Key NHS roles supporting children in care in England are being affected by Integrated Care Board (ICB) workforce reduction
With changes to the NHS happening at pace, CoramBAAF is concerned by reports of specific roles in the health workforce which support and advocate for children in care being reduced or cut. As these reforms take place it is vital we don't inadvertently lose support for some of our most vulnerable children.
CoramBAAF and its predecessor organisations has provided membership services to health professionals who work with children in care since 1964. Our current Health Advisory Committee, formed of NHS professionals from around the UK, provides invaluable expertise to the CoramBAAF community. At our recent committee meeting in December 2025 details regarding NHS organisational change were shared, with a particular focus on the impact of ICBs being instructed by government to implement workforce reduction. Concerns were raised about how some of the proposed changes would affect the statutory designated nurse and doctor roles for children in care in England. These designated roles provide multi-faceted functions, but most importantly 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. More information about the designated health professional roles (level 5 roles) can be found in the recently published intercollegiate competencies framework Competencies - Intercollegiate document (2025) Safeguarding children and young people & children and young people in care: Competencies for health care staff.
These important roles are commissioned and/or employed by ICBs, the current NHS commissioning organisations. Now that ICBs are releasing their new staffing structures, it is evident that these crucial roles will be negatively affected in many areas. 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.
Individuals in these designated doctor and nurse roles are often key professionals in multi-agency partnership working and they have critical expertise in the legal frameworks and social care processes for children in care. This knowledge and competency is not normally available elsewhere in the ICB. These experienced professionals should be pivotal in the Government's current and proposed children's social care reforms, particularly in the delivery of the corporate parenting agenda, yet if the workforce reductions proceed, they will be absent just when they could have most impact. There has not been meaningful consultation at a national level about the impact of these changes and these workforce changes are now happening at pace.
Just one of the many responsibilities of these designated health professionals is to ensure that the health needs of children in care who are moved away from their home area are addressed and supported. The latest statistics show that 45% of children are placed outside of their home LA border with 22% living more than 20 miles from home, so there is certainly no reduction in this area of work.
We would urge social care directors of services, virtual school heads, corporate parenting boards and partners, and adoption and fostering agencies to be alive to these plans locally and the potential impact on multi-agency working. At the very least a determination of impact seems crucial.
We have also noted a live petition which is asking for an impact assessment relating to the wider redundancy situation. The petition is asking the government to halt redundancies until impact assessments are conducted on their impact in delivering the 10 Year Plan. You can find the petition here: Halt proposed NHS redundancies affecting 18,000 staff pending impact assessment.
These roles can make a major difference for children in care and the services and support available to them across agencies - 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.
CoramBAAF is working with its members, committee and other national networks and organisations to monitor and raise questions about this situation. Please do contact me ellie.johnson@corambaaf.org.uk if you have any concerns, information or opinions that you would like to share about these changes.
Ellie Johnson, Health Consultant, CoramBAAF