Lowdown investigators have continued their quest to establish how cash savings are being sought, and the implications for services across England’s NHS, and one conclusion is clear: few at Integrated Care Board or Trust Board level seem willing to set out clearly what is being cut, where or when – and this seems set to get even worse with the proposed new reforms.
In April, UNISON published a short report (Less fit for the Future) that collated responses from trusts in England to Freedom of Information requests for details of how they plan to tackle financial deficits. It warned that trusts in England “will cut at least 21,600 posts by 2028 as they wrestle with deficits totalling more than £1.1bn last year,” and noted:
“The cuts include not just redundancies, but many funded posts to be removed through vacancy freezes, voluntary exits, restructuring and deleted jobs.
“Thousands of clinical staff, such as nurses and midwives, are likely to go, in addition to administrative roles.”
The staffing cuts run against a background of rising demand for health care, and many emergency services already failing to deliver anywhere near target waiting times. But the use of voluntary redundancy schemes also reveals that few trusts have clear workforce plans, since staff are likely to be most eager to leave departments under the greatest pressure.
There are also regional variations in the numbers and proportions of jobs to be cut. UNISON warns:
“The largest reductions are planned in the South East, where trusts report around 5,152 full-time equivalent post reductions. This is followed by London with around 4,232 roles due to be axed and the North West with around 3,701 posts. These regions contain some of the largest NHS organisations in England, but the scale of the reductions also reflects the level of financial pressure they are under.”
While job cuts spread over two years to 2028 may seem to be less than immediate, at the end of May, press reports highlighted a significant number of job cuts are already being planned as a cost-saving measure.
In Peterborough, the North West Anglia Foundation trust revealed it was running a 3-week MARS (Mutually Agreed Redundancy Scheme), aiming to cut up to 350 jobs to save £10m. The only detail given on which posts are to disappear as a result was that doctors and dentists were excluded, leaving the possibility that other clinical as well as non-clinical staff may be among those to take redundancy and leave.
Chief executive Hannah Coffey gave the usual, routine, bland statement, admitting only that the trust would need to ‘reshape’ how it worked and its workforce structure to “continue to provide safe, high-quality care in a way that is both affordable and sustainable for the future.”
In mid-May, Nottingham University Hospitals Trust (which tried to cut 430 jobs last summer but failed to hit the target) confirmed it would be seeking to cut more jobs than originally planned from its 19,000 workforce as it battles to cut £106m from spending in 2026/27. The Trust has refused to answer questions on how many jobs will go in total, or where the cuts will fall.
In the North East, University Hospitals Tees, the group covering North and South Tees NHS Foundation Trusts, announced in early June it is preparing to cut 550 jobs in an effort to save £90m.
Group deputy chief executive Matt Neligan said many of the job cuts would be made by reducing the use of bank or agency staff. But he also diverted from any detail by suggesting “efficiencies” could also be made by reducing the number of patients who miss appointments, reducing unnecessary follow-up appointments, using theatres more efficiently, and reducing staff sickness. It’s not clear how any of these (desirable) measures, even though they would increase efficiency, would actually cut spending.
Chief people officer Rachael Metcalf said it would be ‘unlikely’ the voluntary redundancy scheme would be offered to ward-based nurses, midwives, healthcare assistants and doctors in training. But of course, these are the staff who will face added pressures if they can no longer call in bank staff to fill vacancies and maintain safe staffing levels.
Elsewhere around the country, there are indications that cash-driven cuts (and in fact any cutbacks that the local public fear may threaten to reduce local access to services) will be challenged.
Public challenges:
North Yorkshire
In rural North Yorkshire, there has been strong local resistance by the community and politicians to the threatened closure of the Reeth Medical Centre (which has been triggered not by spending cuts, but by the retirement of an ageing GP). There have been big public meetings and warnings by local councillors that “Shutting the medical centre will have a major impact on the availability and quality of care for the 1,600 patients which it serves across a 200 square mile catchment area in Swaledale and Arkengarthdale.”
The local Care and Independence Overview and Scrutiny Committee agreed to request
“written clarification from the ICB on its approach to primary care resilience planning, including how the delivery of the Hospital Community shift within the NHS 10 Year Plan is intended to avoid unintended disadvantage to rural communities.”
Yorkshire coast
On the Yorkshire coast, an extensive campaign by local residents and politicians has forced a reconsideration of plans to close Bridlington Care Unit, a 28-bed ward at Bridlington Hospital. It was established in 2021 to ease pandemic-related pressures at Scarborough Hospital, and has served as a vital ‘bridge between hospital and home’ for patients from Bridlington, Driffield, Hornsea, and Whitby.
Under sustained public and political pressure, York and Scarborough Teaching Hospitals NHS Foundation Trust, late on Friday, May 29, eventually announced a last-minute pause on the controversial plans to close the unit on Monday, the 1st of June.
Dr Simon Cox from the Humber and North Yorkshire Integrated Care Board went further, noting the additional facilities on the site, denying that closure was on the cards, and hinting that it could have an expanded future role in regional healthcare:
“There are three other wards at Bridlington. There are two operating theatres and an outpatient suite, there is a diagnostic suite. And the information I’ve got is that actually the trust plans to expand those services, not reduce them.”
Sussex
Public pressure is being piled on in other areas too where services are threatened; in sleepy Rustington in seaside West Sussex over 200 people packed out a local hall last month to demand answers on why Zachary Merton Hospital had been permanently closed without any local consultation, and to press the case for local provision of sufficient ‘step down’ community services for frail local residents to avoid longer hospital stays.
