England's Health Boards Spent £582 Million on Redundancies in One Year While Cutting a Third of Staff, Auditors Say
The National Audit Office says the cuts are running behind schedule and that officials have "less assurance" the boards will keep the skills they need.
Original reporting from public records by Watchman Report staff ·
Integrated Care Boards, the 42 bodies that planned and funded NHS services across England at the start of 2025-26, spent an estimated £582 million on voluntary and compulsory redundancy payments that year, the National Audit Office said in a report published Wednesday. NHS England funded about £400 million of that, with the boards paying the rest.
The restructuring aims to cut the boards' running costs by an average of 43%, from £32.98 per person to £18.76, saving an estimated £908 million a year. NHS England estimates that requires cutting about 8,000 full-time-equivalent posts, around a third of all board staff. Between November 2025 and June 2026, about 3,700 staff left through redundancy, the NAO said. By April 2026, mergers and clustering had reduced 42 boards to 25.
The redundancy programmes "have taken longer than expected," the auditors found. NHS England estimates running costs for 2026-27 will be about £1.4 billion, £200 million above the £1.2 billion target. Required cuts varied widely: Surrey Heartlands needed a 63% reduction, North East and North Cumbria 27%.
The NAO concluded that while the Department of Health and Social Care and NHS England "have closely monitored progress towards reducing running costs, they have less assurance about whether ICBs will retain the skills and capacity needed." Fifteen of the 19 boards or clusters that answered its survey said they wanted more guidance on their future roles. The boards were responsible for £171 billion in spending in 2025-26.
Watchman Report read the National Audit Office's value-for-money report "Restructuring of Integrated Care Boards" (HC 620, 2026-27) and its summary, published Nov. 4, 2026. All figures and quotations are from the report. The NAO does not audit individual boards.
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