Unions and public left in the dark about ICBs cutbacks

In August the Unite branch at East London Foundation Trust (ELFT) heard that Mark Dunne, one of their leading reps, who had been included in a list of posts to be made redundant, had been effectively victimised as his job was axed, despite vigorous protests in his support.

The Branch also responded to the Trust’s tokenistic ‘consultation’ on the planned closure of Fothergill Ward, which is part of the package of cuts in jobs, services and staffing levels that the Trust proposed as a way to balance the books – while ELFT on cash reserves of £151 million. Unite has understandably challenged the cuts and the claimed justification for them.

ELFT is one of the two largest mental health trusts in London. It provides a wide range of community and inpatient services to children, young people, adults of working age, older adults and forensic services to the City of London, the London Boroughs of Hackney, Newham, Tower Hamlets, … and to Bedfordshire and Luton.

Fothergill Ward, in East Ham, has (since the closure of six end of life beds in October 2025) provided 20 Community beds. They have been a way to ease the overcrowding in the giant Barts Health NHS Trust.

The unions highlight victimisation, damaging cuts, and the charade of a consultation that reveals only a fraction of the details of the proposed cutbacks — all part of a damaging culture at ELFT.

Unite’s response spells this out. It begins:

“The Staffside unions did not approve this consultation. We understand that the closure of Fothergill ward is part of a much larger cuts package involving the deletion of over 330 posts.  […]

“We cannot make a meaningful assessment of this consultation without seeing what the Trust executive team have planned for other parts of the system. Our concern is that the ward closure is being made based on assumptions about capacity in other teams, which have already been earmarked for cuts.”

It goes on to note that the consultation paper acknowledges that 86% of (local acute) bed days were occupied by patients who were clinically ready for discharge, and that 75% of delays were associated with access to care packages, social care provision and placement availability. It argues

“These findings indicate substantial pressure within local health and social care systems. Removing a 20-bed facility without demonstrable resolution of those underlying issues risks simply shifting pressures elsewhere.”

Unite points out that the consultation lacked basic information to allow an informed decision. It also came long after the decision to replace the ward’s in-patient care with a “Home First” policy had been taken. Trust Board papers (p90) reveal the Fothergill closure was already seen as a fait accompli by the end of June.

Essential details omitted from the ELFT consultation document were: bed Occupancy levels; Delayed discharge days avoided; Readmission rates; Emergency re-attendance rates; Patient outcomes after discharge; and Comparative performance measures. Nor has there been any public consultation on this significant change in services.

The Fothergill closure alone puts approximately 43 Whole Time Equivalent staff at risk, including nurses; health care assistants; therapists, administrative staff, housekeeping staff, ward management and GP cover. Unite expresses extreme concern that all these substantive posts “are proposed to disappear,” and that:

“There is a particular concern about the international nurses who face redundancy. There is no mention of these nurses on the Equalities Impact Assessment, but these nurses face not just redundancy but potential deportation due to their insecure immigration status.”

The consultation paper identifies anticipated savings of approximately £1.811 million. Unitewarns that in the branch’s view:

“financial considerations are driving service redesign more significantly than clinical evidence.”

This ward closure may not even be the biggest cutback in the ELFT cuts package: we can’t yet tell because there has been no clear statement of where most of the 330 job losses are to fall. It’s certainly not the biggest cutback in England’s NHS.

But we have paid it attention because it is the kind of cutback that sums up the furtive, secretive way in which more and more trusts and Integrated Care Boards are seeking to sneak through cuts with minimal public information.

The secrecy prevents unions from fighting in defence of their members (and pointing out flaws in management plans). The wider public, too, are effectively denied the right to protest and lobby against changes that impact on their community.

Staff and the public alike are left in the dark until they come across a service already closed or closing. And even that kind of discovery too often depends upon national or local news media picking up the story and running it, while too many news outlets now ignore such hard news, and prefer to fill their space and time with trivial clickbait material.

Take a recent example: on September 9 the British Medical Journal (BMJ), to which relatively few members of the public or unions subscribe, published a story that relied entirely on answers drawn out by a series of Freedom of Information Act inquiries – even though the issue affects millions of people over much of the country. The headline was ‘NHS rationing revealed: Half of ICBs deliberately delaying patient care with “minimum waits”.’

The article, by Sophie Borland, is available on free access: based on replies from 35 of England’s 36 ICBs, and noting that two replies are unclear in meaning, it warns that:

“A total of 17 of the 36 integrated care boards (ICBs) have introduced minimum waits of between 12 and 16 weeks for procedures including hip, knee, and cataract surgery, freedom of information requests show.”

