Securing the NHS workforce for the future: our recommendations for action
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Introduction
The 10 Year Health Plan is hugely ambitious in scope, and its success depends on robust and strategic workforce planning, with clearly defined actions and responsibilities at local, regional and national levels. The people who work in the health and care system represent the greatest and most critical resource when it comes to delivering the improvements and reform to care that is needed.
Key recommendations
Start with a focus on staff health and wellbeing and addressing the core needs of staff
Culture change must be fostered by compassionate leadership and support for managers to lead well
Drive sustainable change through active staff engagement
Align immigration policy with workforce need
Embed the shift to community by balancing incentives, opportunities and training across primary and community care with acute care
Embed the shift to prevention by removing barriers to holistic approaches to care
Embed the shift to digital by generating better evidence and capabilities to determine the skills and roles needed for new technologies
Base planning on realistic productivity assumptions and direct investment to ensure gains can be realised
Planning for the future health care workforce is difficult – in large part because of the length of time it takes to train a health care professional – 3 years for a nurse, and up to 15 years for a consultant. By the time those in training enter the workforce, the health service will look very different from the one that workforce planners had prepared for. This challenge is compounded by the many uncertainties inherent in forecasting. For example, technological developments may render skills gained in training redundant by the time professionals enter the workforce, and working preferences may change in ways that are hard to predict – for example, increased desire for flexibility.
This government is reprofiling the number of staff needed to deliver care, with the expectation that there will be fewer staff recruited over the next decade than had previously been planned for in the 2023 Long Term Workforce Plan. This is a valid political choice, but the government must demonstrate why it is confident that its expectations for reform and performance improvement in the NHS can be delivered with fewer staff than were previously projected, and this must be based on realistic and evidence-based productivity assumptions.
A focus on the existing workforce is essential
There is a further significant implication of lower-than-projected workforce growth: the majority of the people who will deliver the reform ambitions set out in the 10 Year Health Plan already work in the system.
To make this a success, there is a need to be flexible in approach, focusing on adaptability and making the best use of the current workforce. There must be a strong focus on ensuring that existing staff have the right skills and capabilities, and are enabled and authorised to deliver the three shifts outlined in the 10 Year Health Plan (from hospital to community, analogue to digital, and from sickness to prevention). Retention is more important than ever, requiring a focus on staff health, wellbeing and morale, as well as on the leadership and management that creates the conditions to support it. In addition, there also needs to be consideration of wider migration policy, which may impact numbers.
Finally, this and any future workforce plans must be dynamic and iterative given the inevitable demographic and technological changes. Adaptability and creativity at all levels of the health system will be needed, and there must be a commitment to biennial review and adjustments as needed.
Our recommendations seek to address these challenges, as well as offer considerations for how to embed the government’s three shifts.
Although the forthcoming 10 Year Workforce Plan only considers the needs of the NHS workforce (and therefore so do the recommendations below), it is essential to recognise the interconnected needs of the social care workforce and unpaid carers. It is important that the Casey Commission into social care reform and the creation of a ‘national care service’ considers the needs of the workforce and carers when setting out its recommendations.
Start with a focus on health and wellbeing and addressing the core needs of staff
First and foremost, the focus must be on improving staff experience, which among other things requires managers who are well-trained and supported at all levels of the system. There has long been an established link between staff experience in the NHS and the quality of care and patient experience. But the impact of the Covid-19 pandemic, coupled with ongoing operational pressures, has impacted the capacity of health and care staff to manage all the challenging aspects of their roles effectively. This has led to a reduction in resilience and health and wellbeing across the workforce, with accompanying high levels of burnout, which in turn impacts productivity and patient care. Morale is low and sickness rates are high. Staff report experiencing racism and harassment, and there continues to be high vacancy and turnover rates.
Indicators of staff health and wellbeing, including sickness absence rates, reported risk of burnout and self-reported stress, have all worsened in recent years. In the 2024 NHS Staff Survey, 42% of staff report feeling unwell as a result of work-related stress in the past 12 months, and 30% 'often' or 'always' feel burnt out because of their work.
Levels of discrimination experienced by NHS staff remain persistently high, with over one quarter of staff (25%) experiencing at least one incident of harassment, bullying or abuse in the past year.
Despite the ethnic diversity of the NHS workforce and its long history of relying on international recruitment, racism at the hands of colleagues is a known and persistent issue. The annual NHS Staff Survey continues to show unacceptable levels of bullying and harassment, and Black and other global majority groups report worse experiences than their White colleagues.
