Advice & support

NHS job cuts & system changes: info for members

This page will be updated with the latest developments regarding the government’s plan to cut jobs in the NHS in England. It sets out what MiP is doing to support members, how you can get involved and the latest activities from the union.

Planned cuts in the NHS in England

The government has announced a reorganisation of the NHS which will lead to a series of job cuts throughout the NHS in England.

This page covers the latest information on the cuts and will be updated regularly. It covers developments on the cuts nationally, outlines how MiP is challenging them and what your union is doing to support you.

It also contains information about MiP’s activities locally and actions members can take now to support the union and your colleagues.

This page was last updated on April 30 2025.

Not a member yet?

MiP can only support members with workplace issues four weeks after their join date. If you think you could be affected by the planned cuts then it’s important to join now to ensure you’re covered.

join now

Update April 30 2025:
National voluntary redundancy scheme discussions are drawing to a close

Discussions, via the national partnership structure, between NHS England and DHSC and trade unions and employers on a model voluntary redundancy scheme are drawing to a close. The final version of the scheme will then go to the Treasury for approval.

While the VR scheme has been subject to detailed engagement with unions, it is not a formal agreement. If it is approved, FAQs will be developed to support the scheme’s implementation.

The model scheme will cover all NHS employers, including NHS England, ICBs and NHS trusts. It will use the full financial terms in the Agenda for Change handbook’s Section 16 and allow approval decisions to be delegated from the Treasury to DHSC and NHS England. The scheme will cover the following areas: local consultation with trade unions (including reasons for job losses, selection criteria and panel composition); eligibility; application process; appeals; notice; pension options; settlement agreements; and clawback on re-employment.

Employers can decide whether and when to use the model VR scheme during the 2025/26 financial year. MiP’s position is that employers must not offer lower-value MARS terms for staff and functions where there is a likely risk of redundancy. Early engagement with local staff sides is essential before any scheme’s launch.

Members have been raising two issues in particular.

Redundancy payments should be calculated using contractual pay on the last day of employment. Calculations will be adjusted to reflect any backdated pay award to 1 April 2025. (The government has received the NHS Pay Review Body report and is expected to receive the Senior Salaries Review Body report shortly. It will then decide on the recommendations.)

Some members have taken partial retirement under recent changes to pension scheme rules. Current Agenda for Change rules (see section 16) exclude from redundancy calculations any reckonable service for which a pension has been paid. Staff side is clear that this is an unintended consequence of partial retirement’s introduction. The Agenda for Change handbook needs to be revised to allow full reckonable service to count for staff who partially retired. This is allowed elsewhere in the public sector, including the civil service. We have asked DHSC to give an urgent mandate to the NHS Staff Council to make the necessary changes. We would then expect any new rules to be reflected in the model VR scheme.

Updates on the scheme will be posted here.

MiP policy statement on NHS job cuts and system changes (April 2025)

MiP has released an updated statement on the NHS job cuts and system changes.

Our members strongly support change and reform in the NHS, but MiP is opposed to the scale and speed of these cuts and changes and warns the government that it is running a huge risk.

MiP, through its National Committee, will continually review its campaigning, bargaining and legal objectives and escalate action as needed. The committee will convene fortnightly.

Please read our statement in full from the box to the right.

Read latest MiP statement on NHS job cuts

MiP has released an updated statement on the government’s plans to cut NHS jobs and restructure the system. You can read our statement here.

mip policy statement

What we know so far: NHS England and DHSC

The government has announced that NHS England will be abolished with remaining staff merging with the Department for Health and Social Care.

  • 50% of the total staff of NHS England and DHSC will be cut
  • Remaining staff at NHSE will merge with DHSC
  • The DHSC will launch a separate voluntary exit scheme for civil servants
  • All NHS England vacancies are frozen apart from in ‘exceptional circumstances’
  • A formal change programme board and team have been established to lead this work
  • Change process expected to be concluded by October 2026
  • Planned transfers of specialised commissioning functions from NHS England to ICBs are expected to go ahead

NHS England will establish a dedicated Change Forum to manage the organisational change process. The forum’s remit will include consultation processes, change governance, coordination with DHSC, and alignment of communications. The forum is expected to be operational before Easter.

NHS England has indicated that the initial redesign of the centre will be shared in April with work beginning on the design of the consultation process following.

MiP is working closely with our partner union the FDA to ensure staff at both NHSE and the DHSC are represented.

We still have no definitive timeline on when this process will start and how individual posts will be impacted. Members must join prior to the formal change programme beginning to ensure they can access MiP support.

