Thousands of roles in the NHS England are now set to be cut, following an agreement with the HM Treasury that will allow the health service to overspend this year to cover the cost of pay-offs. Earlier in the year the government announced that approximately 18,000 administrative and managerial jobs would be eliminated across NHS England and that NHS England itself would be brought back into the Department of Health and Social Care (DHSC).
The agreement permits the NHS to incur an overspend of about £1 billion, which will be recouped in later years—but no additional cash beyond the spending review settlement has been granted.
Why the cuts and overspend deal?
Health Secretary Wes Streeting said that feedback from patients and NHS staff revealed “too many layers of management, too many layers of bureaucracy”, and that the aim is to prioritise frontline care by cutting back excessive administrative functions.
The plan is to achieve £1 billion a year in savings by the end of the parliamentary term, by redirecting funds from bureaucracy into hip and knee operations, evenings/weekend services, digital modernisation and other patient-facing areas. The government claims that each £1 billion in savings equates to the capacity to fund roughly 116,000 operations.
What the deal involves
•The NHS will not receive additional funding beyond the agreed settlement (an extra £29 billion a year by 2028-29 above inflation) but will be allowed to exceed its budget this year to cover redundancy costs.
•The cuts will primarily affect administrative and managerial posts within NHS England, DHSC and the 42 regional Integrated Care Boards (ICBs), which are also being directed to reduce their headcounts by around 50%.
•NHS England is expected to be merged back into the DHSC within two years.
Reactions and concerns
Daniel Elkeles, chief executive of NHS Providers, welcomed the move as “a pragmatic step” allowing planned redundancies to proceed while helping generate future savings for frontline investment. He urged that staff facing uncertainty should be recognised for their service.
However, Patricia Marquis of the Royal College of Nursing warned that making thousands of experts redundant—particularly nurses and specialists in public-health programmes and social-care links—could backfire and undermine patient care. She argued that reducing “administrator” roles indiscriminately shows a lack of understanding of how these roles support frontline services.
Broader context of NHS reform
These job-cut decisions form part of a broader restructuring of the NHS in England. The creation of NHS England in 2012 under former Health Secretary Andrew Lansley was intended to grant greater autonomy—but has since been criticised, including by his successor Jeremy Hunt, as becoming a “bureaucratic monster” that stifled innovation.
In earlier reporting this year, the government admitted it did not carry out an impact assessment of the planned cuts, prompting concerns that rapid reductions in administrative staff may impair the ability of ICBs and trusts to deliver services. Critics warned that thousands of job losses could destabilise the system when it is already under pressure.
What this means for patients and staff
For patients, the government argues the reforms will free up resources for operations, weekend/evening care and digital services, thereby improving access and modernising the health service.
For staff, especially those in administrative and managerial roles, uncertainty looms. Many face redundancy as the 18,000-post figure comes into effect. While savings are promised for the future, unions and professional bodies warn of potential service-disruption, loss of institutional knowledge and increased pressure on remaining staff. The DHSC said there will be no cuts to investment in frontline or back-office services, despite the savings drive.
Outlook and next steps
The Treasury deal unlocks the path for redundancies to proceed, but the true impact of the changes will unfold over years. The NHS must recoup the overspend, meaning future budgets will be tighter. The overhaul of ICBs, merging of NHS England into DHSC and the ambitious savings targets all signal a major transformation of how health services in England are organised and administered.
The success of this restructuring will depend on whether savings are realised without harming service delivery, how well the workforce adapts, and how patients’ care experiences evolve amid the changes.
