Canary, this is not new, this is not "further cuts". It depends which part of the NHS your wife works in, mafbob - my NHS employer had to make management cuts of 45% before 31 March this year. There is no money washing around in our part of it, and my team only had 2 or 3 sick days in the whole of last year. Those of us managing teams are all targeted with reducing sickness absence. It can't carry on like this, the NHS is so overspent, we have get back to a modicum of budgetary constraint. The NHS has been grossly overspent for years - if the Tories hadn't come in, Labour would still have had to to cut back funding, they were giving money they hadn't got. The hospitals are at the moment commissioned by the PCTs and once they become Foundation Trusts they will be responsible for their own budgets - but the services (as sqad says) will be commissioned by the GP Consortia. Trusts which don't perform or don't deliver may not get the contracts.