How will staffing numbers be affected by abolishing NHS England?

Last week, the government announced that NHS England would be abolished, in a move meant to reduce layers of bureaucracy and duplication, reportedly resulting in around 9,000 job cuts. In addition, integrated care boards (ICBs), which bring together provider organisations locally, have been asked to cut their workforce by 50%, equating to a further 12,500 jobs. But where would such cuts leave levels of central and support staffing capacity compared to historic levels?

Following the 2013 NHS reforms, there was a significant increase in staff across the bodies under scrutiny, which accelerated during the Covid-19 pandemic, despite some reductions in the last couple of years. Across the Department of Health and Social Care, NHS England and ICBs, a reduction by 50% from current levels would leave the workforce at around 20,150. While this could be considered as in a similar ballpark to 2013 given the size of the fluctuations in the last decade, it would still be 11% below that level and there were fairly high vacancy levels shortly after the Lansley reforms.

Specifically, in the 11 years to September 2024, the number of full-time equivalent (FTE) staff:

• in NHS England, and the organisations that have been subsumed within it in recent years, increased by almost half (up 49%; 4,760 additional FTEs), with a slightly larger increase in the Department (57%; 1,257).
• across local commissioners (formerly clinical commissioning groups and currently ICBs) more than doubled (110%; 11,725), although the responsibilities have changed over time.

The workforce data underpinning this chart also reveals some other cost pressures on this pay bill, as well as number of staff. In particular, there appears to have been a rapid increase in the number of staff on higher pay grades with, for example, NHS England tripling the number of staff at Band 9 on Agenda for Change (which typically carried an average annual earnings of around £103,500 in 2022/23), while the proportion of non-medical staff at Band 8c (typically £70,200) or above rose from 17% to 26% between 2013 and 2024.

As the dust settles, attention will turn to the process for, and implementation of, the redundancies, and there are lessons to be learnt. In the 2013 reforms, some 10,000 staff were made redundant over a three-year period with an average payout of around £43,000. Of those staff made redundant, thousands (including 2,200 of those made redundant between May 2010 and September 2012) were re-employed in the NHS, but redundancy payments could not be reclaimed if the individual concerned rejoined the NHS more than four weeks after leaving. Even though the redundancy costs are not expected to come from the NHS budget but rather HM Treasury, this perhaps evokes an even older adage – measure twice and cut once – given the consequences for the individuals involved and taxpayer.