Vacancy rates and turnover rates are high. The NHS Hospital and Community Health Services (HCHS) Workforce has nearly 103,000 vacancies, a vacancy rate of around 1 in 14. Between March 2024 and March 2025, the annual NHS (HCHS) workforce turnover rate was 9.9%, during which time nearly 152,000 people left active service in the NHS. The 2024 NHS Staff Survey found that nearly 1 in 3 staff (29%) often think about leaving their organisation.
There is a huge opportunity to improve the experience of work for NHS staff, and in turn, improve patient outcomes and performance.
The King’s Fund has conducted research into the workplace factors that affect staff health and wellbeing and effectiveness at work, and how to develop positive work environments. Our original research focused on nursing and midwifery, but these principles are applicable to all staff across the NHS and help to meet the three core needs of people at work: Autonomy, Belonging and Contribution.
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Recommendations
Invest in staff health and wellbeing, particularly mental health support, and tackle chronic excessive workloads and staff burnout.
The ambition to reduce NHS sickness rates is welcome, but to achieve this it is essential to tackle staff burnout and improve mental health support. Local areas must develop workforce health and wellbeing plans, with dedicated funding set aside to enact them.
There are many models and examples of approaches that can be taken to improve health and wellbeing and tackle burnout. For example, it is important to consider the type of work that staff undertake, ensuring they have appropriate supervision. Restorative models have been shown to effectively decrease burnout and stress. They have been widely used in the Professional Nurse Advocate workforce and adopted internationally (including in Australia and the United States), helping health visitors stay engaged, think clearly, and make better decisions.
Another successful example of health and wellbeing interventions are health and wellbeing hubs. These were established across England during the Covid-19 pandemic to enable NHS staff to access a range of mental and physical health services in confidence and be supported to continue at work. Learning from what worked in these hubs should be used when considering the setup of Staff Treatment Hubs, and support should be available for all staff who need it across all NHS settings.
Use frameworks and standards to create a common understanding of core values and behaviours.
There are several successful examples of co-developing strong core values and behavioural frameworks with staff – and embedding these into everyday leadership, decision-making and service delivery – that could be shared and adapted for use elsewhere. For example, Royal Berkshire NHS Trust has created a framework with staff setting out clear expectations around values and behaviours. It has also invested in training and development of their staff in compassionate leadership.Use apps to collect real-time feedback and help create an environment of psychological safety.
We recommend considering how to leverage technology to ensure all voices are heard equally. Employers can use apps for real-time, anonymous feedback, helping managers identify and address emerging challenges early. This proactive approach moves beyond relying on sickness, absence or grievance data after issues arise. Creating a space for open dialogue about staff experiences, supported by a simple scoring system, directs attention to areas that need it most.Introduce minimum standards for facilities and working conditions that meet staff needs and are backed by funding.
We welcome the focus in the 10 Year Health Plan on the introduction of these minimum standards, as The King’s Fund and others have called for. It is clear that for too long, the basic human needs of staff have not always been met. All staff must be provided with adequate spaces and time to take breaks, rest and, where necessary, sleep. Staff must have guaranteed access to bathroom facilities, and nourishing food and drink in appropriate settings, as well as basics such as functioning lockers. Standards for work schedules and rotas should be based on realistic forecasting that supports safe shift-swapping, enables people to take breaks, adheres to the Working Time Directive, takes account of fatigue and staff requests, and involves staff with knowledge of the specialty to consider the demands that will be placed on them. But without funding to implement these standards, they will not be met, and so employers must receive funding to adhere to them. New estates, including new hospitals and new neighbourhood health centres, must be built with these standards in mind.
Culture change must be fostered by compassionate leadership and support for managers to lead well
High-calibre, well-trained management and clinical leadership is critical to the delivery of the ambitions of the 10 Year Health Plan. NHS management really matters. For too long, NHS plans have treated management as an afterthought, despite its critical role in delivering change. Reform will fail without skilled managers and leaders who can navigate complexity, drive improvement, and unite people and systems around shared goals. It’s time to move beyond rhetoric and put leadership and management at the heart of transformation.
The NHS needs a cultural shift, from compliance and oversight to one rooted in commitment, shared purpose, and professional accountability, and where effective performance management is not about control or enforcement but about enabling improvement, supporting development and fostering a culture where people feel valued and trusted. Instead of being denigrated, managers and leaders must be supported and celebrated within a proportionate framework of professional development and accountability. Leaders must have the accountability structures, resources and support to enable this. Workforce must be a constant priority for national and local leaders, and be reflected in operational planning guidance and performance frameworks – crucially, these must be seen as important priority metrics. The ability to attract and retain staff must be key indicators of organisations’ progress towards national objectives for improving the NHS.
