6,000-plus jobs to be cut at ‘new NHS England’

Thousands of jobs – amounting to around 30-40 per cent of posts across NHS England, Health Education England and NHS Digital – will be cut over the next year as the organisations are merged, it was announced today.

Plans for the merger of all three arm’s-length bodies into NHSE were due to be set out to the NHSE board publicly today, and staff informed.

They say the estimated impact is a total reduction of between 30 and 40 per cent of whole time equivalent posts across NHSE, HEE, NHSD and some roles which have transferred from Public Health England. Based on 20,000 current roles, this will mean a reduction of 6,000-8,000 posts.

The restructure and post reductions will take place by April 2024, although NHSE, HEE and NHSD are due to merge legally in April next year.

The note from NHSE chief Amanda Pritchard to staff says that, as well as combining “all NHS data, digital services and workforce functions”, “we will bring together our corporate services and integrate currently separate NHS England and Health Education England regional teams”.

The organisations “will review all our national programmes to ensure effective, streamlined delivery of key priorities and consider new ways of enabling sustainable improvement”. They will also “review which functions we can delegate to [integrated care systems] and from national to regional teams” to “build on the delegation of direct commissioning functions [of primary care and specialised services], transferring roles to the wider system and explore what other functions would best be delegated or transferred locally”.

A top-level structure has been decided and separate directorates will now design their structures. One well-placed source said this was due to happen by September, with recruitment into the new roles beginning after that, but NHSE indicated different parts of the restructure would happen to different timetables.

Ms Pritchard told staff the organisations are “restricting external recruitment, with immediate effect” and “will explore how all three organisations can offer voluntary redundancy schemes from this autumn”. NHSE has not specified whether any compulsory redundancies are expected or planned. 

Ms Pritchard, who is also writing to ICS leaders about the changes today, said: “Based on our initial work, we expect that, by the end of 2023-24, the new single organisation will be at least 30 per cent, and up to 40 per cent, smaller than the current combined size of NHS England, Health Education England and NHS Digital. We will take account of any vacancies we have.”

In her note to staff, she said they had “told me that you are often frustrated by the complexity and bureaucracy that characterise some parts and activities of our organisation, concerns consistently raised by our colleagues delivering frontline care. Creating the new NHS England will mean a smaller, combined organisation. This means we can build a high performing organisation that addresses these frustrations and focuses on where we do, uniquely, add value”.

She said: “We are creating a new NHS England as we emerge from a pandemic which required us to rapidly, but temporarily, expand the size of our organisations.

“And we have also created new integrated care systems who need the space to lead at local level, working alongside our seven regions. This move to system working is important and, to maximise its potential, we must adapt to ensure we lead the NHS as effectively as possible to deliver its core purpose of high-quality services for all.

“The new NHS England will still have a vital role, but it will be more focused on enabling and supporting change through an organisation that can speak with a single national voice, remove duplicative activities, and model this effective joint working.”

She continued: “We need to reduce the size of our organisation, so that we are focused on enabling and supporting change and empowering systems to lead locally. This means being rigorous about the activity our new organisation undertakes. We need to simplify how we work across the new organisation and how we work with the wider NHS.

“As the NHS maintains its recovery from the pandemic, and the economic position across the country is tighter, we also need to continue to ensure our resources are used as effectively and efficiently as possible.”

The move follows increasing scrutiny of the size of the centre of the NHS and the Department of Health and Social Care, as well as other parts of government. 

In May, the Telegraph reported on what it called an “‘astonishing’ explosion in central bureaucracy”, based on a report by the Policy Exchange think tank, which found the “number of officials working in the Department of Health and NHSE has more than doubled in two years, with even sharper rises seen at the most senior levels”.

HSJ reported in October on the huge increase in staff numbers during the pandemic at DHSC and NHSE up to July 2021. DHSC had more than doubled its total payroll staff, while NHSE and NHS Improvement had increased by 27 per cent. Local senior managers were up by 7.8 per cent.

New figures to April this year (see chart below) show that NHSE/I has continued to grow since that point, while DHSC has stabilised — but the UK Health Security Agency, which took over from PHE last year and is part of the department, appears to have a much larger payroll staff than its predecessor.

 

Full note to staff

I promised I would update you at each stage of the process as we bring NHS England, Health Education England and NHS Digital together. This is a significant moment to further support our move to system working across the NHS and the change will affect us all.

As you know, the three organisations will formally merge on 1 April 2023 but we are committed to working ever closer together in the meantime.

We are creating a new NHS England as we emerge from a pandemic which required us to rapidly, but temporarily, expand the size of our organisations. And we have also created new integrated care systems who need the space to lead at local level, working alongside our seven regions. This move to system working is important and, to maximise its potential, we must adapt to ensure we lead the NHS as effectively as possible to deliver its core purpose of high-quality services for all.

We have a unique opportunity to reshape our new organisation because of the decision announced by the previous Secretary of State for Health and Social Care to merge NHS Digital, NHS X and Health Education England into NHS England. This means we can put workforce, data, digital and technology at the heart of our plans to transform the NHS. Our people will be central to realising this opportunity.

The case for change

We have been working over recent months to understand how we can build on the strengths of each of our organisations as part of the merger, but also to identify how we do things more efficiently, avoid duplication, reduce bureaucracy, and streamline our ways of working.

The distinct skills in each of our current teams in Health Education England, NHS Digital, NHS England and colleagues formerly from NHS X will allow us to build empowered, capable, multidisciplinary teams for the future. The new NHS England will be a simpler and more integrated organisation providing improved leadership and support to the NHS. This includes delivery of our workforce aspirations; more effective, digitally enabled transformation of the NHS; better, more joined-up, decision-making at system, regional and national levels; and a more effective and efficient way of using our collective resources. All while making our new organisation a great place to work, including fully meeting our commitments on our equality, diversity and inclusion.

