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14th April 2025

Shor on time and so much always happening on the health front.
Roy Lilley with huge management experience offers a newsletter casting an eye over the health service mainly in England but something inevitably find heir way to Scotland.

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When the prime minister and chancellor say the world has changed, mostly for the worse.

... there's a certain type of person who takes that as permission to do the big and ugly things voters would never vote for a Labour government to do.

It's happening to the NHS, right now.

Who and how was it decided that NHSE would go, budgets would be cut by 50% and the upshot... thousands of people sacked?

Where is the strategic analysis. The Board decision. The Bill. The risk assessment? The analysis. The impact statement. The plan? The license from the voters to demolish parts of their NHS?

Capricious decisions, erratic, volatile and like a ticking time-bomb smuggled deep into the foundations of the service.



As Isabel Hardman comments in the iNewspaper; Wes Streeting has a chainsaw but no vision for the NHS. She is right about the vision and the chainsaw but not the person wielding it.

Tell me decisions weren't arrived at on the hoof over a weekend, by Alan Milburn egging on Silly Boy and announced the following Monday.

The cunning plan; slash the budgets, stand back and let the service fight itself for survival; forcing a reduction in headcount, without wasting time on analysis or permission.

You'll have to go some to tell me that the poor-man’s Elon Musk, Alan Milburn doesn’t own the chainsaw.

Some of the impact;

Reduce corporate function costs by half. Between 41,100 and 150,700 people across 215 trusts, dumped.
Halving NHSE’s workforce, slashing 6,500 jobs.
Redundancy costs around £1 billion.
Northern Care Alliance to cut approximately 14% of its corporate workforce .
Mid and South Essex Trust, cut 150 non-frontline, clinical posts.
East Suffolk and North Essex FT, approximately 350 jobs to go to the private sector.

Royal Derby Hospital, introduced Mutually Agreed Resignation Scheme (MARS) offers severance pay to non-clinical staff.
Glenlyn Medical Centre (Surrey), salaried GPs were invited to apply for voluntary redundancy. Three doctors set to leave as a result.

Nottingham University Trust, where 'staff can't sleep with worry', outsource parts of its finance department approximately 80 administrative staff at risk of redundancy. Plus, a MARS option. ​
Southampton University Hospitals Trust, plans to make 100 job cuts; administrative, clerical, and management roles.

There’ll be more this week.

If MARS is a personnel strategy it would have been cobbled together by Del-Boy, on the back of a fag packet, in the Nag's Head.

It's just a way to ‘get rid of people’.

More expensive than statutory redundancy, but the key benefit, it avoids consultation.

MARS is arbitrary and open to favouritism.

Recipients cannot receive unemployment benefits after leaving, as their dismissal is ‘agreed’.

It’s bad management. Not a serious long-term solution.

People are just tipped-out with no thought other than to reduce headcount and cut spending. It does not address the harder decisions around tackling structural problems in service delivery;

the future of work;
how it will be done,
who does it...

… neither, does it fix the root cause of the NHS doing more work than it’s funded for.

Worse, it only appeals to people with long-service. Dump them and you dump, knowledge, legacy, skills and the organisation's memory.

MARS = Management that’s Arbitrary and Really Stupid.

And, there’s this…

… the Darzi Report, accepted and agreed by Charmer and Silly Boy as the new testament, which warns:

'... management capability is still behind where it was in 2011' (Para 21)

… and emphasises the critical role of management in driving effective reform.

Analysis by the Chartered Management Institute and the Social Market Foundation agrees. Their research indicates;

'... management capability has regressed... primarily due to prolonged restructuring and austerity measures.'

Skilled managers are essential for implementing reforms and keeping the show on the road.

An organisation can only do a few things well, at once. ‘Try to do everything, and you’ll end up achieving nothing’… so said the guru’s guru, Sir John Harvey-Jones.

The NHS is trying to;

Cut waiting lists, a political priority
Reorganisation and restructuring
ICBs slashed, smashed and crashed
NHS England, dumped
New Ten-Year Plan, any time soon.
Workforce reform and redundancies.
Savings programme and financial pressures to find £illions.
Service consolidation.

The potential for more strikes by junior doctors.
Digital transformation, roll-out shared care records,
Adopt AI in diagnostics and admin.

Public health and prevention; obesity, smoking, alcohol, and mental health being targeted all at once.
Primary care reform, fewer full-time doctors, rows about PAs, rising demand, new GP contract, expanding roles for pharmacists and other professionals.

… do all that with managers who have no idea if they will be in a job this time next year.

This is total, unadulterated, copper-bottom, 24ct gold, big-time, bigly bonkersness.

Milburn madness.

Everything the capricious, mercurial Milburn did for Blair, from markets and PCTs to Foundation Trusts was eventually dumped and disowned by the Labour Party.

Don’t let him do it again.

Postscript; just hearing 800 jobs earmarked to go at Isle of Wight and Portsmouth Hospitals trusts and 500 non clinical posts to be cut at Cambridge University Hospitals.

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