Advice & support

NHS job cuts & system changes: info for members

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

Planned cuts in the NHS in England

Latest update: 6 June 2025

The government is reorganising the NHS and ordering thousands of job losses throughout the NHS in England by the end of 2025.

This page will give you the latest information on the cuts and is updated regularly. It covers the latest news by sector on the cuts nationally, explains how MiP is challenging them and what your union is doing to support you.

It will also offer information about MiP’s activities locally and what members can do now to support the union and your colleagues.

Read our recently published guide to the consultation process, It’s Your Future, on how you can help yourself and support your colleagues during the re-organisation process.

Not a member yet?

MiP can only support members with workplace issues arising four weeks or more after their join date. If you think the planned cuts might affect you, then it’s important to join now to ensure you’re covered.

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National voluntary redundancy scheme

The model voluntary redundancy scheme is still stuck with the Treasury. We will keep asking officials for regular updates.

NHS England has changed the scheme’s terms after comments from trade unions and employers, made through the national partnership structure, but it is not a formal negotiated agreement. If approved, NHS England will publish FAQs to support use of the scheme’s by individual employers.

All NHS employers, including NHS England, ICBs and NHS trusts, will be able to use the scheme. But it will not apply automatically; individual can employers decide whether and when to use the scheme during the 2025-26 financial year. Early and meaningful conversations with local staff sides are therefore very important before launching a scheme.

The scheme will use the full financial terms in the Agenda for Change handbook’s Section 16 and delegate decision-making from the Treasury to DHSC and NHS England, which should speed up processes. The scheme covers: 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 the clawback of redundancy payments on re-employment.

Some employers have launched ‘Mutually Agreed Resignation Schemes’ (MARS) . The terms are typically half the value of section 16 benefits. MARS is not the same as voluntary redundancy and should not be used in redundancy situations. MiP’s position is that employers must not offer lower-value MARS terms to staff at likely risk of redundancy and that, for such staff, employers should withdraw MARS schemes when the VR scheme becomes available.

Separately, the NHS Staff Council is looking at the current Agenda for Change rules (see section 16) affecting the eligibility for voluntary redundancy of staff who have partially retired. The introduction of partial retirement in October 2023 led to unintended consequences for the redundancy rules. The Agenda for Change handbook needs revising so that full reckonable service counts for staff who have partially retired, as happens, for example, in the civil service. We have asked DHSC to give an urgent mandate to the NHS Staff Council to make these changes, and would expect any new rules to be reflected in the model VR scheme.

Updates on the scheme will be posted here.

ICBs consolidation plans emerge

Regions are planning ICB mergers or clusters, with the total number of ICBs due to drop from 42 to 27, according to internal documents seen by the Health Service Journal. National rules are being changed to allow joint leadership appointments, although an approach or timetable has not been agreed for appointing new leaders of merged ICBs or what staff will remain in the new organisation. These decisions are expected later in June according to the same report.

NHS England expects ICBs to have completed mergers by April 2026, or April 2027 at the very latest.

MiP and other unions have not been involved in these discussions and are seeking clarification on what mergers mean for our members in affected organisations.

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 opposes the scale and speed of these cuts and changes, and has warned the government that it is running a huge risk.

MiP’s National Committee, elected by our members, will continually review its campaigning, bargaining and legal objectives and escalate action as needed. The committee now meets fortnightly.

You can read our statement in full here.

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 is abolishing NHS England 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
  • The DHSC will launch a voluntary exit scheme for civil servants
  • All NHS England vacancies are frozen other than in ‘exceptional circumstances’
  • A formal change programme board and team is leading this work, with former regional director Richard Barker as senior responsible officer, reporting to both Sir Jim Mackey and DHSC’s new permanent secretary Samantha Jones
  • Publication of the initial re-design of the national centre has been delayed until late May
  • A Joint Partnership Forum has been set up, comprising management and union representatives from both NHS England and DHSC, to engage nationally on organisational change (see below for a summary of the first meeting below)
  • The transfer of specialised commissioning staff from NHS England to ICBs, planned for July, has been postponed, possibly until March 2026.
  • NHS England will not use a MARS scheme (see above)
  • The change process is expected to be completed by October 2026

The Joint Partnership Forum met on 13 May for the first time. It discussed its terms of reference, agreed a plan for future meetings — acknowledging the need for flexibility as change plans develop — and stressed the importance of representation from leadership and communications on the forum. The forum considered proposals for supporting for staff during the transition, including for senior leaders. Unions raised low morale amongst staff from frequent organisational change, the need for better communications to line managers and promoting civil service benefits, given the different cultures of NHS England and DHSC. The forum next meets on 29 May. 

