“We need to understand how these cuts will impact on patient care. Which roles will go? How will that impact on remaining staff?”
By Margaret Greenwood, former MP for Wirral West
There is a major reorganisation of the NHS underway, but the full scope of what is being done and the reasons for it are yet to become apparent.
On 13th March, Keir Starmer announced that NHS England would be abolished in a bid to cut bureaucracy. On the same day, the new Transition Chief Executive Officer of NHS England, Sir Jim Mackey, informed Integrated Care Boards (ICBs) that they are required to make spending cuts of 50%. It’s anticipated that around 12,500 jobs are to go, and ICBs are required to set out their plans by the end of May. This will be devastating for thousands of dedicated workers. Moreover, the timing does seem curious given that the 10 Year Plan is due to be published in June: why are ICBs being asked to make decisions about cuts without sight of it?
In addition, cuts required to NHS trusts are considered to potentially bring total redundancy figures to over 100,000 – longer waits for diagnoses and treatments seem inevitable.
NHS England was established by the Health and Social Care Act 2012 as an arms-length organisation with responsibility for managing the National Health Service in England, commissioning healthcare services and overseeing the allocation of funding.
However, its abolition does nothing to address the increased opportunities for private companies to deliver NHS services that the 2012 act ushered in, nor does it address the sharp increase in the amount of money that NHS foundation trusts are allowed to make from private patients to 49%; prior to the act, the average they had made from private patients was around 2%.
The rationale given for the cuts to ICBs has been that it is to strip out duplication of roles; however, there are those who contest this. The question arises, are levels of duplication sufficient to warrant a 50% cut? The Francis Inquiry into Mid Staffordshire recommended that risk and impact assessments be carried out, and debated publicly, before major structural change to the healthcare system is implemented. We need to see such assessments now, and time must be provided for full scrutiny.
We need to understand how these cuts will impact on patient care. Which roles will go? How will that impact on remaining staff? Will the cuts impact on training and development, and on NHS buildings and equipment? And would we be prepared in the event of another pandemic?
Meanwhile, The Lowdown has reported that Sir Jim MacKey has said that support staff employed by NHS trusts should be transferred to wholly-owned subsidiary companies, known as SubCos. SubCos often give employees inferior terms and conditions and pensions. According to the Health Service Journal, Sir Jim Mackey has given assurances regarding current and future SubCo staff being given NHS pay and terms and conditions.
However, Unison has long fought against SubCos and is warning that they would lead to a two-tier workforce.
The continued and increased use of SubCos will damage staff morale and undermine the public service ethos of the NHS that has served us so well for decades.
As things currently stand, we know that there is a great deal of effort being put into cutting jobs and reorganising structures. What we do not know is where all of this is heading.
If the government intends on carrying out a major reorganisation of the NHS, they do need to set out their plans for scrutiny and debate.
At a time when waiting lists are in the region of 7 million, patients are waiting in discomfort, pain and anxiety for treatment, and many NHS England and NHS staff are wondering if they will still have a job this time next year, we really do need to know what is happening.
- Margaret Greenwood was the Labour MP for Wirral West from 2010 to 2024. She can be found on x/twitter.
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There is no actual need for wholly-owned subsidiary companies. It may be useful to have semi-separate ‘departments’, but cooperation to reduce duplication would not be served by creating ‘SubCo’ s.
However, their existence DOES create a potential for substandard T&Cs, and would make privatisation easier.
Therefore they should be opposed by Unions and potential patients. (ie all of us except the very very rich 0.1 %