The move to more partnership working through ICSs, including the establishment of 42 integrated care boards as statutory bodies from 1 July, requires us to do things differently and creating the new NHS England is also an important opportunity to support and accelerate these system changes.

The new NHS England will still have a vital role, but it will be more focused on enabling and supporting change through an organisation that can speak with a single national voice, remove duplicative activities, and model this effective joint working. All with the aim of becoming a more agile organisation that responds flexibly and quickly to changing demand, priorities and, opportunities.

Our future size and shape

All NHS data, digital services and workforce functions will be within the same organisation. To support systems, providers and clinicians alike, we will bring together our corporate services and integrate currently separate NHS England and Health Education England regional teams.

But we need to go further.

We need to reduce the size of our organisation, so that we are focused on enabling and supporting change and empowering systems to lead locally. This means being rigorous about the activity our new organisation undertakes. We need to simplify how we work across the new organisation and how we work with the wider NHS.

As the NHS maintains its recovery from the pandemic, and the economic position across the country is tighter, we also need to continue to ensure our resources are used as effectively and efficiently as possible.

So, we will review all our national programmes to ensure effective, streamlined delivery of key priorities and consider new ways of enabling sustainable improvement. We will review which functions we can delegate to ICSs and from national to regional teams. Where we can, we will build on the delegation of direct commissioning functions, transferring roles to the wider system and explore what other functions would best be delegated or transferred locally.

Based on our initial work, we expect that, by the end of 2023-24, the new single organisation will be at least 30 per cent, and up to 40 per cent, smaller than the current combined size of NHS England, Health Education England and NHS Digital. We will take account of any vacancies we have.

Our purpose statement and next steps

Our purpose must guide the detailed design work which we now need to undertake.

The NHS England Board, working with colleagues at Health Education England and NHS Digital, has set out the top-level purpose for the new organisation: to lead the NHS in England to deliver high-quality services for all.

We will achieve this purpose by:

• enabling local systems and providers to improve the health of their people and patients and reduce health inequalities
• making the NHS a great place to work, where our people can make a difference and achieve their potential
• working collaboratively to ensure our healthcare workforce has the right knowledge, skills, values and behaviours to deliver accessible, compassionate care
• optimising the use of digital technology, research, and innovation
• delivering value for money.

Our design programme, informed by this purpose, will be guided at directorate level.

Given the design work we will now take forward, we are restricting external recruitment, with immediate effect, for all existing roles that become vacant or where there is a request to create a new role. We know there will be exceptions, for example to ensure effective running of live digital services for which the new organisation will be responsible. But recruitment will be very tightly controlled, and we will only recruit individuals from outside the organisation if there is an exceptional reason.

We will explore how all three organisations can offer voluntary redundancy schemes from this autumn, using common criteria.

We will manage this important organisational change process in close partnership with our staff trade unions including how we consult with you and manage any selection processes and redeployment or redundancy exercises.

I understand you will have questions following today’s announcement.

I will be hosting a webinar with Dr Navina Evans and Simon Bolton, my CEO colleagues at Health Education England and NHS Digital at 4.30pm today for all colleagues across our three organisations. Leaders will also be hosting webinars for their teams across NHS Digital, Health Education England and NHS England to give you a chance to share your views and ask any questions. They will circulate details of these webinars to you later today.

You, your role and how we support you

I recognise this is a difficult message, and we will run this process demonstrating compassionate leadership in all we do. We will demonstrate learning from previous reorganisations in the way we design our new organisation.

I also know this process will create uncertainty. It is important to me that managers across our organisation show empathy and recognise that the change will land differently for everyone. We all need to look out for, and support, our colleagues.

We are now entering into a critical design phase for the programme, but I’m sure you will appreciate, it’s too early to tell you, at this point, precisely what these changes will mean for you and your role.

I commit to:

• involve each directorate in playing a central role in design using organisation wide principles, ensuring dedicated capacity to do that as well as opportunities for engagement across every directorate and region
• put equality, diversity and inclusion at the centre of the design of the new organisation, striving to be a great place to work for all of us
• protect time for union representatives and freedom to speak up guardians to support colleagues affected by any changes
• ensure support packages for health and wellbeing support and employee assistance, for everyone who needs it
• enhance our organisation development support to help teams manage these changes and, longer term, develop to meet their new future role
• put in place specific support and plans for staff who may transfer to systems or our regional teams.

The opportunities of creating a new NHS England

Talking to many of you over the last year I know that, like me, you value the unique prospect of working together at NHS England, leading our country’s most valued and treasured public service, will provide.

But you’ve also told me that you are often frustrated by the complexity and bureaucracy that characterise some parts and activities of our organisation, concerns consistently raised by our colleagues delivering frontline care. Creating the new NHS England will mean a smaller, combined organisation. This means we can build a high performing organisation that addresses these frustrations and focuses on where we do, uniquely, add value.

As the General Sir Gordon Messenger’s independent review highlighted, high-performing organisations rely on their inclusiveness, compassion, and ability to develop staff, offering them rich and fulfilling career and development opportunities. I am committed to ensuring that is built into the future ways of working in our new organisation.

Your feedback

If you have any feedback on what I’ve shared with you in this email, please email england.newnhsengland@nhs.net. Whatever your view it is important and will be valued. We will use your input to inform our future activities and how we communicate next steps.

With best wishes

Amanda