Strategic health authorities are actively exploring cutting local NHS workforces by up to 10 per cent in order to make the £15bn-£20bn savings required by 2014.

NHS South East Coast’s latest board documents included a “near final” version of its operating framework for 2010-11, which said the 10 per cent increase in size of its local NHS workforce over the last two years “must be reversed”.

I’m not interested in proposals. I want the money in the tin; I’m counting on the money

Sir David Nicholson

“The numbers must return to 2007 levels - or further - in the period to 2012-14, starting in the coming year,” it said, suggesting a headcount reduction of 10,000.

Figures collated by NHS North West show NHS organisations across the region are planning to reduce their total workforce by a similar amount: 8 per cent - or 5,500 full time equivalents - by the end of 2011-12.

The bulk of that will be non-clinical staff with a 17 per cent reduction in their numbers from just under 22,000 to just over 18,000.

The documents suggest SHAs are considering workforce reductions similar in size to the 10 per cent cut proposed by consultancy McKinsey in a report prepared for the department of Health and revealed by HSJ last September. Ministers said at the time the proposals contained in the report had been rejected.

A senior director for NHS Yorkshire and the Humber told HSJ the McKinsey report formed the basis of the region’s analysis of the quality, innovation, productivity and prevention (QIPP) programme.

However, contacted by HSJ, a spokeswoman for NHS South East Coast said the part of its report on workforce reduction had been retracted.

She said: “The document is now being finalised. There is no intention of reducing the workforce; that is not what we need to do to meet the challenges ahead.

“The section has been revised to say that we must have a flexible, responsive workforce.”

The SHAs’ plans come after the 2010-11 operating framework for England set out a primary care trust and SHA management cost reduction target of 30 per cent by 2013-14.

Speaking last December, NHS chief executive Sir David Nicholson said he wanted the NHS to “front load” the cuts with as much as half of them achieved in 2010-11.

Sir David told HSJ he was relatively open minded about how organisations made their cuts but they needed to be firm and implemented rapidly.

He said: “I’m not interested in proposals. I want the money in the tin; I’m counting on the money.”

The target has now been absorbed into QIPP’s back office efficiency and management strand, which is being led by Tony Spotswood, chief executive of Royal Bournemouth and Christchurch Hospitals Foundation Trust.

Asked if he thought the 30 per cent cuts to management costs would mean redundancies, Mr Spotswood said: “I think if we are going to see some radical changes, not all of that is going to be made up by natural wastage.”

Management savings would be “one of the areas we look at early on”, he said, although it had to be “balanced with retaining appropriate capacity”.

The threat of job cuts for both managers and their staff comes as union officials and managers attempt to agree proposals to help avoid redundancies by asking staff to work “short time” - for example by moving to three-day weeks.

But a leaked briefing paper by the Foundation Trust Network said compulsory redundancies may need to be considered, alongside a raft of other changes to employment conditions.

Senior national officer for Unison Mike Jackson said it was disappointing but the union did not believe the paper reflected the view of most foundation trusts.

He said the union wanted to explore the possibility of job guarantees in talks that began last week, as it “recognised job security is the priority for our members”.

Chartered Institute of Personnel and Development public policy adviser Gerwyn Davies said short working had been successfully used over the last two years by private companies trying to survive the recession.

The institute has done research suggesting 15 per cent of companies did that with just 7 per cent actually cutting wage rates.

This week health minister Mike O’Brien said: “The main conclusions of the McKinsey report were rejected by ministers so it is nonsense to suggest it is some kind of NHS plan of action.

“Our focus over the next five years will be protecting and improving frontline services and supporting NHS staff.”

It’s crunch time, but job cuts are not the only way to save the NHS money