The BMJ’s story was also released as a syndicated report from the PA Media (Press Association) wire, featured in the Daily Mail, in local and health media, and the next day was featured in the Independent.

If the FoI request had not been made, the news would have remained undiscovered – but the delays would still be affecting millions, with no chance of any challenge to the policy. The BMJ article notes that Health Minister Karin Smyth agreed last October that ICBs could delay treatment of waiting list patients to help cut costs, a policy which the BMA denounced as “absurd”.

Just 16 of the 36 ICBs states that they had not imposed minimum waiting times, two gave vague replies, and one (Cheshire and Merseyside) failed to respond to the FoI request.

For folks with long memories, the BBC last December ran a similar, but much less wide-ranging story – focused mainly on the complaints of private sector providers that their contracts to treat NHS patients had been reduced. However neither ITV News nor the BBC ran the most recent story.

So even after investigative journalism has revealed a major issue affecting over 7 million patients on waiting lists and their families, and as statistics show waiting lists and long delays are rising again, only a small section of the news media has shared the story. As a result only a small section of the public will be aware of this impact of the spending cuts imposed on local NHS services in 2026/27.

The delays further increase inequalities in health. Royal College of Surgeons of England’s president Tim Lane, responding to the new information on minimum waits said:

“We are concerned by the scale of this and, particularly, by the variation in approaches between ICBs. Patients should be able to expect that access to treatment is determined by their clinical need, not by where they live.”

He added:

“Minimum waits are not a substitute for addressing the NHS’s underlying capacity problems.”

Moreover Mr Lane warned that the consequences of minimum waiting times could be further increases in even longer delays in treatment over much of the country:

“A minimum wait of 16 weeks, for example, leaves just two weeks within the NHS’s 18 week referral-to-treatment standard for treatment to take place, leaving very little margin for any further delay and potentially increasing the risk of patients waiting beyond 18 weeks.”

A more local story – on the financial plight of Kent’s Medway Maritime Hospital foundation trust – that was first flagged up by Alison Moore in the Health Service Journal over a week ago has yet to surface in the local news media or wider national news. The HSJ is widely read by NHS management, but with a hefty paywall, is not widely read by the general public, or by most trade union activists.

The trust ended 2025/26 with a staggering £190m deficit – even after £69m ‘deficit support funding’ from NHS England.

As Roy Lilley points out that means “… in effect… the money runs out on the 22nd of every month, but… the patients don’t.”

Medway FT now faces a 26% cut in its budget and a near 15% cut in its workforce by 2029 in a draft five-year ICB plan to shift spend away from the acute sector. As Roy Lilley argues:

“Let’s be clear. This is not an efficiency programme. It’s a different hospital.

“… you cannot remove one person in seven and pretend no one will notice.

“There’ll be fewer people to answer phones, clean wards, take blood, read scans, run theatres, dispense medicines, prepare patients for discharge and provide bedside care.”

The ICB’s draft Medium Term Financial Plan is even more far-reaching. Beginning with an underlying system-wide recurrent deficit of £334m excluding deficit support funding, it proposes to seek close to £1 billion in “efficiency savings”:

“system-wide recurrent balance by 2030/31 through a common methodology, left-shift of care and c.£898m efficiencies.” (p183 ff)

However even as the Medway trust board reveal the scale of the ICB cuts to come, they once again fail to give any concrete details on what their own medium term or immediate “efficiency” savings might entail in terms of actual services, actual staffing cuts, etc, making the plans difficult to challenge or to fight against.

All this underlines the need to fight in every area for trusts and ICBs to stop taking key decisions in private session, and to publish full, timely information in Board papers on all of the steps they are proposing to take to cut spending – whether these be:

• cuts in jobs and staffing levels (or outsourcing of NHS jobs to private contractors);
• dilution of skill mix – putting quality of care at risk;
• closures of services;
• ‘centralisation’ of services with consequent local closures;
• reducing access or increasing delays in accessing services;
• and reducing or ending NHS coverage of health care (such as ear wax removal and podiatry) leaving patients a ‘choice’ of going private or going without.

The Lowdown continues to appeal for information on the cuts and their consequences across England. Wherever local trade union reps or campaigners have been able to identify cutbacks threatened or in progress, we want to see the evidence and help publicise the details to warn what is happening.

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