Our working conditions and the care for patients are under attack at Southmead hospital and the BRI. We have already reported about the plans to close the Acer Detox unit at Southmead and the tension around using private companies in surgical theatres. At UHBW, management plans to cut jobs and reshape services at the Unity sexual health clinic.
Many fellow hospital workers that we spoke to both at Southmead and the BRI didn’t know that these attacks were happening. We need to be aware of them, firstly to support the colleagues who are directly affected, but also because these job cuts will affect our own conditions in future. If they close a Detox unit, people with substance issues will just wash up in ED or on hep wards. If they cut services in sexual health, people will be treated later and end up sicker on general wards. If commissioners, politicians and management see that they can get away with cuts in one area, they will be tempted to be more bolshy in general.
The interview below shows us the difficulties. With the commissioning process and various levels of political hierarchies involved, everyone can blame everyone else for the cuts. With a service that is already separated out into various charity and NHS organisations, it is more difficult to find a common answer. But it is possible!
We know many examples where health workers and patients have successfully defended jobs and services. In the UK in the 1970s to the 1990s hospitals threatened with closure were occupied and run under worker-patient control, until the politicians reversed the closure. More recently in France, workers and patients defended a mental health unit from cuts and workers in Buenos Aires a whole hospital. In Germany, midwives and women successfully campaigned to keep a maternity clinic open. In Bristol, local community action managed to defend a dental clinic in St.Pauls.
Things can be done, we just have to take the first step and come together face-to-face and start planning. On Saturday, the 22nd of November 300 people protested in Bristol city centre against the cuts in disability benefit / personal independence payment – a wide working class front against the cuts is possible. If you are up for meeting up about the hospital cuts, drop us an email and please share this article with colleagues and patients.
“The Unity sexual health clinic has around 92 staff and provides various sexual health related services, from rapid testing for sexually transmitted diseases to contraception advice to abortion services.
Because of the tendering system, there are various organisations and charities involved at Unity. For example, Brook deals with services for young people under 20 years of age, the Terrence Higgins Trust does a lot of health promotion around HIV and Brigstowe is a local charity for HIV advice and support. The abortion service is split up, as well, as the initial assessment is mainly done by the charity MSI Reproductive Choices UK supported by the clinical care team at UHBW NHS Trust. Most of the actual clinical service for sexual health is done by UHBW, but even there you might have a situation where a nurse might have a part-time contract in the community clinic and another contract for abortion care. Also the lab work is separated, as we have a microscopic lab on site and a sub-contracted lab technician, but many samples are processed by the neighbouring North Bristol NHS Trust.
Despite the fragmented nature of the organisations, the actual clinical team has been very consistent, with many doctors and nurses working together for more than a decade. There is a lot of expertise and collective knowledge, which is now threatened by the restructuring and job cuts.
In March 2024 the contract for the Unity sexual health services came up for retendering, meaning, the health commissioners send out a proposal and organisations can bid to get the contract. As workers, we are left predominantly in the dark about these proceedings. We knew that UHBW tried to come up with a bid that would fit the commissioners’ proposal. In July 2024 the tendering process was closed and we found out that UHBW decided not to put in a bid, as the conditions were too bad. The proposal basically required that with less funding and less staff we were supposed to expand our services, both geographically and in terms of weekend work. Since Covid, sexual health services are not part of NHS funding anymore as public health was moved to council funding, and they claim to have no money.
In September we heard that basically no one put in a successful bid for the clinical care services, while a different organisation would take over the digital / social media part of our clinic. As there was no bid on the table the commissioners approached UHBW and they started negotiating. They then came to an agreement and in February 2025 we were finally presented with a rough model by the business team about how our services would be restructured under the new contract. So at that point our team had gone through a whole year of having job changes and potential job cuts hanging over our heads. This had a very negative impact on the work atmosphere and on the services, as well. For example, we used to send out postal testing kits, so that people could test for STIs at home. This scheme was closed down without warning, as there was a gap between then and when the private company who will be taking over this element of the service starts properly. The retendering process created tension amongst the staff and required an extra-layer of bureaucracy, for example in the form of a ‘change manager’ who had been hired to overlook the change of contract. The general public, the patients and the users were not really informed about the upcoming changes, they only heard about it from staff informally.
Once it was clear that there would potentially be restructuring and job cuts, or at least redeployments involved, we were given 45 days of consultation period. Most of my colleagues think that this is just lip service and that they won’t take our input into account. The restructuring also involves a reshaping of the relationship between nurses and doctors, with more influence going to doctors – which has an impact on the relationships. The current plan says that a significant number of nurses, doctors and health advisors would have to be redeployed. According to the new model they want to cut patient contact, as well – we are supposed to primarily focus on the ‘complex cases’, such as sex workers and victims of sexual assaults. I think it is important to keep providing a more general service, as STIs are on the rise again over all. Most of these cases will now go back to the GPs, who are also overwhelmed and often lack specific skills, for example regarding treatment of gonorrhea. It is likely that more people will be tested later, diagnosed later and the risk of complications increases
Despite having the threat hanging over us for months, the actual result was surprising for us. In mid-April 2025 we are supposed to re-apply for our jobs at Unity or for jobs within the wider UHBW Trust. The unions were supportive, but only in terms of consultation and redeployment. There was no general suggestion to oppose the cuts. It would have been interesting to see what had happened if UHBW had refused to put in a bid – as commissioners are obliged to provide the service. As it stands, management can just point at the commissioners and blame them for the fact that they have to restructure a well-working team and service. The whole commissioning process is a way to push towards privatisation and disrupts the fabric of teams that have cooperated for years.”
