NHS England to cut workforce by half as Streeting restructures

NHS England will lose half its staff and a huge swathe of its senior management team as part of a brutal restructuring under its new boss.

Its workforce will shrink from 13,000 to about 6,500 as entire teams are axed to save money and avoid “duplication” with officials at the Department of Health and Social Care (DHSC).

NHS England staff said they were “in shock and awe” at the scale of the job cuts, which go far beyond the loss of 2,000 posts to save £175m announced just weeks ago.

The DHSC will also become smaller as a result of a process that will see it working much more closely from April with NHS England, though it will shed far fewer staff than the latter. The changes will give Wes Streeting, the health secretary, far more control over the organisation that is responsible for the operational performance of the health service in England.

“These changes represent the biggest reshaping of the NHS’s national architecture in more than a decade,” said Matthew Taylor, chief executive of the NHS Confederation, which represents NHS trusts in England.

Amanda Pritchard, NHS England’s outgoing chief executive, broke the news to staff today in an email that made clear Streeting had instigated the organisation’s dramatic downsizing.

He has asked Jim Mackey, her successor, and Dr Penny Dash, NHS England’s incoming new chair, to lead on the “radical reform of the size and functions of the centre [how NHS staff refer to NHS England and the DHSC’s respective headquarters in London],” Pritchard said. That will “deliver significant changes in our relationship with DHSC to eradicate duplication”.

Pritchard announced two weeks ago, after weeks of talks with Streeting, that she was stepping down at the end of the month.

A “formal change programme board” or “transition team” of DHSC and NHS England officials will oversee the slimming down of the two organisations. It will report to Dash and Alan Milburn, the former Labour health secretary Streeting appointed as the DHSC’s lead non-executive director, the board’s co-chairs.

“As part of this, they will be looking at ways of radically reducing the size of NHS England that could see the centre decrease by around half,” Pritchard said. The news would be “very unsettling” and involve “uncertainty and worry” for staff, she added.

Pritchard also announced that Julian Kelly, NHS England’s deputy chief executive and finance chief, chief operating officer Emily Lawson and chief delivery officer Steve Russell will follow her out the door this month.

They “feel it is the right time to move on and allow a new transition team, led by Jim, to reshape how NHS England and DHSC work together,” she said. Prof Sir Stephen Powis, the service’s national medical director, announced last Thursday that he was leaving too.

One NHS England staffer said: “People here have been expecting change over the last couple of weeks but not as much change as is now apparent. They feel baffled, unnerved and fearful.

“The speed at which Emily Lawson, Julian Kelly and Steve Russell are going is bewildering.”

Streeting has made no secret of his ambition to gain more power to direct NHS England, which has been semi-independent of ministerial control as a result of then health secretary Andrew Lansley’s shake-up of the service in 2012, as part of the biggest overhaul of the NHS since it was founded.

The Guardian revealed last month that thousands of jobs were going to be axed at NHS England and disclosed last week that Mackey was planning a major cull of NHS England’s senior leadership team. Further departures are expected.

Mackey and Pritchard warned NHS leaders last week that the organisation is facing a possible overspend of £6.6bn in the 2025/26 financial year and that “a fundamental reset of the financial regime” will help “get a grip of this situation”.