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I'm returning to the topic I started the week with. The decimation of the NHS’ workforce.
It is important for people, their lives, careers, families, hopes and the NHS brand as an employer in good faith.
Unfortunately, it isn’t new.
In April 2002 when Alan Milburn was the secretary of state for health (yes, him again), 95 health authorities were replaced by 28 strategic health authorities.
The redundancy costs of that were about £45m. To minimise compulsory redundancies, the DH+ implemented a voluntary exit scheme, costing approximately £15 million
Just before that, when Milburn was secretary of state for health (yes, I know), Primary Care Groups came along but they were too small and dinky and they morphed into primary care trusts. That cost another packet in consultancy and legal fees.
Later Community Health Councils were abolished and the redundancy costs racked up about £12m.
So far I think Milburn (who is now really running the DH+) has cost the taxpayer north of £70m. He is at it again and the costs will be in the billions.
Another restructuring, another wave of NHS staff shoved out the door. A cheque in one hand and a CV in the other, they're told: ‘Thanks very much. Best of luck.’
You can’t just clear the offices and expect a system as complex as the NHS to hum along.
People aren't filing cabinets to be chucked out, but they are full of knowledge and that is precious…
… all about commissioning cancer services… keeping A&E doors open… managing millions of appointments. Health and safety. Legal obligations. Managing the workforce that delivers over 1.3 million interactions every 24 hours.
When we treat NHS people like office furniture, spare parts, plug and play, we lose something far bigger than a line on a spreadsheet. We lose memory. Damage trust… confidence, continuity, capability.
Do we learn, anything?
You’d think, by now, someone might say… hold on, we've done this before. Did it work? Did we fix the thing we were trying to fix?
No, the culture of top-down change is baked in.
Each new Secretary of State wants their own Plan. Reforms. Diagrams. Boxes and arrows. But what we never get is continuity, respect for experience, or proper workforce planning…
… and the money?
Every pound we spend on a redundancy cheque or a MARS bribe is a pound we’re not spending on nurses, on care packages, on digital kit that actually works.
It’s not just inefficient, it’s criminally wasteful. Scandalous.
We say we’re short of managers. We are. But not because they don’t exist. Because we keep showing them the door every time the organisation chart changes.
Do you think we could;
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Stop blowing the place up every five years.
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Stop pretending structure is strategy.
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Start investing in people.
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Start valuing institutional memory.
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Stop wasting time and money making people redundant when we know…we’ll need them back.
Maybe, just maybe, let’s start leading like we mean it.
Milburn has form for triggering a pattern of redundancy-rehire cycles.
It's a long-standing and troubling trend that reflects deeper issues in workforce planning, organisational memory, and how the system values its people and its engagement with blind political ambition.
The NHS repeatedly makes large numbers of staff redundant during reorganisations… spending hundreds of millions in payouts. The evidence is the workforce swells again, just in time for more redundancy.
This cycle sends a demoralising message:
- Staff are treated as interchangeable cogs, not long-term assets.
- Careers are disrupted for the sake of political reshuffles.
- Institutional knowledge is lost.
- The brand NHS, is an unreliable career choice.
This is not just inefficient, it’s disrespectful to the people who make the system work.
The NHS suffers core flaws:
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Short-term thinking: Each reorganisation is treated as a clean slate, ignoring past lessons.
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Political churn: Ministers and leadership teams come and go, wanting to leave their own legacy, regardless of what was actually working.
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Poor workforce planning: There’s a chronic failure to model the long-term implications of structural changes on staffing.
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No investment: that could streamline the management of the system by the use of technology.
The bottom line, the NHS doesn’t just have a funding or capacity crisis, it has a leadership and strategic foresight crisis.
The repeated redundancy-rehire cycle is wasteful, destabilising, and reflects a cavalier attitude to human capital.
It's time to ask:
How can we expect a stable, respected, long-term NHS workforce...
... when the likes of Milburn keep pulling up the roots?
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