How trusts are being forced to make cuts

News of plans to save money by cutting staff in NHS trusts and foundation trusts began to emerge in the spring, but has continued through November. From a Lowdown survey, we have identified examples of Trusts where the financial squeeze is tightening, and the effect on services is becoming clear.

Among the varied examples, University Hospital Southampton is aiming for “workforce reductions of 785 WTE … over 2025/26 and £110m of savings.”(p68). Just along the coast Portsmouth Hospital University Trust, grouped with Isle of Wight Trust were seeking to cut 798 jobs (7% of the combined workforce) which they hope will save £39m across the financial year, against a total combined savings target of £82m.

The November Board papers from Hampshire and Isle of Wight Integrated Care Board (ICB), which covers all three trusts, plus the local mental health trust and Hampshire Hospitals, note that not all the job cuts had yet been achieved: but also note the potential impact on quality of care:

“The key quality challenges this month fall into the following categories:

• Workforce: staffing gaps across all care sectors (including social, primary, secondary, mental health, autism, and learning disability) are affecting access, waiting times, supervision, training, and overall experience for both service users and staff.
• Demand and capacity: challenges across all pathways in relation to demand, capacity (including access to equipment) and access are leading to delays, increased waiting times, patient harm, and poor experiences, with responses which may impact the wider system.” (p81)

Similar problems are arising in Torbay and South Devon, where the Trust is seeking to cut 107 jobs, along with cutbacks in elective work and the controversial closure of a virtual ward for heart patients as part of a £41.5m savings target. The Trust has had to:

“reduce the amount of additional ad-hoc activity being provided through the elective recovery fund to support the Trust financial position. Activity has been reduced in ENT, OMFS, Colorectal surgery, Upper GI, Gynaecology and Urology will cease in October.”

The cutbacks have saved only £438k, but “there has been a clear impact on the performance in some of these specialities, particularly wait for first appointment in ENT and colorectal surgery.” (p159).

University Hospitals North Midlands, aiming to cut 567 whole time equivalent staff from October, in addition to a reduction of 162 bank and agency staff, as part of its effort to deliver cost improvement savings of £75m, is cutting its overall workforce by 4%, but its nursing workforce by 7%.

Here again the impact is a reduction of capacity, as the Trust’s Director of Strategy, Ms Ashley told the May Board meeting. As the minutes show, she

“stated that the plan aimed to reduce inpatient capacity, and through turnover the Trust was aiming to reduce the amount of inpatient capacity as this would not require the same level of workforce. She stated that if the improvement did not take place, then headcount could not reduce.” (page 14)

In the North East, Gateshead Health Trust – which according to NHS England figures is expecting to end the year £12m in the red – defied a substantial campaign against closure Ward 23, a 24-bed specialist ward for older people with physical health problems and dementia. It closed on October 1. The cutback is part of the Trust’s efforts to deliver savings of £32.8m in 2025/26.

The Trust argued that there had been no public consultation process because the Trust believed there to be “no substantial variation in how services are accessed by patients”. However as campaigners explained, the ward has been closed, the treatment has apparently been handed over to Community health staff: and, with Ward 23 closed, if in-patient treatment is required, then the patient can now only go to a generic in-patient ward – not one that specialises in dementia / physical health presentations.

In North Bristol NHS Trust it seems that all of the jobs to be cut are nursing staff: the November Board papers show pay costs remain higher than plan “mainly due to the cost of nursing staffing levels exceeding planned values.” Levels of substantive and temporary staffing have been “beyond the Trust’s funded establishment by an average of 211WTE since April, and nursing staffing levels exceed the funded establishment by 188WTE in September.” To tackle this: “Additional workforce controls have been put in place with effect from 1st August and the expected reduction in staff in post back to establishment remains the focus of the Clinical Divisions.” (p119)

Nottingham University Hospitals is sounding the alarm on its finances, warning that its attempt to generate savings totalling £97m could misfire by anything from £19.7m to a worst case of £86.7m off plan – even after £22.4m of deficit support funding.(p163) Its Chief Operating Officer lists the greatest challenge as “Balancing achieving the financial challenges whilst mitigating the impact on the delivery of activity plans and key performance targets.”

The Trust’s November Board papers refer repeatedly to “premium pay” as a problem to be confronted, describing it as “a barrier to transformation,” (p298): premium pay includes higher rates of night shift, weekend and bank holiday pay for thousands of staff. For staff who regularly work unsocial hours, removing the premium could mean a cut of up to 30% in take-home pay.

Premium pay also seems to be a concern of the Mid and South Essex Foundation Trust, which is aiming to make savings equivalent to 7% of trust turnover, but expecting to end the year £85m in deficit, despite having apparently achieved a reduction of 724 WTE jobs compared to the same period reporting in August 2024 (p35). The Board papers give no breakdown as to where the jobs have been cut, or how many more may still be needed to reach the target of reducing the workforce to 15,980 by March.

