Government reforms are leaving managers without a lifeline

When the NHS is discussed in the media or political circles, we hear of frontline pressures such as ambulance delays, bed shortages, and clinical demand. These stories sell newspapers, provoke public outcry, and ultimately influence policy and votes, so it is not surprising that they dominate the headlines. Yet behind the headlines, there is another crisis quietly undermining the system from within.

A crisis that rarely earns any column inches, receives minimal attention from the general public, and is often overlooked by policymakers, while being no less damaging to the health of the system. This is the breakdown of internal support services that managers rely on to keep services running smoothly. These are the behind-the-scenes teams that team leaders rely on daily, handling recruitment, training, rostering, and more, so that services run smoothly and staff can be supported.

NHS operational leaders are tasked with delivering safe, efficient, and patient-centred care. But increasingly, they are being failed by the corporate services designed to support them, including recruitment, HR, training, IT, and rostering teams. These are not optional extras in a manager’s toolkit; they are critical components for operational delivery.

Without these supportive services, operational leads cannot recruit staff, access training, or resolve HR issues that underpin clinical care. Managers have no choice in who provides these services, nobody to escalate concerns to, and no alternatives when these services fail to deliver.

 It will not be the lack of clinical staff that breaks the system. It will be the silent, unreported collapse of the infrastructure that holds the NHS together

This lack of support is becoming alarmingly routine for NHS managers. Recruitment lines frequently ring out with automated messages, offering no option to leave a voicemail, leaving callers stuck in a loop with no resolution. HR responses are often limited to lengthy, two-page out-of-office emails that simply direct managers to policies they have already reviewed, with no human follow-up.

Meanwhile, training and IT teams regularly take days or sometimes even weeks to respond, citing “capacity issues” or “short staffing” as the reason for delays. These recurring obstacles are not just frustrating, they are symptomatic of a deeper breakdown in the internal support infrastructure. They create delays, inefficiencies, and confusion that is felt through whole teams like a ripple effect. Team leaders are left navigating a warren of bureaucracy, often without guidance or timely support.

So why is this happening? The answer can be found in a sustained drive to reduce corporate staffing across the NHS, which is a familiar pattern to anyone who has worked in the NHS for a number of years. As integrated care boards and trusts merge, corporate teams are being streamlined. Staff are left in limbo for extended periods - in the case of the ICBs, nine months and counting - unsure if they will have a place in the organisation when the dust settles.

These team members are often told they need to reapply for the jobs they have been doing for years. Morale has plummeted, trust eroded, and many have simply disengaged.

The result is a dangerous paradox that managers are expected to do more with less, while the support structures they depend on are unresponsive. Team leaders are spending hours chasing answers, deciphering policies, and firefighting issues that should be resolved with a single email or phone call. Every minute spent doing this is a minute not spent supporting their overworked, understaffed teams, focusing on elements such as best practice or risk, or (wait for it) seeing patients.

Let us be clear, corporate support services are not a luxury, they are a necessity. Without them, the NHS cannot function. If the government does not act swiftly to stabilise and prioritise these services, it will not be the lack of clinical staff that breaks the system. It will be the silent, unreported collapse of the infrastructure that holds the NHS together. These are the systems, teams, and processes that ensure that clinical staff are able to do their jobs effectively and safely.

Over its 77-year history, the NHS has consistently proved that it is a world leader in healthcare and resilience. But resilience without support is just burnout waiting in the shadows to happen. If we keep on this trajectory without intervention, we could witness the slow, silent dismantling of the NHS. Not through a spectacular collapse, as some may predict, but through slow erosion of the very systems provided to keep it alive.