Government drive for integrated care boards to cut headcounts by 50% is leading to designated doctor and nurse roles being put at risk of redundancy or amalgamated with other posts, says charity
Government-ordained NHS job cuts are hitting specialist roles designed to improve the health and wellbeing of looked-after children, social care leaders have warned.
Charity CoramBAAF and the Association of Directors of Children’s Services (ADCS) have raised the alarm about the impact on NHS support for children in care of integrated care boards (ICBs) reducing their complement of designated doctors and nurses for looked-after children.
The Department of Health and Social Care (DHSC) has asked the 42 ICBs, which are responsible for commissioning NHS services within their regions, to cut their workforce headcounts by 50%, as part of moves to redirect £1bn from “bureaucracy” to patient care.
The DHSC has said that the move, combined with the absorption of NHS England by the department, would lead to the loss of 18,000 “administrative posts”.
However, CoramBAAF, the good practice body for adoption, fostering and kinship care, said that it had been told that designated doctor and nurse posts were being put at risk of redundancy or being amalgamated into other roles.
Looked-after children professionals’ responsibilities
Under statutory guidance on promoting the health and wellbeing of looked-after children, all ICBs must have “access to the expertise of a designated doctor and nurse”, to help NHS commissioners fulfil their responsibilities to improve healthcare for children in care.
Competencies for the role drawn up by representatives of the medical royal colleges include:
- Ensuring quality of health care and improved health outcomes for children in care and care leavers, providing advice and oversight and leading innovation and change to improve outcomes and reduce disparities.
- Providing advice to professionals and leaders about health services to children in care and care leavers.
- Incorporating feedback from, and the voice of, children and young people to ensure that services are relevant and accessible, and ensuring mechanisms are in place to enable consultation, participation and involvement.
- Ensuring continuity and quality of services for children placed out of their local area, and ensuring governance arrangements are in place for the commissioning of specialist placements for this group.
Posts ‘pivotal to children’s social care reforms’
In a blog post published last month, CoramBAAF’s health consultant, Ellie Johnson, a former designated nurse, said the roles “ensure that clinical expertise as well as trauma informed understanding, knowledge and advocacy for care experienced children and young people exists at the heart of the strategic decision-making bodies in the NHS”.
She wrote that the knowledge held by these professionals was “not normally available elsewhere in the ICB”, and that the practitioners should be “pivotal” to the delivery of the government’s children’s social care reforms.
These include a new “corporate parenting duty” on a range of government and public bodies, including ICBs, which will require them to, among other things, take action to help looked-after children and care leavers access their services and provide them with opportunities to enhance their wellbeing.
Children in care roles ‘being cut or amalgamated’
However, Johnson added: “We have been informed that staff in some of these roles have received notice that their job is at risk and that some posts are being amalgamated with the idea that individuals will cover much wider population areas. In some instances, posts are also being combined with other safeguarding and SEND roles resulting in the reduction of time for children in care responsibilities.”
“It is wrong for such important roles to be caught up and so significantly changed in this far-reaching restructure without proper consideration of the potential impact,” she added.
In a subsequent interview with Community Care, she said she had come across knowledge of the proposals through her attendance, on behalf of CoramBAAF, of meetings of the National Network of Designated Healthcare Professionals for Children. The network brings together designated doctors and nurses for looked-after children, and those in parallel roles with responsibility for safeguarding children and child death overview panels.
ICBs were established in 2022, replacing clinical commissioning groups (CCGs), of which there were 106 at the time of their abolition, though there were previously as many as 211.
Johnson told Community Care that, previously, there was approximately one designated nurse per CCG, while each group also had an allocation of designated doctor hours, generally amounted to less than a full-time post.
She said that while there was a small reduction in the number of posts after the abolition of CCGs, significantly greater reductions were being planned now.
Understanding the law and supporting children out of area
Alongside shaping ICBs’ commissioning decisions to take account of the needs of looked-after children, designated professionals were also the ICB staff who best understood the legislation, regulations and statutory guidance relating to the care system, adoption and fostering, she added.
Their roles also encompassed supporting individual children, particularly those placed out of area, of whom there were 36,350 in England – 44% of the total care population – as of 31 March 2025 (source: Department for Education).
“There are often difficulties in meeting children’s needs out area, and designated nurses, in particular, are very often involved in trying to address those issues,” Johnson told Community Care.
Cuts ‘risk gaps in support for children in care’
The proposals also sparked concern from ADCS, whose president, Rachael Wardell, warned: “ICBs are being put in an impossible position, where significant cuts with up to 50% reductions need to be made without a national directive that statutory functions in safeguarding, SEND and continuing care must be upheld and improved.
“Cuts to designated doctor and nurse roles risk weakening longstanding safeguarding arrangements, delaying decisions, and creating gaps in support that directly affect the health and wellbeing of children in care.
“Health partners must sit at the table alongside local authorities and other agencies if the system is to work effectively for children. Reforms to ICBs should strengthen joint working and protect children, rather than undermine, the services that safeguard them.”
ICBs ‘having to take difficult decisions’
From an NHS perspective, Sarah Walter, interim deputy chief executive of the NHS Confederation and director of its ICS [integrated care systems] Network, said: “ICBs are having to make difficult decisions as they undertake significant staffing reductions at the same time as taking on their new function as strategic commissioners.
“Given the scale of the reductions they must make, many ICBs have clustered together and begun merging arrangements to achieve economies of scale and remain viable organisations capable of meeting statutory duties, mandated by NHS England, at a much lower running cost. Few, if any existing functions or teams within ICBs will be unaffected by these restructures.”
The government is currently reviewing the statutory guidance on promoting the health and wellbeing of looked-after children.
Source: Community Care
