Thousands of NHS staff at health trusts across England are to lose their jobs as deficit-hit employers struggle to balance their books, new research by UNISON finds today (Monday).
At least 21,000 roles are due to be cut by 2028 in hospitals and other health facilities, according to a major data-gathering exercise by the union.
The union’s new report, Less Fit for the Future, shows NHS providers ran up a combined deficit of more than £1.1bn last year.
It warns that efforts to meet the government’s demand for trust budgets to break even from this year are driving widespread workforce reductions across hospital, community and mental health services.
The fresh wave of NHS posts being axed – revealed by trusts in response to Freedom of Information requests – are in addition to major job losses at NHS England and integrated care boards announced last year, says UNISON.
The union’s research reveals trusts are planning cuts to at least 3,600 clinical roles including many nurses and other clinical staff, as well as support post reductions through vacancy freezes, restructuring and reduced use of agency workers. Many have not specified where the axe will fall.
Some of the largest planned cuts include University Hospitals Sussex NHS Foundation Trust, which is cutting more than 1,500 funded posts, and Blackpool Teaching Hospitals NHS Foundation Trust and Frimley Health NHS Foundation Trust, each planning to remove around 1,200 roles.
At the same time, huge financial pressures are being felt at trusts. They include East Lancashire Hospitals NHS Trust, which reported a deficit of more than £47m in 2024/25, and Barking, Havering and Redbridge University Hospitals NHS Trust, with a shortfall of nearly £39m.
Some trusts reveal they will be unable to balance their books by 2028 and could require additional government support. Hull University Teaching Hospitals NHS Trust, for example, warned it faces deficits of £50.2m and £46.2m in 2026/27 and 2027/28. Despite this, the government recently introduced financial penalties for trusts that failed to break even – a situation the union says could make matters worse.
UNISON says the true scale of workforce reductions is also likely to be significantly higher, as not all trusts were able to provide full workforce data in response to the union’s Freedom of Information requests.
A separate UNISON workforce survey of almost 20,000 NHS staff shows they are already feeling the pressure of financial strains. Nearly two-thirds (65%) of NHS staff say job cuts have led to an increase in their workload, while the same number (65%) report rising stress levels.
Almost half of staff (47%) report that systems and processes are slower following job cuts or vacancy freezes, while a worrying 42% say patients are receiving a worse service.
UNISON says the NHS is already hugely understaffed and needs to expand its workforce to meet rising demand, not cut it.
The union warns of a doom loop, with increased workloads leading to burnout, sickness and even more staff leaving overstretched services so the pattern continues.
The union is calling on the government to review the impact of break-even financial rules on staffing and services, and ensure NHS organisations are supported to expand their workforces to meet demand, rather than trim them.
UNISON head of health Helga Pile said: “Cutting thousands of NHS jobs is the wrong answer when staff are already stretched to breaking point.
“The public are all too aware how understaffing is a major problem, so they’ll be rightly alarmed when the situation’s getting worse.
“Years of underfunding have left many trusts out of pocket and ministers’ financial reset is creating deep uncertainty about services and staff.
“Morale is through the floor as workers worry whether their jobs are at risk, amid soaring levels of stress and violence.
“The NHS is being asked to transform how care is delivered, with more community services and technology. But none of this is possible without the staff to make it happen.”
Notes to editors:
– UNISON sent Freedom of Information (FOI) requests to 202 NHS provider trusts in England and combined responses with published accounts and NHS England financial data to build a national picture of deficits and workforce reductions.
– NHS trusts reported deficits of more than £1.1bn for 2024/25, but this was offset by more than £300m of surpluses, leaving an overall deficit of £818m.
– The Less Fit for the Future report can be found here. UNISON’s Your Life at Work survey received 19,356 responses from NHS staff. Both pieces of research will be discussed at UNISON’s annual health conference beginning today (Monday) at the Edinburgh International Conference Centre and continuing until Wednesday. Health workers from across the UK will attend.
– A 2025 British Social Attitudes survey found that 71% of people think there aren’t enough NHS staff.
– UNISON is the UK’s largest union, with more than 1.3 million members providing public services in education, local government, the NHS, police service and energy. They are employed in the public, voluntary and private sectors.
Media contacts:
Dan Ashley M: 07508 080349 E: d.ashley@unison.co.uk
Anthony Barnes M: 07834 864794 E: a.barnes@unison.co.ukUNISON
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