The North West NHS · 2025/26 and the year ahead
Across the North West, the tighter the money, the deeper the workforce cuts — and the more red-rated risks pile onto trust boards.
The pressure to find savings — at least £1.09bn across the North West in 2026/27 — comes at a price. It is driving trusts to reduce the cost of workforce, affecting what trusts can deliver, overloading staff and creating very serious risks to the standards and availability of healthcare.
£665m of that total is the trusts’ own savings programmes — the part that bears directly on staffing — and it counts only the 16 of 31 trusts that have published a figure. The rest is what the three commissioners must save from their own budgets.
Nine of sixteen trusts in Cheshire & Merseyside, seven of nine in Greater Manchester, four of six in Lancashire & South Cumbria.
The evidence runs in three steps. Each has a section of the briefing.
Posts did go — 1,560 clinical support roles across the region. But of the 20 trusts that set a target to cut posts, 13 finished the year above their own workforce plan.
Read this section2Ninety-three risks are rated very high to extreme by the boards that own them — and they are not confined to money.
Read this section3Only about a third of North West staff say there are enough of them to do the job; around three in ten say they are often or always burnt out.
Read this sectionOur reading of that evidence
NHS commissioners and hospitals have become caught in a dangerous annual cycle, chasing unrealistic financial targets and making plans to cut workforce costs.
Cuts to the workforce are being made, but often not on the scale planned. Last year, 20 of 31 set a target to cut posts: 16 reported a reduction, in full or in part, and 13 finished the year above their workforce plan. Seven trusts are in both groups — they made some of the cuts they planned but still ended the year above the level their own plan set. Trusts highlight patient demand and safety as putting the brake on their plans, and in some cases the staffing spend rose, reaffirming the idea that trusts’ savings plans are frequently unachievable. See it trust by trust
Clinical support posts fell at 19 of the 26 North West trusts that can be tracked, by 1,560 over the year to April 2026. Five trusts cannot be tracked on the same basis. Over the same year the registered clinical workforce grew by 1,634: doctors, nurses, midwives and scientific and therapeutic staff all rose.
Beyond permanent posts, the workforce costs were reduced in a patchwork of ways. At least 18 of the 31 trusts have run a mutually agreed resignation or voluntary redundancy scheme; at least 26 have run a vacancy control panel or recruitment freeze. Cheshire and Merseyside, the one North West system publishing the detail, planned to cut bank staffing by 16.6% and agency by 35%. By March 2026 agency use was running 23% below plan at nine of its sixteen trusts, but bank use was 28.5% above plan at fifteen of the sixteen.
The strain shows in the boards’ own registers. In 93 instances risks were rated “very high” to “extreme”, 30 of them at the top of the scale. The same boards record this pressure delaying investment in staff and buildings.
Only around a third of staff in the North West say there are enough of them to do their job properly; around three in ten say they are often or always burnt out, and a similar share think about leaving.
Explore a whole system, then click into any trust ↓
Showing Cheshire & Merseyside only — the system, its worked example, then every other trust in it. Switch system above.
Showing Greater Manchester only — the system, its worked example, then every other trust in it. Switch system above.
Showing Lancashire & South Cumbria only — the system, its worked example, then every other trust in it. Switch system above.
Each tile reads top-to-bottom Finance → Workforce → Risk → Staff: the money pressure, the workforce response, the board risk it creates, and what staff say. Colours are red / amber / green by severity; — means not yet sourced. Figures from published board papers and NHS Staff Survey 2025.