NHS managers in England are carrying an unacceptable burden. Not only the pressures of the day job, but the psychological toll of nearly 18 months of organisational change. This does not feel like just another restructure, the latest in a long line of chops and changes. Unpromised, dragged out and badly planned, this shakeup is leading directly to burnout, depression and long-term ill-health. Worse still, leaders seem to be pricing this into a micro-ideology around the financial reset, in which distressed people resigning to protect themselves is chalked up as some kind of win.
MiP members describe feeling stressed and betrayed. Nine out of ten MiP members in NHS England, for example, say work is harming their wellbeing. Years of uncertainty about jobs and structures have created a climate of fear and instability, with managers expected to make decisions without knowing what the future looks like. Many are left asking: Will my role exist? Do I still matter or am I just disposable? As one member said to me, ”Staying feels scarier than being made redundant.”
Researchers agree that uncertainty is often more stressful than change itself. When people don’t know what’s happening to them, anxiety rises, concentration falls and engagement drops. In the NHS, this is being made worse by a messy reorganisation in which people have to deal with plans made on the hoof, fragmented processes, and shifting timelines and messages. This is what experts call ‘toxic change’.
The impact on people is severe. Our members report change fatigue and a growing sense of helplessness. They are feeling a loss of professional identity, pride in public service and their ability to do a good job. Trust in leaders is falling fast. Those leaders, themselves suffering from burnout, are struggling to support their teams. Occupational health services are stretched and unable to meet rising demand. This is a system under strain, unable to discharge legal duties to safeguard mental health—and it is the people holding it together who are paying the price.
Many managers have been left asking: Will my role exist? Do I still matter or am I just disposable? As one member said to me, “Staying feels scarier than being made redundant.”
The damage does not stop with people. The NHS suffers too. Anxious, disengaged managers cannot deliver transformation. Productivity falls. Sickness absence rises. Institutional knowledge is lost as experienced staff leave. Safety risks abound. An arbitrary financial cut dressed up as genuine reform risks becoming a cycle of instability and decline.
And ultimately, the public pays the price. The NHS depends on committed, skilled managers who feel safe, valued and able to do their jobs well. When those managers are worn down, patient care is affected. A system that makes its own workforce unwell cannot deliver the high-quality care the public deserves.
This harm is not inevitable. It is avoidable — and therefore unacceptable.
So what needs to change?
First, the people at the top must recognise the scale of the problem and treat the psychological impact of reorganisation as a serious system risk. And also take action on the related equality impact.
Second, there must be honesty and clarity. Staff deserve clear timelines, clear structures and clear communication — not vague promises and shifting plans.
Third, consultation must be real. That means engaging trade unions early, sharing actual proposals and giving staff a genuine say in decisions that affect their lives.
Fourth, a trauma-informed approach must be applied. Change must be managed in a way that is open, supportive and respectful — not imposed from above in ways that deepen distress.
Finally, proper support must be in place. This includes access to mental health services, trained managers who can spot early signs of distress and real investment in staff wellbeing.
NHS managers have shown extraordinary commitment, especially in recent years. They deserve stability, respect and care — not endless uncertainty. If we are serious about protecting the NHS, we must start by protecting the people who make it work.
Enough is enough. //
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