Kent and Medway Integrated Care Board (ICB) in south-east England is demanding unprecedented cuts from Medway NHS Foundation Trust (MFT) over the next five years, threatening hospital services, treatment and patient safety.

Kent and Medway are the canary in the coal mine for the National Health Service’s (NHS) wider financial crisis. Its health system recorded England’s largest deficit in 2025/26: £190.2 million with government support funding, rising to £259.3 million without it. According to MFT board papers reported by the Health Service Journal (HSJ), MFT must cut its workforce by 14.7 percent—861 full-time equivalent (FTE) posts—and deliver £143.8 million in savings, 26 percent of its costs, by 2030/31.

This is not an isolated failure. The Labour government’s NHS 10-Year Plan, now being implemented by Andy Burnham, demands £17 billion in annual “efficiency savings”, threatens up to 100,000 jobs and transfers £2.5 billion in patient care to private providers each year.

A report by public sector union UNISON, based on Freedom of Information, exposes the scale of planned NHS job cuts as trusts face government demands to balance the books. Deficit-bound trusts such as MFT risk losing even limited financial support with funding tied to break-even clauses.

UNISON found that trusts plan to cut at least 21,663 funded NHS posts nationally between 2024/25 and 2027/28, including more than 3,600 clinical roles such as nurses, midwives and healthcare assistants. The union warns that the real figure could be as high as 30,000. Not all 202 trusts supplied full data, and many said their plans were incomplete.

These cuts add to the Trump DOGE-style plan announced last year by then health secretary Wes Streeting to cut 20,000 jobs across NHS England and the ICBs.

The south-east of England faces the largest reported cuts—5,152 FTE posts—followed by London with 4,232 and the north-west with 3,701.

Jobs are being eliminated through vacancy freezes, recruitment controls, attrition, and Mutually Agreed Resignation Schemes (MARS) that offer limited compensation. Presented as cuts to non-patient-facing roles, they dismantle support essential to safe care.

In Kent, MFT, and Dartford and Gravesham NHS Trust opened MARS to staff in all departments last November, with chief executive Jonathan Wade telling KentOnline, “like all NHS trusts, we need to significantly reduce our costs”, including by “reducing our staffing levels”. East Kent Hospitals confirmed redundancies across all corporate departments, affecting under 1 percent of staff, alongside restricted recruitment and reduced bank and agency staffing.

Last year, Streeting paused further plans to transfer the lowest-paid NHS workers into subsidiary companies, or “subcos”, used by trusts to slash pay and conditions, but this was a manoeuvre to restore relations with the trade unions to enforce the budgetary cuts via other means and block widespread opposition.

MFT, one of nine trusts in NHS England’s turnaround programme and one of 14 rated “red” for capability, warns in its board papers that the ICB proposals create “disproportionate risk”. This meant an underlying deficit of £74.6 million, with deficit support falling from £35.4 million to zero by 2030/31, £9.4 million lost through “deconstructing” block contracts, and “ambitious” workforce assumptions.

Across the NHS, trusts ran up a combined deficit of £1.1 billion in 2024/25, UNISON found, which other trusts offset with surpluses, achieved through efficiency drives that cost jobs and weakened services.

A separate UNISON survey found that 65 percent of NHS staff reported increased workloads and greater stress. The waiting list rose again to 7.33 million in July, while prolonged A&E delays were linked to over 300 deaths a week in 2025—around 10 times the figure a decade earlier.

The government’s regime—“very much a ‘top-down’ approach”, as MFT’s paper puts it—pushes deficit-bound trusts into a spiral of ever deeper cost-cutting. Withdrawing support funding and “deconstructing block contracts” strip hospitals of the stability needed to maintain services. This creates the conditions for greater private-sector involvement. As trusts cut capacity, consolidate “shared corporate services” and “redesign pathways”, outsourced providers are positioned to fill the gaps.

Under Labour’s 10-Year Plan, the government will introduce Private Finance Initiative-style funding for 250–300 Neighbourhood Health Centres, despite PFI schemes saddling the NHS with £80 billion in repayments under the Blair Labour government.

Defending cuts to hospitals and acute care, ICB chief finance officer Jonathan Wilson said funding is being redirected into prevention, primary care, community services and mental health support so that people can be treated closer to home “whenever it is safe and appropriate.”

But MFT’s own paper says the “evidence chain” linking community investment to reduced hospital demand is incomplete, with benefits “indicative rather than committed”. Dorset HealthCare University NHS Foundation Trust, which runs community services, plans to cut 599 posts. Devon Partnership NHS Trust closed a specialist mental health programme in 2025 and transferred patients to community teams, undermining services expected to provide care closer to home.

The pattern extends well beyond Medway. UNISON’s Less Fit for the Future report found that Kent Community Health NHS Foundation Trust plans to remove around 884 posts. Elsewhere in the South East, University Hospitals Sussex NHS Foundation Trust is cutting around 1,530 posts and Frimley Health NHS Foundation Trust around 1,200. In the North West, Blackpool Teaching Hospitals NHS Foundation Trust plans to remove around 1,200 roles.

East Lancashire Hospitals NHS Trust reported a deficit of more than £47 million in 2024/25. Hull University Teaching Hospitals NHS Trust faces deficits of £50.2 million in 2026/27 and £46.2 million in 2027/28. Yet the government has introduced financial penalties for trusts that fail to break even, a measure UNISON warns could make matters worse.

The Burnham government’s “priority” of slashing public spending to fund rearmament is driving the cuts. The King’s Fund warned that Starmer’s Defence Investment Plan—adopted in full by Burnham—would draw on NHS capital budgets, leaving hospitals with delayed building projects, outdated scanners and mounting maintenance backlogs. Its policy director, Siva Anandaciva, warned that cutting investment in NHS buildings and equipment “will have a knock-on effect on patient care.”

Underscoring this commitment, Defence Secretary Wes Streeting is providing Ukraine with a minimum £3 billion annually to sustain NATO’s war against Russia. The government will slash tens of billions more from the NHS to fund Burnham’s pledge to raise military and related spending to 5 percent of GDP by 2035. The appointment of John Healey as chancellor—who resigned as Starmer’s Defence Secretary demanding a massive increase in military spending—confirms the direction of travel. The NHS is being dismantled to pay for war.

UNISON’s figures expose the scale of the assault, yet its leadership has mounted no opposition. Responding to the mass jobs cull in Kent, the union said it opposes “all compulsory redundancies” and called for “full and genuine consultation”. UNISON, like the other unions, has long used the fig leaf of no compulsory redundancies while collaborating to destroy jobs through “voluntary” means, burdening NHS staff with greater workloads and undermining patient care.

UNISON backed Starmer into Downing Street, hailing Labour’s policies as “moves in the right direction” even as thousands of health workers faced dismissal. UNISON general secretary Andrea Egan, elected last December as a self-styled “left” on a turnout of just 7 percent, has committed to a “constructive working relationship” with Labour, greeting Burnham’s arrival as “the first chance for tangible change in a long time.”

NHS FightBack calls on workers and patients to build independent rank-and-file committees against NHS cuts, privatisation and the diversion of public funds to war. Subscribe to our newsletter and contact us today!