MiP will write to members directly and update this page when further information is received. For MiP Chief Executive Jon Restell’s initial response to this please see here.

What we know so far: Integrated Care Boards

The government has announced that Integrated Care Boards must reduce their running costs by 50%.

  • NHS England says ICBs in future will act ‘primarily as strategic commissioners’ with ‘wider performance management’ done by regions and in providers
  • Penny Dash is leading work considering the model functions of ICBs with a view of providing guidance on future functions by the end of April
  • The Health Service Journal has reported that NHSE has told ICBs to reduce spending to an average of £18.76 per head across each of the seven English regions
  • The Health Service Journal has also reported that plans to reduce the number of ICBs through a series of mergers from 42 to 23 – 28 are ‘well advanced’ – MiP and trade union colleagues have not been involved in these discussions and are seeking clarity for what this will mean for our members at affected organisations
  • ICBs must submit plans ‘to live within’ their reduced running costs for sign off by 31 May
  • Plans are expected to: maintain staff in delegated commissioning, continuing healthcare, and finance and contracting; invest in strategic commissioning; and commission and develop neighbourhood health
  • Reductions are expected to fall hardest on staff in assurance and regulatory functions, wider performance management and communications and engagement
  • ICBs have already reduced running costs by 20-30% in the last two years and many processes are still ongoing
  • Reductions and changes are expected to be made between Oct – Dec 2025

MiP is seeking clarity about the running costs envelope for ICBs and, critically, the new functional framework for ICBs. We also want to know about any guidance on mergers, which some ICBs are said to be considering. MiP is also calling for flexibility with the per head spending targets set to ensure that regional inequalities in healthcare access and outcomes are not exacerbated. We believe that national partnership discussions with unions are needed for reductions and change in ICBs.

Members must join prior to any formal change programme beginning to ensure they can access MiP support.

MiP will write to members directly and update this page when further information is received. For MiP Chief Executive Jon Restell’s initial response to this please see here.

What we know so far: NHS trusts

NHS trusts were told in January to reduce base costs by 1% and make productivity improvements of 4% so the NHS as a whole achieves financial balance in 2025/26. NHS England has since demanded specific cuts to ‘corporate costs’.

  • NHS trusts must reduce the growth in ‘corporate costs’ since ‘pre-pandemic levels’ by 50%, between Oct-Dec 2025
  • NHS England will say more about how to make these cuts, including on pooling resources at geographical and system level, and collect monthly corporate cost data
  • Some cuts are expected to focus on functions such as HR, communications, estates and finance;
  • The Transforming People Services programme will identify people services needed and develop a target operating model. MiP will represent staff side on the programme board.
  • The CNO for England will advise on reducing unwarranted variation in the number of corporate nursing roles
  • NHS England will talk to unions nationally about new guidance to providers on Wholly Owned Subsidiaries (subcos)

MiP is seeking clarity about these cuts and associated guidance, both nationally and with local employers. Members must join prior to any formal change programme beginning to ensure they can access MiP support.

MiP will write to members directly and update this page when further information is received.

What we know so far: Commissioning Support Units

NHS Commissioning Support Units (CSUs) provide support, specialist skills and knowledge to the NHS. There are four CSUs in England that are currently operating as a group with a shared Executive structure. CSUs provide a broad range of services from at-scale corporate services including people services, finance and IT, to support for major national programmes like the New Hospitals Programme, to specialist transformation consultancy services. CSUs are funded through the income they generate, mostly from NHS England and ICBs, but also from NHS Trusts and provider collaboratives, primary care and non-NHS organisations like local authorities. 

The four CSUs are almost a year into a review to determine their future operating model, which started with the appointment of a shared Managing Director in April 2024. The government and NHS England have so far been silent on how their wider system cuts and changes will affect CSUs. National changes create risk for the CSUs because the majority of their income comes from NHS England and ICBs. However, NHS England has said the NHS needs to invest in strategic commissioning, ‘building skills and capabilities in analytics, strategy, market management and contracting’ and CSUs may be well-positioned to provide solutions which enable the NHS to reduce overall service costs and to support the transformation that needs to happen to deliver the changes the government wants to make.

CSU members have shared a recent update published in April 2025 which included a new vision for the CSU Group – “To be the delivery partner of choice to the NHS for the benefit of patients and our communities.”

MiP will make sure that our CSU members’ interests are considered in national change discussions.

