Waiting

Some days I open my inbox and think there’s a glitch.

A gremlin in the works.

The messages feel like they’re from a decade ago… déjà vu… all over again!

Genuine people are writing to me about their personal circumstances—facing the prospect of losing their jobs to redundancy, not knowing if or when.

Back in 2016 the NHS tried to cut headcount: managers, admin, back‑office.

The redundancy cheques were huge—and in the meantime, the work didn’t go away. It came back as consultants on day‑rates, interims and agency cover.

Consultancy spend trebled to £22.65 million in just two years.

By 2018, NHS England was quietly rebuilding headcount, merging quangos to plug the gaps—and again, consultant spend ballooned.

It’s always the same… the jobs go but the work stays and mostly increases.

Unless the work itself is redesigned—with proper IT, process remapping and change—this new round of cuts will go the same way. A merry‑go‑round of payouts, backfill and disappointment.

The NHS never learns. It certainly didn’t in 2018, because…

… in 2010–13… the DH tried to save £20 billion and disingenuously dumped it on the then‑NHS boss, calling it the “Nicholson Challenge”.

Consultancy bills ballooned and, although not directly involved, the quest to balance the books was implicated in the Mid‑Staffs debacle…

… the Francis report said;

‘… corporate self‑interest and cost control [was put] ahead of patients and their safety.’

The quest for cuts in the boardroom is always found at its deepest, by the bedside.

Mark my words; the same will happen this time.

The absence of up‑front investment in digital and process redesign means managers leave, and external consultants and clinicians pick up the load. Overall spend won’t fall, and quality and safety will be jeopardised.

This time, 20,000 NHS admin and management posts are to be cut to save about £1.7 billion a year.

The redundancy bill… probably around £1.3 billion.

My guess is the Treasury will look the other way. We might hear more in the upcoming October Budget—and that’s a long time for people to live in limbo.

Assume the money‑tree does its thing… the aim is a 12‑month payback…

… but here’s the snag:

When you cut management and admin roles, the work doesn’t vanish. It falls into three types:

Automated – IT systems take over: HR, rostering, finance, coding, digital-care records, and so on.
Redistributed – the work is absorbed by clinicians, remaining managers or consultancies.
Deferred or abandoned – things just don’t get done, meaning unpredictable service gaps, compliance breaches, quality risks.

Without investment in IT and process redesign, almost nothing moves into the first category.

Without IT investment, shadow‑admin systems are created… bodged along with Excel, phone calls and emails—labour‑intensive and inefficient. Plus failure‑demand—the cost of doing things again.

Work shifting is not work shaping.

The NHS “money thing” makes redesign prospects poor.

At the coalface, instead of leaner, digital‑enabled processes, you get clunky, paper‑heavy workarounds.

It’s probably safe to assume 20‑30 % of work will be backfilled by temporary staff, clinicians’ time, or consultancy. That’s likely to eat £330 million–£500 million per year. In which case the ROI on redundancies stretches from one year to three, maybe four—or never.

In the meantime, agency and consultancy rates will surge. We know all this because we’ve been here before.

Unless there’s serious investment in the time and space to train and make new IT and process‑redesign work, the jobs just reappear—as agency contracts and invoices.

Even if only 25 % of the work leaks back, the savings evaporate. These numbers never stack up.

Despite workforce growth and efforts to improve productivity, the system is struggling to keep pace, with backlogs, longer waiting times, staff pressure and the Service emerging as a rotten place to work.

And…

… we enter the territory of the Jevons Paradox. In our parlance: the more efficient the NHS becomes, the more patients it will see—and the greater the demand for more revenue…

… and consequently, up goes the cry “the NHS costs too much”. The greater the demand to cut headcount to achieve productivity gains…

… whereas we know investment‑led efficiency creates capital deepening:

‘… productivity improves when each worker has more or better capital…’

Meaning: IT, machinery, infrastructure. Efficiency gains come from modernisation and investment—not blindly attacking labour or revenues.

If turfing people out of their jobs makes the NHS any more productive—somebody tell me how?

My inbox is waiting.

News and Comment from Roy Lilley
Contact Roy – please use this e‑address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.