The NHS chief executive is tying nursing directors to controversial staff cuts by saying they must sign all such savings plans.
The demand from Sir David Nicholson last week follows many hospital trusts announcing plans for significant post reductions, including of nursing staff. The Royal College of Nursing has said it has identified plans for nearly 40,000 post cuts, and as many as half may be clinical.
Many hospital trusts are preparing for their funding to stand still or fall while costs rise.
In a letter to all NHS chief executives Sir David suggested the Department of Health had limited the need for staff cuts with the national pay freeze for most employees, and focusing on reducing sickness absense through improved health and wellbeing.
He added: “Where significant staffing changes occur, we expect plans to be agreed with medical and nursing directors, as well as workforce and finance directors, to assure the resilience of quality and safety.”
It follows high profile cases of failure like Mid Staffordshire Foundation Trust where it has been suggested major cost and staff cuts led to appalling treatment of patients.
Dartford and Gravesham Trust nursing director Jenny Kay said: “I would think it unimaginable that any trust board would make a decision to reduce clinical posts without the full involvement of their medical and nursing directors.
“Any such plans must be based on real evidence of changing pathways or clinical developments. We do have to accept that the NHS is changing - in future there will be less care provided in hospitals, more care in the community.
“The NHS will also have to show that it is offering cost effective services. So it is inevitable that workforce changes will be needed, but these must be supported by clinical rationale and support.”