Downsizing of staff is becoming increasingly common in hospitals as a way to meet the demands of shrinking budgets. This study, based in Sweden, used a longitudinal design to study staff views of their work environment, their individual health and the quality of the care they were delivering during a period of hospital downsizing. Although there were no significant changes in perceptions of quality of care, perceptions of workload substantially increased whilst perceptions of mental energy substantially decreased. These two changes could point to future problems with quality of care after a period of hospital downsizing.