MiP and our partner union the FDA are working together to represent members in both NHS England and DHSC. The timelines for the changes and how they may affect individual posts remain unclear. Members must join MiP before the formal change programme starts to qualify for the union’s support.

MiP will write to members directly and update this page, as further information comes in. For MiP Chief Executive Jon Restell’s initial response to the abolition decision please see here.

What we know so far: Integrated Care Boards

The government has told Integrated Care Boards to reduce their running costs by 50% between October and December 2025 and move towards acting ‘primarily as strategic commissioners’.

  • NHS England has shared a Model ICB Blueprint with ICBs to guide their planning. Described as a ‘working document’, it outlines which functions will transfer out of ICBs, which will be added or expanded, and which existing functions ICBs will keep.
  • The blueprint says ICBs should reduce spending to an average of £18.76 per head of population across each of the seven English regions, suggesting an overall cut in running costs of less than the 50% first announced.
  • ICBs must still submit plans ‘to live within’ their reduced running costs for sign off by 31 May. ICB’s plan templates will then be ‘sense checked’ nationally and possibly adjusted in June. Formal consultation with staff and unions would then follow.
  • Factors that could lead to adjustments in running cost budgets include where ICBs provide functions to other ICBs, co-terminosity with local authorities and effects on other place-based relationships.

  • Regions are planning ICB mergers or clusters, with the total number of ICBs due to drop from 42 to 27, according to internal documents seen by the Health Service Journal. National rules are being changed to allow joint leadership appointments, although an approach or timetable has not been agreed for appointing new leaders of merged ICBs or what staff will remain in the new organisation. MiP and other unions have not been involved in these discussions and are seeking clarification on what mergers mean for our members in affected organisations.
  • NHS England expects mergers to be completed by April 2026, or April 2027 at the very latest.
  • Plans must cover implications for Commissioning Support Units, which provide several services to ICBs. Some ICBs are considering ending their contracts with CSUs.
  • NHS England are talking to the Local Government Association, particularly around three functions: Special Educational Needs and Disabilities (SEND), continuing healthcare and safeguarding.

  • The Blueprint identifies some functions and responsibilities for transfer to providers or into reconfigured regional set-ups.
  • Work on a ‘Model Region’ is underway and unions have asked for consultations on this, as well as a stronger role for regional social partnership forums in developing the plans.
  • When the Ten Year Plan is published, plans for both ICBs and regional structures may need to be adjusted again, with some changes needing new legislation.
  • NHS England is preparing FAQs to encourage a consistent approach between ICBs and have agreed to involve unions nationally in developing these.

Nationally, unions are raising concerns about:

  • the method and pace of the change demanded, and lack of engagement with staff and unions in planning
  • the scale of cuts expected before reassigning or removing existing functions and accountabilities
  • the risks this creates — including the loss of skills and experience, damage to staff morale, upheaval and uncertainty affecting service delivery.

Members must join MiP before any formal change programme starts to ensure they can access the union’s 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 the ICB cuts 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% by the end of 2025
  • NHS England will give more details about how these cuts should be made, including guidance on pooling resources at geographical and system level, and will collect monthly corporate cost data
  • Many trusts are undertaking widespread organisational change and proposing job losses to deliver savings this year
  • Trusts are expected to target cuts on non-clinical functions such as HR, communications, estates and finance. NHS England is developing a target operating model for people services, the ‘Transforming People Services’ programme. MiP represents staff side on the programme board.
  • The Chief Nursing Officer 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 the associated guidance, both nationally and with local employers. Members must join MiP prior to any formal change programme beginning to ensure they can access union 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. The four CSUs in England now operate as a group with a shared executive structure. Their services include at-scale corporate services such as HR, finance and IT, support for major national programmes like the New Hospitals Programme and specialist transformation consultancy services. CSUs generate their own income, mostly from NHS England and ICBs, but also from NHS trusts and provider collaboratives, primary care and non-NHS organisations like local authorities. 

CSUs have been reviewing their future operating model for over a year, after a shared managing director was appointed in April 2024. The government and NHS England have so far said little about how their wider system cuts and changes will affect CSUs, despite the obvious risks to their income from NHS England and ICBs. ICBs are expected to say how their plans will affect CSUs, and several are considering ending their contracts with them. 

However, NHS England wants more investment in strategic commissioning to build “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 government’s changes.

A update in April 2025, shared with staff, offered 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: Arm’s-Length Bodies

We are still waiting for the government to publish the review of health and care regulatory bodies being lead by NHS England chair Penny Dash.

Separately, the Cabinet Office asked all government departments, including DHSC, to review their arm’s-length bodies (ALBs). These reviews will look at closing or merging bodies, or bringing their functions back into the civil service department.

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

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 action is 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.

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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.

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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.

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