There’s a line between ambition and recklessness—and ministers have crossed it with their plan to cut tens of thousands of NHS jobs. Around 12,500 roles are set to be lost, with half coming from Integrated Care Boards (ICBs), and shockingly, this move is proceeding without any formal impact assessment.
Cutting Without Clarity: A High-Risk Gamble
ICBs were established only recently to coordinate regional healthcare delivery and improve outcomes through collaboration. Yet NHS England’s 42 ICBs have now been instructed to halve their running costs by the end of 2025. The justification? To reduce NHS bureaucracy and channel funding into frontline services. But no risk assessment, no modelling, and no clear roadmap have been offered.
Health Minister Karin Smyth recently admitted—under questioning from the Liberal Democrats—that the Department of Health and Social Care (DHSC) conducted no impact assessment on the implications of the ICB cuts. That isn’t just a policy gap—it’s administrative negligence.
“Streamlining” or Structural Sabotage?
This is not careful reform. It’s a dangerous, uncalculated leap. Helen Morgan MP rightly called it “reckless policymaking, done on the hoof to please the Treasury.” And it’s not just ICBs facing the axe—NHS England is cutting 50% of its 15,000 staff, and similar downsizing is planned across the DHSC and local NHS trusts. The result is the largest NHS job reduction in history.
This strategy comes at a time when the health service is already stretched to breaking point. Vacancies, service delays, and workforce burnout are mounting. Slashing the very workforce tasked with navigating these crises is counterintuitive at best, destructive at worst.
Undermining the System from Within
ICBs are responsible for overseeing vital elements of NHS care—contracting GPs, managing cancer pathways, coordinating discharge plans, and driving integration between health and social care. Removing half of their workforce means fewer hands to deliver these complex tasks. One NHS leader described the move as “vandalism.” Former Health Secretary Andy Burnham warned it would likely force ICB mergers and stall efforts to improve care.
If NHS reform is the goal, dismantling the infrastructure before the strategy is even published is a sure way to fail. NHS Confederation CEO Matthew Taylor has cautioned that these cuts will derail long-term reform plans.
The Myth of “Bloated Bureaucracy”
It’s become a convenient political narrative: NHS managers are often portrayed as unnecessary bureaucrats siphoning money from frontline care. But this is a dangerously simplistic view. In truth, NHS managers handle the logistics that keep hospitals running, ensure staff are paid, contracts fulfilled, and services coordinated. Strip too many out, and systems seize up.
Ironically, the very efficiencies ministers claim to seek—better patient flow, shorter waits, digital innovation, and reduced delays—rely on these professionals to implement.
Efficiency Needs Strategy, Not Panic
Yes, efficiency is essential. The NHS must be lean, agile, and financially responsible. But efficiency requires thoughtful design, not rushed culls. Cutting thousands of roles without understanding the consequences or planning how work will be redistributed is not reform—it’s risk-taking with lives and livelihoods.
Jon Restell, chief executive of Managers in Partnership, has warned that the cuts threaten patient safety and progress on key government pledges—like reducing waiting times and transforming care. And let’s not forget: the UK already has one of the most under-managed healthcare systems in the developed world.
Call for a Pause and a Rethink
There is still time to act responsibly. Restell and other NHS leaders have called for an immediate pause to the job cuts, allowing time for impact assessments, staff consultation, and operational planning. This is not obstruction—it’s common sense.
If Health Secretary Wes Streeting is serious about building a stronger, more effective NHS, he must listen to those who understand its inner workings. A blanket reduction in managerial staff, without considering the knock-on effects, will do more harm than good.
Conclusion: Fixing the NHS Requires More Than Headlines
Improving NHS performance is essential. But gutting the very people responsible for planning, coordinating, and delivering that improvement is a strategic contradiction. This is not just about saving money—it’s about risking institutional memory, clinical safety, and patient trust.
Policymakers must ask themselves: Can the NHS really afford to lose this knowledge, capacity, and experience right now? The answer is clear—no. It’s time to pause, assess, and build a smarter path forward.
