Concerns over job security and the future of patient care are mounting across England’s National Health Service (NHS) as sweeping changes to administrative structures and staffing loom large. In Lincolnshire, the proposed introduction of a new ‘Patient Service Hub’ has sparked fears of significant job losses, while on a national scale, Health Secretary Wes Streeting’s announcement of 18,000 administrative redundancies signals a major shakeup in NHS operations.
In Lincolnshire, the Lincolnshire Community and Hospitals NHS Group—which oversees Lincolnshire Community Health Services NHS Trust and United Lincolnshire Teaching Hospitals NHS Trust (ULTH)—recently unveiled plans to modernize its outpatient and inpatient administrative services. The initiative, branded as the ‘Patient Service Hub,’ aims to streamline patient bookings and communications by consolidating existing systems and introducing digital tools. According to ULTH, the current patchwork of 15 different systems and 40 mailboxes is simply not fit for purpose. "Three-quarters of calls to the Outpatient Appointment Service are simply to check, rebook or cancel appointments—tasks that most people would expect to complete online or via an automated system nowadays," explained Caroline Landon, group chief operating officer at Lincolnshire Community and Hospitals NHS Group, in a statement provided to The Standard.
While the trust insists that the proposal is still in its consultation phase, staff and unions are voicing deep unease. Unite, one of the UK’s largest unions, estimates that nearly 650 employees—spanning both medical and non-medical roles—could be affected by the shake-up, with as many as 180 jobs potentially on the line. Sharon Graham, Unite’s general secretary, was unequivocal in her opposition: "The trust’s staff have legitimate concerns that the transformation programme is a euphemism for cost-cutting at the expense of staff and patients. Any job losses will not be tolerated by Unite. Redundancies would only increase the pressure on overworked staff and negatively impact patient care."
The trust, for its part, has initiated a six-week consultation with workers at Lincoln, Boston, and Grantham hospitals to gather feedback and involve staff in designing the new service. Yet, for many, the assurances ring hollow. Garry Guye, Unite’s regional officer, pledged that the union would "scrutinise the proposals in detail and offer maximum support to our members," adding, "Unite will not accept staff being pushed out of their jobs by being told they have to travel unfeasible distances every day to go to work." The proposed changes have already galvanized public support, with a petition opposing the hub surpassing 2,600 signatures—a testament to the community’s anxiety over potential reductions in service quality and patient safety.
These local concerns are unfolding against the backdrop of a much larger transformation at the national level. On November 12, 2025, Health Secretary Wes Streeting announced a landmark restructuring of NHS administration, targeting 18,000 managerial and back office roles for redundancy. The plan involves scrapping NHS England as a standalone entity and merging its back office functions into the Department of Health and Social Care (DHSC). The government claims the move will eliminate "unnecessary bureaucracy" and ultimately save £1 billion a year by the end of this Parliament—savings that, it argues, can be redirected to frontline care.
But the transition won’t come cheap. The upfront cost of redundancy payouts is expected to reach £1 billion, a sum that initially worried NHS leaders who feared a gaping hole in the health service’s finances. However, Chancellor Rachel Reeves has struck a deal to allow the DHSC to overspend by about £1 billion this financial year, with the understanding that the sum will be recouped from future savings—meaning less money available in 2026/27. Reeves has also rebuffed requests for an emergency cash injection, insisting that the reforms must be self-financing.
Integrated care boards (ICBs), the regional bodies responsible for commissioning NHS services, have been told to make about 12,500 redundancies from their 25,000-strong workforce. The government had previously announced that the overall headcount across NHS England and the DHSC would be halved, with the 18,000 administrative roles targeted in this latest round of cuts.
Streeting has been forthright about his rationale. Speaking on LBC, he said, "There will be more jobs on the front line in the NHS, and there are many people who work in these organisations who have either valuable skills that could be used in the NHS or elsewhere, or indeed are qualified clinicians who I'd rather see closer to the frontline, or at the front line." He added, "I'm not running a job creation scheme, I'm running a National Health Service, and I've got to make sure that every penny that's going in is going to the front line." The Health Secretary’s view is that every £1 billion saved from bureaucracy could fund an additional 116,000 hip and knee operations, a tangible benefit for patients awaiting care.
Nevertheless, the human cost of such sweeping changes is not lost on those affected. Streeting acknowledged the dedication of NHS administrative staff, saying, "I say this with care and sensitivity for people who come to work in these jobs, work hard and are dedicated to the NHS—it’s my responsibility to make sure that we're spending every penny wisely." He reiterated that the priority must be patient care, especially in light of a challenging budget environment.
Despite government assurances, critics warn that the scale of redundancies may have unintended consequences. Unions such as Unite fear that the loss of experienced administrative staff will increase pressure on remaining workers and could compromise the very efficiency and patient care the reforms seek to enhance. Local campaigns, like the one in Lincolnshire, echo these worries, warning that "the proposals threaten the jobs of countless dedicated employees and could significantly reduce service quality and compromise patient safety," as reported by The Standard.
Amid these debates, Streeting has pointed to signs of progress. In a speech to health leaders at the NHS Providers conference in Manchester, he stated, "We're finally on the road to recovery. There are lots of green shoots. Waiting lists are finally beginning to fall after 15 years, we're exceeding the promises we made to the public in our manifesto on the NHS." Yet, he conceded, "for all of those green shoots of recovery and things that are going well, there'll be people today who are struggling to get access to a GP, can't get a dentist, are waiting far too long for treatment, are worried about whether they're going to get their test or scan for things like cancer, and that is the thing that drives me, knowing that we're moving in the right direction, but there is so so much more to do."
As the NHS embarks on these far-reaching reforms, the tension between efficiency and compassion, between cost-cutting and care, remains at the heart of the debate. Communities, unions, and policymakers alike are grappling with the challenge of modernizing a cherished public institution while safeguarding the livelihoods and wellbeing of those who keep it running.