What we know so far: Arms Length Bodies

The Cabinet Office has written to all government departments asking them to review their use of arms length bodies (ALBs). The review will asses ALBs in departments with a view of ‘closing, merging’ or bring ‘functions back into the department. The DHSC is included in this review and the review will assess ALBs beyond NHS England.

The government will consider legislation if necessary to implement any changes pursued as a result of the review.

NHS England Chair Penny Dash is currently reviewing NHS regulatory bodies, with further reorganisations expected.

The government and NHS England have so far been silent on how their wider system cuts and changes will affect CSUs, although NHS England has said the NHS needs to invest in strategic commissioning, ‘building skills and capabilities in analytics, strategy, market management and contracting’.

How MiP has responded to the announcements

MiP is strongly opposed to cuts on the scale announced and shocked by the way the news has been delivered – with most staff finding out their jobs could be at risk through announcements made to the media. While structures are not set in stone and many of our members welcome reform, we are clear that cuts are not reforms. If the government wants to truly reform how the NHS works and make it work better, it must outline its plan before cutting thousands of dedicated staff. Form must follow function.

For more reaction please see this press release containing MiP’s view.

For MiP Chief Executive Jon Restell’s response to the abolition of NHS England and reductions to ICB’s, please see here.

MiP has already written to members at large and at affected organisations. We advise members to make sure you are subscribed to our mailing lists to receive the latest updates. If you are not receiving emails or would like to resubscribe please contact info@miphealth.org.uk.

What actions are MiP taking to challenge these cuts

Your union is taking action to challenge these cuts. Our immediate priority is to get a clearer picture of what the government has planned, particularly what staff will be affected, what functions will go, what processes will be followed to implement reductions and what the future NHS structure will look like. We are actively:

  • Seeking clarity from government and employers on how the cuts will be implemented and under what timeframes consultations will be delivered
  • Raising concerns with ministers and NHS England’s new leadership team directly and through existing partnership working arrangements
  • Engaging with MPs in areas where affected employers are based
  • Raising awareness with policymakers on the role NHS England and ICBs play in our health system
  • Calling on employers to ensure unions and their staff are involved in any change process at the earliest possible stage, including increased facility time for workplace reps
  • Calling for a reset of partnership working to ensure unions and staff are properly engaged before announcing major reforms
  • Pushing back on reported timescales, especially in ICBs, to ensure fair consultation processes can be established and delivered
  • Seeking clarity on what parts of the system are expected to take on additional functions as a result of these cuts and how this will be resourced
  • Working to ensure as many jobs are saved within the system as possible

At this early stage, more is unknown than known. The government has not outlined its plan and most NHS employers have not been given written notices of the planned changes. That means many questions cannot be answered at this stage. MiP is seeking clarity and will inform members as soon as it is received.

We have written to Health and Social Care Secretary Wes Streeting to raise concerns directly. You can view this letter from the box to the right.

MiP has already hosted a number of member drop-in sessions and meetings to discuss the cuts in more detail. More of these are planned and this page will be updated with upcoming events. In the meantime, please check your email for the latest activity from MiP in your workplace.

What members can do now

Until written notices are presented it’s important to continue carrying on as normal. You may have concerns that you could be at risk, questions about your terms and conditions if transferred to a different employer or what options are on the table if your role is in scope of the cuts. At the moment, it is impossible to answer these as processes have not begun. We understand that this uncertainty creates anxiety, however your union will be there to support you through the process if and when it begins.

MiP will keep members updated on national developments as well as local ones, so please keep checking this page and your emails regularly.

View MiP letter to Wes Streeting MP

MiP has written to the Secretary of State for Health and Social Care Wes Streeting MP directly to raise concerns about the job cuts and system changes. MiP has yet to receive a response from the Secretary of State, but once it has been received in will be posted here.

Read our letter in full.

mip letter to wes streeting mp

Actions for members

Update your membership details

Ensure your details are up-to-date to receive information on the latest developments via email. You can update your details by logging into this website.

Update your details here

Consider becoming a workplace rep

In times like this our workplace reps are needed more than ever. Your union and your colleagues will be relying on you throughout this. You can find out more about the role by visiting the link below.

become a workplace rep

Tell colleagues to join now

A union is only as strong as its collective strength. Every member is another voice to challenge these cuts. But they need to join now prior to formal processes starting to access support.

colleagues can join here

Joining when work is going well means your union will be there if you ever need it

MiP can only offer one-to-one support on issues that occur after your first four weeks of membership. Join today to ensure you are protected if you ever need it in the future.

join today

Latest News