Cuts to non-patient-facing nursing roles may be on the horizon, a letter from the new chief executive of NHS England suggests.
The chief nursing officer for England, Duncan Burton, has been tasked with reviewing the current size of the “corporate” nursing workforce and addressing “variation” in numbers between organisations.
“These roles are vital to delivery of safe and effective services in health and care and should be protected”
RCN spokesperson
Mr Burton has been given to just the end of this month to complete this work, according to a letter to chief executives of trusts and integrated care boards (ICBs) by Sir James Mackey on his first day as the new head of NHS England.
In his letter, Sir James provided more information on the changes set to take place under the new NHS reform programme, which will see NHS England abolished and its functions transferred to the Department of Health and Social Care.
Since the announcement of the reorganisation, which has the stated aim of reducing duplication of back-office NHS work and saving money, there has been uncertainty over how nursing will be affected.
The letter reveals that what Sir James describes as “corporate” nursing jobs in trusts and ICBs are among those being looked at for potential savings.
In the letter, Sir James said corporate costs in NHS providers had increased by 40% – or £1.85bn – since 2018-19, and that this now needed to be scaled back.
In particular, he said since 2019, there had been a “substantial increase in the number of non-patient-facing corporate nursing roles across NHS providers and ICBs”.
“These roles have supported significant improvements within the nursing workforce, such as sustained post-pandemic low leaver rates and reductions in vacancy levels,” he said.
“However, initial analysis indicates significant sector and regional variation with the deployment and proportion of these roles within NHS providers,” added Sir James.
He went on to say that Mr Burton had been asked to lead a fast-track review of the corporate nursing workforce and to set a new “threshold” for ICBs and providers to align to.
“To ensure optimal deployment of the corporate nursing workforce, Duncan Burton, chief nursing officer for England, will lead a benchmarking analysis to identify potential unwarranted variation and utilise this knowledge to set an appropriate threshold which we will ask systems and providers to align to in 2025-26,” wrote Sir James. “We aim to complete this work by the end of April 2025.”
He said all NHS providers would be expected to reduce their “corporate cost growth” by 50% by the third quarter of 2025-26 and reinvest the savings locally to “enhance frontline services”.
Nursing Times asked NHS England whether this directive could mean that some existing corporate nursing roles will be axed, and for examples of the types of roles it covers. However, it did not provide a response.
In another section of the letter focused on ICBs, Sir James was more explicit about the expectation of redundancies.
As part of the reorganisation, ICBs are being asked to reduce their running costs by 50%.
“These roles have supported significant improvements within the nursing workforce”
James Mackey
In his letter, Sir James asked ICBs to produce “bottom-up plans” by the end of May for how they are going to achieve this reduction, for implementation in the third quarter of 2025-26.
He said, as part of their cost-saving plans, ICBs should “look carefully at functions where there is duplication” and provided a list of roles that could be targeted for cuts.
These included assurance and regulatory roles such as those covering safeguarding and infection control; jobs focused on performance management of providers as opposed to contract management; and communications and engagement roles.
Responding to the letter, the Royal College of Nursing (RCN) warned that cutting non-patient-facing nursing staff would be a “mistake”.
A spokesperson told Nursing Times: “These nursing roles provide valuable clinical expertise in the design, commissioning and delivery of services.
“Even if they are not directly patient-facing, it would be a mistake to lose this expertise simply to reduce corporate costs.
“These roles are vital to delivery of safe and effective services in health and care and should be protected,” they said.
“Those carrying out the work need to use a broad definition of what is in the interest of patients and allow clinical experts and nursing leadership to be maintained.”
Last week, the chief executive and general secretary of the RCN, Professor Nicola Ranger, made a similar point during an appearance at the Health and Social Care Committee.
She told the committee that the RCN represented nearly 4,000 nursing professionals who work in NHS England and ICBs and that none of them were “bureaucrats”.
“They are clinical nurses who run all sorts of brilliant services for patients: safeguarding, infection control, nurse leadership,” she said.
“So, what we would say is… every nurse at the moment counts in the UK, we don’t want to lose that expertise.”
More on the NHS reorganisation