Royal Free London FT, still reeling from a merger with the North Middlesex Hospital, is also seeking very substantial £121.5m target for ‘efficiency savings’ for 2025-26 (p10), with a target to cut 607 jobs (3%) by March (p50). By August only 19 jobs had been cut, and the further reduction of 585 is seen as “a significant risk to the financial plan’s delivery.”

What may be more surprising is that the plans to cut spending on staff runs alongside plans to hold down numbers and even close front line beds, reducing capacity to admit elective and non-elective patients. The Trust’s Director of Operations sums up:

“RFH bed reduction plan will reduce headcount and deliver financial savings that do not include additional temporary bed capacity to mitigate extreme activity pressures putting achievement of the financial plan at risk.”

This same objective is summed up again as:

“Focus on improved productivity and efficiency thereby enabling RFL to reduce the size of its workforce. Significant emphasis on agency and bank reduction, alongside opportunities to reduce RFL’s substantive footprint, via initiatives such as:

▪ voluntary redundancy schemes in targeted areas. […]

▪ bed closures.

▪ enhanced workforce controls across the enlarged Group. (p560-561)

In East Kent University Hospitals, where the pressure on beds led to the scandal of emergency patients overflowing from corridors into a Costa Coffee area, significant cuts in staffing, to save £43m, is a crucial part of the trust’s savings target of £80m.  But there seems to be little hope of restricting the cuts to non-clinical staff, and saving money this way is complicated:

“Whilst progress was being made on agency costs, bank costs were significantly above plan. Lower staff turnover also reduced potential savings in substantive staffing. The Committee noted the concerns around the workforce programme, and discussed options to get back on track. The Trust was limited in offering any further redundancies as the actual redundancy costs would outweigh any salary savings made in the financial year. Further restrictions on recruitment would be looked at, but this might lead to ongoing use of higher cost bank and agency staff. Patient safety remained the key priority and services needed to remain safely staffed, especially approaching winter.” (p381)

Cambridge University Hospitals claimed back in March that the 500 jobs it was seeking to axe over the 2025/26 financial year (4% of the workforce) were exclusively from “support functions” (with the cuts dismissed by NHS England as “cutting bureaucracy”). The Trust needs to make a minimum £91 million in ‘efficiencies and productivity’ by April 2026.

However figures produced for the Trust’s September board meeting show a reduction of just 52 corporate posts since April, compared to 96 clinical jobs, suggesting that more clinicians than bureaucrats have been axed. (p85) Different figures on the next page show a reduction of 281 substantive staff by July – from the Electronic Staff Record, Healthroster and Medical Staffing, again suggesting largely clinical posts. A comment also suggests the job losses have not gone as planned:

“the decrease of 281 WTE from March to July 2025 (2.2% decrease), is greater than the 0.1% planned decrease for the same period.” (p86)

However one knock-on impact from the Trust’s attempts to balance the budget has been an £800,000 cut in its funding for Arthur Rank Hospice, forcing the closure of 9 of its 21 beds, and cutting the numbers of patients who could opt for palliative care there instead of at Addenbrooke’s Hospital in Cambridge by 200 per year. Arthur Rank costs £14m a year to run, of which £8.1m comes from the NHS and the remainder from donations, legacies and fundraising. It delivers palliative care to more than 3,800 patients a year from two hospices and from patients’ own homes.

Across England’s NHS there are examples of the extent to which local services are hugely over-stretched, with shortages of staff and the desperate quest to cut costs forcing temporary (or more lasting) closures of smaller hospitals and clinics, whether they be for cancer care in West Cumbria, Accident and Emergency services in Merseyside, urgent treatment centres in County Durham, Devon or south west London, a cottage hospital in Kent.

The problems don’t just affect acute hospitals: Nottinghamshire Healthcare NHS Foundation Trust which delivers mental health services is battling to tackle a £17m deficit at month 7, which is driven by “a combination of increasing bank staffing costs, private sector bed usage and under-delivery of efficiency.” Plans to address this problem include capping the number of independent sector beds to 25; reviewing processes for accepting admissions to in-patient beds and facilitating discharges; and an “Independent consultant review”. (p52)

If you, dear reader, have any additional examples of the ways these cuts in staffing and spending are impacting on services, please share them (and any evidence in local press or NHS documents).

But from this round-up two things at least are clear:

• nowhere in the country does the information available properly match the initial announcements of job losses, nor has any trust published a clear statement of which jobs are to go, what work they have been doing, why that it no longer needed, or how much will be saved.
• Even where a trust workforce has been reduced in size, it’s not clear what proportion of the staff who have left have been clinicians, or support staff who work closely with clinicians. The claim that this is simply ‘cutting bureaucracy’ has not been proven.

As the harsh reality of winter pressures makes itself felt once more, the question is whether NHS management have been diverted into chasing their own tails and impossible savings targets rather than focusing on the needs of patients. The headlines that scream out with horrors of corridor care, staff shortages and days-long waits for emergency treatment will be louder and sharper than any rebuke over missed targets for cash savings.

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