The Consequences of Axing NHS Managers Without an Impact Assessment

There’s a difference between ambition and recklessness. Ministers have crossed that line with their plan to cut tens of thousands of NHS jobs—half from Integrated Care Boards (ICBs)—without conducting any formal impact assessment.

NHS England’s 42 ICBs have been instructed to halve their running costs by the end of this year. That means around 12,500 job losses, primarily from management and commissioning roles. According to the Department of Health and Social Care (DHSC), this is part of an effort to slash bureaucracy and redirect funding to frontline care. The problem? No one has assessed what the consequences might be.

Policy-Making Without a Safety Net

Health Minister Karin Smyth recently admitted—under parliamentary questioning from the Liberal Democrats—that the DHSC has not conducted any impact assessment of the ICB cuts. That’s not just an oversight. In a system as complex and vital as the NHS, it’s malpractice.

This isn’t streamlining. It’s a blind gamble. Helen Morgan, the Lib Dem health spokesperson, rightly described it as “reckless policymaking, done on the hoof to please the Treasury.”

Disassembling the System Mid-Flight

Integrated Care Boards are still relatively new. Designed to enable more local, collaborative health planning, ICBs are responsible for ensuring services in their regions are coordinated, funded, and responsive to patient needs.

Slashing their workforces in half threatens to render them dysfunctional. One NHS boss called it “vandalism.” Former health secretary Andy Burnham warned that it would force ICB mergers, divert energy from core challenges, and ultimately undermine patient care.

The Largest NHS Job Cull in History

These losses don’t stop at ICBs. NHS England is also cutting 50% of its 15,000 staff. The DHSC and individual NHS trusts are planning similar savings. The entire system is bracing for the largest workforce reduction in NHS history.

Jon Restell, chief executive of Managers in Partnership, says this is a “huge risk” that will directly undermine the government’s stated goals: reducing waiting lists, improving productivity, and reforming care delivery. Worse still, it’s being done in one of the most under-managed health systems in the developed world.

Management Isn’t the Enemy

It’s politically convenient to frame NHS managers as bureaucrats draining resources from patient care. But the reality is far less dramatic—and far more important.

Behind every GP contract, cancer pathway, or discharge plan is a manager ensuring things run smoothly. Strip away too many of these people, and you don't liberate the system—you paralyse it. Waiting lists grow, discharges slow, and coordination between services breaks down. The very outcomes the government claims it wants to improve—efficiency, speed, integration—become increasingly impossible to deliver.

Rushed Reform, Repeated Mistakes

Even more baffling is the timing. The government hasn’t even published its 10-year NHS strategy, yet it’s already remodelling the very infrastructure tasked with delivering it. The NHS Confederation’s Matthew Taylor has warned that the scale and speed of these cuts threaten to derail reform. Ministers keep making promises—to reduce waits, modernise services, and restore trust—but this disruption could undo that progress before it begins.

Efficiency Needs Planning, Not Panic

Efficiency is a worthy goal. But cutting thousands of roles without a clear roadmap, risk analysis, or delivery plan isn’t reform—it’s roulette. A government that claims to be serious about NHS productivity can’t ignore the role of managers in delivering care safely and strategically.

Restell has called for a pause in these plans so proper risk management and planning can take place. It’s a measured and responsible request. NHS staff deserve more than political soundbites—they deserve leadership that understands the system it’s trying to fix.

Let’s be clear: improving NHS performance is essential. But improvement doesn’t happen in chaos. It doesn’t come from gutting the very people tasked with driving reform, or from announcing structural upheaval with no clear explanation.

If Health Secretary Wes Streeting is serious about fixing the NHS, he must listen to those inside it. Pause the ICB cuts. Conduct a full impact assessment. And protect the management infrastructure essential to delivering patient care. Anything less risks making a struggling system even more unstable.