Local MP Alison Griffiths, who had led the campaign along with Rustington Parish Council chair Andy Cooper, said: “This campaign has never simply been about nostalgia for a building. It is about practical access to healthcare close to home. In an area like ours with a large older population, local step-down beds and community healthcare services matter enormously for residents and their families.”
Cotswolds
Inland, a petition to halt further cutbacks to health provision in the Cotswolds was launched last December following the temporary closure of the daytime operating theatre in Cirencester Hospital, attracting over 2,500 signatures. Local politicians and community leaders still fear that closure could become permanent and other services could be reduced as the newly combined ICB now covering Gloucestershire with Bristol, North Somerset and South Gloucestershire ICB leaves less voice for rural areas. Last month Cotswold District Council voted unanimously to raise further concerns and its leader, Mike Evemy, has written to NHS leaders in Gloucestershire to seek assurances on the future of rural healthcare and facilities in Cirencester, Moreton-in-Marsh, and Cheltenham.
Kent
In Kent, the long fight still goes on over the reorganisation of stroke services. The County Council’s Health Overview and Scrutiny Committee (HOSC) voted in April to formally request updates from Kent and Medway NHS leaders on its plans for centralising stroke services at William Harvey Hospital in Ashford (due to begin construction on June 1) and subsequently closing the temporary but successful unit at Kent and Canterbury Hospital (which is much closer to the coastal areas of the county).
The information requested includes: updated modelling; an independent assessment of travel‑times; a new Equality Impact Assessment; a side‑by‑side comparison of Canterbury vs Ashford; and an explanation for why the Canterbury unit cannot be retained. The local campaign (Concern for Health in East Kent, CHEK) also insists that no final decision has yet been made on the permanent location of East Kent’s Hyper Acute Stroke Unit (HASU).
A CHEK statement argues that the more central Canterbury Hospital was only excluded as a possible centre because it was assumed that a HASU must be co‑located with a full A&E; however, it is now clear that “national stroke guidance does not require a HASU to have an A&E, and several operate safely without one.” CHEK therefore insists the siting of the new centre at Canterbury should be back on the agenda.
London
But it’s not only the NHS making cuts to save cash: councils too have been desperately seeking ways to cut spending – often with a knock-on effect on health care. In London the only specialist unit offering detox services to homeless people in the capital has been closed after councils cut the funding, with no replacement or plan for alternative services in place.
The Addiction Clinical Care Suite at St Thomas’ Hospital has treated 1,000 patients since it opened in 2021, but on May 14 the Department of Health and Social Care said: “Rising costs meant the London boroughs determined the service was no longer affordable – with a £1 million shortfall and times when beds were underused. They are inviting tenders for a more sustainable service and ministers have requested further advice on future provision.”
North East
Of course not all campaigns against cuts are successful. Last year we reported on the controversial closure by Gateshead Health NHS Trust of Ward 23, a 24-bed specialist ward for older people with physical health problems and dementia. It closed on October 1 as part of the Trust’s efforts to deliver savings of £32.8m.
In April this year health bosses attempted once again to justify the closure – by releasing completely irrelevant performance data which appears to show improvements across their services from March 2024/25 to March 2025/26 – six months before the closure took place!
When information that wide of the mark is rolled out in answer to an issue that appeared to be settled a year ago we can only assume that Keep Our NHS Public North East (who loudly challenged the ward 23 closure) has kept up the pressure … and that there is no actual evidence to prove the campaigners wrong.
Chronic issues:
A&E under pressure
Financial constraints don’t always take the form of cuts: they can be revealed through long term failure to tackle chronic problems or properly resource services to meet known levels of need.
Several A&E departments have been complaining in May of high levels of emergency attendances, while two hospital trusts (Hampshire Hospitals – Basingstoke and Winchester – and Ashford and St Peters in Surrey) have declared ‘critical incidents’ in the normally quiet month of June as numbers of patients needing admission exceeded the number of beds available.
Dr Nick Ward, deputy chief medical officer for Hampshire Hospitals, where the crisis ran into a third day, said:
“Declaring a critical incident in early summer is extremely unusual; however, it reflects the unprecedented attendance at our Emergency Departments as well as a high number of inpatients.”
East Midlands Ambulance Service also declared a critical incident on May 26 as emergency calls in the heat wave exceeded the number of available ambulances.
Deaths due to waits
Meanwhile, new analysis in the Royal College of Emergency Medicine’s (RCEM) ‘State of Emergency Medicine in England’ report conservatively estimates that there were 15,860 excess deaths associated with long waiting times in English EDs in 2025.
That’s the lives of 305 people lost every week. It’s a near-tenfold increase compared to 2015 (when the year’s estimated total was 1,657).
RCEM’s report examines the scale of overcrowding in EDs and the impact this is having on patient safety and staff. Drawing on national data, research and frontline evidence from clinicians, it highlights how long waits, high bed occupancy and a lack of patient flow continue to lead to overcrowded emergency departments. And long waits are closely linked to an increased chance of death within the following 30 days.
Our Lowdown analysis of NHS figures shows that while numbers of Type 1 A&E patients in England have increased just 0.4% since July 2024, and emergency admissions have increased by 4.9%, the numbers of 12-hour plus trolley waits (‘corridor care’) have soared by 30% over the same period. More than a third of patients needing emergency admission waited over 12 hours from the decision to admit in April 2026. And the RCEM calculates that over a whole year, nearly half a million people (489,138) waited 24 hours or more in EDs.
As long as Labour refuses to acknowledge the long-term structural damage done to the NHS by 14 years of austerity under the Tories, and refuses to put in even enough funding to prevent more cuts this year, it’s unlikely any amount of restructuring or ‘reforms’ will paper over the cracks or halt the decline.
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