The public announcement of at least 430 jobs to be axed and some wards closed in Nottingham University Hospitals Trust was bad enough news for the 2.5 million patients in its huge east midlands catchment area – but it could be worse. NUH chief executive Anthony May has told local Keep Our NHS Public campaigners the eventual figure could be as high as 750 jobs at risk from its 19,000 workforce.
The Trust’s Board Papers from its 12 June meeting claim 208 of these reductions will be non-clinical staff, achieved through the Mutually Agreed Resignation Scheme (MARS), as part of the Trust’s corporate admin transformation.
However, that leaves more than 200 jobs that the Trust is hoping can be lost without compulsory redundancies, through the Trust’s 10% annual turnover of staff. But this is a haphazard way of reducing the workforce, and it’s by no means guaranteed that clinical staff displaced by the cuts will be able to find appropriate vacancies opening up.
Services are being put at risk because – after delivering record-breaking £91m savings last year – NUH is battling to make savings of £98m in 2025/26 (5.8% of its £1.7 billion budget). Even after making these savings the Trust still needs a top-up with a payment from NHS England (“revenue deficit support”) of £36.1m to break even.
Worse still the Nottingham and Nottinghamshire Integrated Care System, which includes the Trust, also has a hefty savings target of £279 million, 7% of its £4 billion budget, and it is starting to look more than likely that some of this will result in cutbacks on provision or quality of patient care.
None of that can be deduced from the NUH Board papers of course, which give a bland list of areas in which they apparently have plans: (“A transformed outpatient experience; Making the best use of our beds; Optimised diagnostics; Optimised administration services; Optimised use of theatres … etc.) but no details of how any money will be saved in any of these.
Even the “Financial Transformation Delivery Plan” for 25/26 ducks out of giving any real detail, with pages that appear to give a breakdown without making clear the consequences of savings. Under “people” for example the total target is £2.24 million, with £1.35m to come from “enhanced vacancy controls” and £0.47m to come from “Bank volume reduction” – but no translation of what these might mean in numbers of staff.
Under UEC (Urgent and Emergency Care) the only item listed is “Reconfigure our bed base – data drive review of our bed base to deliver a reduction [in] our bed capacity” (£1.1m). It does not say how many beds would close – but it won’t be many if the annual saving is so small.
Under Diagnostics “CT productivity” is estimated at just £80,000 – but not explained: nor is “MRI productivity” (£0.46m).
The smallest item on the list is “Reducing drug wastage at ward level” – just £0.02m (£20,000) for a whole year.
In line with Wes Streeting’s manic enthusiasm for AI, “Innovation and Emerging Technologies” aims for savings from “AI Innovation – develop and deploy AI solutions across the Trust” – but the projected saving is a minimal £430,000 for the year.
Under Estates Optimisation, with a target saving of £520,000, the Trust includes “Works and Maintenance – manage consolidation of maintenance,” but adds: “look to bring more in-house.”
All of these apparent details seem to add up to £98.2m – but without giving any real indication of what the changes would mean in practice either for patients or for staff.
Compared with many other trusts NUH is a paragon of transparency: but the information has been published in such a way as to leave health unions and campaigners unable to single out key issues and challenge specifics.
After 15 years of austerity-driven squeezes on budgets the scope for further substantial savings without damaging the quality and accessibility of services is increasingly limited. The reductions now taking place in the workforce of trusts like NUH seem likely to increase the pressure on the clinical and support staff who remain behind and face the struggle to maintain safe, high quality services.
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