Thousands of NHS administrative and managerial staff in England are set to lose their jobs after the Treasury approved a deal allowing the health service to overspend this year to fund redundancy costs. Earlier, the government confirmed that 18,000 roles would be cut as part of major reforms bringing NHS England back under the Department of Health and halving staff numbers in local Integrated Care Boards. The £1bn cost of pay-offs will be recovered in future years through expected savings, with ministers insisting no additional funding is being provided beyond existing spending plans. Health secretary Wes Streeting argued that patients and staff want bureaucracy reduced so frontline care can be prioritised, saying the reforms would help rebuild the NHS. Government estimates suggest the changes could save £1bn annually, enough to fund over 100,000 extra hip and knee operations. However, the Royal College of Nursing warned that losing expert staff risks harming patient care rather than improving it. NHS leaders have called the agreement 'pragmatic' but acknowledged the uncertainty and disruption facing affected workers.