in other campaigning organisations advocating for the NHS to stand with us and oppose these brutal NHS job cuts.