ICB Watch · NW NHS workforce evidence

Northern Care Alliance (Acute (group) · Greater Manchester)

2026/27 — the year ahead

£104mthe savings this board must find in 2026/27.CIP target, 5.5% — financial balance in 26/27 needs £104m CIP plus a further £19m (1%) via a joint NCA–GM ICB strategic service review
No 2026/27 workforce target published — none appears in the public papers we hold. iWhat does a “workforce reduction” mean? Not always people losing their jobs. Boards count in WTE — units of one full-time post — and the routes differ in who they touch. Cutting agency work: paid work lost, but no NHS post existed. Cutting bank shifts: extra shifts mostly worked by the trust’s own staff — a pay cut that never shows in post counts. Freezing vacancies: no one is dismissed, but the post and its future job go, and the work lands on those who remain. Deleting posts shrinks the establishment itself. Voluntary exits: MARS is a paid resignation without redundancy rights; voluntary redundancy is redundancy on volunteered terms. Compulsory redundancy is the rarest route — boards report it separately in their audited accounts.
Last year
Cut posts in 2025/26 — its figure counts all staff — substantive plus bank and agency — and still finished above its workforce plan. 546 WTE above its substantive plan at March 2026 (18,023 against 17,477) and 739 above on total workforce; March alone added 202 WTE, mostly bank and agency. How they went about it: a voluntary exit (MARS) scheme ran and recruitment controls operated. National payroll figures show that over roughly the same period (April 2025 to April 2026) the trust’s workforce grew by 107 whole-time-equivalent (WTE) posts (+0.6%).
Who was cut

The national payroll change above, broken down by staff group (April 2025 to April 2026):

NHS infrastructure support
−97
Support to clinical staff
−96
Central functions
−72
Managers
−54
Hotel, property & estates
+8.8
Senior managers
+20
Professionally qualified clinical staff
+301
Risks it carries
The board’s own risk register scores 11 risks at 15 or more out of 25 iHow risk scores work. Boards score each risk out of 25 (how likely × how serious). We mark every score of 15 or more red — the range treated as very high or extreme. The highest of them:
  • “Digital Systems Sustainability” — 20 of 25 — financial pressure
  • “Financial Delivery” — 20 of 25 — financial pressure
  • “Cyber Security” — 20 of 25 — IT, data and cyber risk
A Section 29A Warning Notice was issued on 21 October 2025 due to concerns that significant improvement was required to reduce the risk of harm to patients. The warning notice focused on: Staffing levels across surgical wards; Inadequate systems and processes for identifying and managing risks to quality and safety.
Local Safety Standards for Invasive Procedures – LocSSIPs remain in an unsafe position due to repeated delays, inconsistent processes and unrealistic timelines, creating a material patient safety risk and exposing weaknesses in capability and assurance.
What staff say
27.9%say there are enough staff to do their jobtheir benchmark group: 31.3%
32.9%often or always feel burnt outtheir benchmark group: 32.4%
30.9%often think about leavingtheir benchmark group: 29.9%
NHS Staff Survey 2025 · compared with similar trusts iNHS Staff Survey 2025. The comparison figure is the average of the trust’s own “benchmark group” — the set of similar trusts NHS England compares it with.
Why the cuts?
The trust’s own papers state why it is reducing its workforce: its own financial position — the deficit or savings gap it faces; and its savings programme (what the NHS calls a cost improvement programme, CIP). iThese are the reasons the trust itself gives for its workforce reduction, coded from its public board papers. Wider pressures — on services, waiting times or safety — appear under “Risks it carries”, from the board’s own risk register.
On the record — the board’s own papers & where every figure comes from
  • NCA 2025/26 planned substantive WTE curve: M1 17,958 falling to M11 17,399 (M12 17,477) — 481 WTE M1 to M12 NCA Board of Directors Papers March 2026 — Workforce Performance Plan vs Actual table · p.132
  • NCA 2025/26 ACTUAL substantive WTE M10 vs plan — 495 above plan NCA Board of Directors Papers March 2026 — Workforce Performance Plan vs Actual table · p.132
  • NCA December 2025 in-month WTE — net +93 WTE INCREASE despite annual reduction plan NCA Board of Directors Pack 14 January 2026 — Month 9 Finance Report · p.124
  • Northern Care Alliance runs MARS scheme (launched May 2025) NCA Board of Directors Meeting Pack — November 2025 · p.10
  • Northern Care Alliance vacancy-hold + MARS in-year savings NCA Board of Directors — 14 January 2026 (Workforce + Vacancy Hold report) · p.108
  • NCA Workforce Efficiency Programme Phase 1 vacancy hold — ~£12m saved by Jul 2025 NCA Board of Directors papers, 2 July 2025 · p.34
Sources: the trust’s own board papers (cited above) · NHS England workforce statistics (Apr→Apr, our arithmetic) · NHS Staff Survey 2025 · every figure is traceable to the evidence ledger on the audit twin of this page
Plain-English key
WTE / FTEtwo names for the same measure — one full-time post’s worth of paid staff time (two half-time staff count as one). It is a unit of time, not a count of people: a reduction of 100 WTE can mean fewer people, fewer hours, or fewer bank and agency shifts, and is usually a mix. Boards plan and report in WTE across all staff — permanent, bank and agency together — and so does this card, which says which of those a figure counts. Boards write WTE (“whole-time equivalent”); the national statistics write FTE (“full-time equivalent”).
CIP“cost improvement programme” — the NHS term for a savings plan.
Deficitspending more than the money coming in. A trust whose plan is a deficit is planning to end the year in the red by that amount.
MARS“mutually agreed resignation scheme” — a voluntary paid-exit scheme.
Establishmentthe number of funded posts a trust plans to employ — its budgeted staffing level — whether or not each post is filled. Removing a vacancy from the establishment cuts the planned staffing level without anyone losing a job.
Substantivepermanently employed staff, as opposed to bank or agency staff.
Benchmark groupthe set of similar trusts NHS England compares each trust with in the staff survey.
ICB“integrated care board” — the NHS body that plans and funds care for an area.