A key enabler of staff health and wellbeing is compassionate leadership. This involves a focus on relationships through careful listening and understanding, showing empathy and offering support, enabling those we lead to feel valued, respected and cared for so that they can reach their potential and do their best work. There is clear evidence that compassionate leadership results in more engaged and motivated staff with high levels of wellbeing, which in turn results in high-quality care.
Recommendations
Invest in leadership development by professionalising and supporting NHS management.
As proposed by the Messenger and Pollard review, and the Rose report before that, there is a need for accredited, funded and mandated training of NHS managers, including chairs and non-executive directors. This must be a formal requirement of continuing professional development, and be expected of, funded and provided for everyone who takes up an NHS leadership role, including those in central and regional roles.Encourage peer networks for senior managers.
These networks may be self-organising, provided centrally by the NHS or offered by a membership body such as the NHS Confederation. Similarly, buddying and mentoring can help senior NHS managers and leaders grow in their roles, avoid significant pitfalls, and remain focused on the central challenges of clinical and corporate governance.Hold board and executive leaders accountable for staff health and wellbeing. Organisations should be monitored on their ability to create healthy working environments, and be able to demonstrate how they act on feedback, including the annual NHS Staff Survey, to make improvements in partnership with staff. As part of next year’s (2026/27) NHS Oversight Framework, specific metrics related to workforce health and wellbeing must be reported more prominently, and include further indicators that capture staff experience.
Organisations must place equity and anti-racism at the core of their culture and leadership.
This requires moving beyond compliance towards bold, systemic change that dismantles the structures and practices that perpetuate inequalities. Recent changes across integrated care boards and NHS England have significantly affected workforce diversity. Recent headlines highlight the disproportionate impact of organisational redesign on global majority colleagues. As NHS England transitions into the Department of Health and Social Care (DHSC), it is critical to address these risks and ensure diversity is protected during structural change – for example, ensuring that diversity, equity and inclusion roles are not lost in the reorganisation. NHS England, DHSC and the arm’s-length bodies must work in genuine partnership to lead action on equity and embed anti-racist practice across the health and care system. An example model to follow could be that of the National Ambulance Diversity and Inclusion Forum, which created an Equality and Diversity Improvement Plan for the ambulance sector that aims to reduce disparities in recruitment and improve staff experiences.
Trust local leaders to innovate. Any approach to workforce planning must encourage local innovation and creativity. Resourcing decisions should be bottom–up so that, for example, funding for training places and placement supervisors is more consistently targeted to areas of greatest need, and NHS organisations have freedom to resource innovations with local partners, such as supporting workers to settle their families in an area. The focus should be on local strategies between NHS organisations, higher education institutions and local partners, with less reliance on nationally determined approaches and initiatives. DHSC should reshape its role accordingly to include more support for the sharing of innovation and good practice, and ensure there is transparency about both challenges and progress.
Act now to build commissioning leaders with data, strategy and system skills. Achieving the ambitions of the 10 Year Health plan also demands a radical shift in commissioning leadership towards strategic, population-based commissioning. Leaders must be able to move decisively from managing procurement and contracts to shaping whole-system outcomes, with the confidence to challenge entrenched models and invest in prevention. This requires mastery of data-driven strategy, the ability to lead and influence across organisational boundaries, and the courage to make long-term decisions in the face of short-term pressures.
Drive sustainable change through active staff engagement
This workforce plan must be developed in close consultation with staff. Previous attempts to introduce new roles or change ways of working have been unsuccessful due to a lack of staff buy-in and, ultimately, ownership.
Frequent changes in workforce planning approaches have eroded staff and management trust. Over the past 20 years, the NHS’s workforce planning function has changed materially six times. Workforce development confederations, created in 2001, were consolidated into England’s then 28 strategic health authorities in 2003, which were themselves rationalised into 10 strategic health authorities in 2006. These were then abolished in 2013 in favour of Health Education England, which in 2023 was merged into NHS England, which will now be merged into the Department of Health and Social Care. As a consequence, workforce policy has changed frequently, leading to challenges in long-term planning and a lack of strategic approach.
Recommendations
Be transparent about staff engagement. The government must be clear on how staff engagement (through engagement for the 10 Year Workforce Plan itself and around the 10 Year Health Plan) has influenced workforce planning, for example by publishing staff engagement findings and outlining specifically how this has informed the planning.
Keep engaging with staff.
Staff engagement should not be a one-off event. Over the next 10 years, the government must continue to listen to staff at regular intervals as part of its planned biennial reviews.
Align immigration policy with workforce need
The NHS workforce continues to rely heavily on the employment of staff from overseas. Proposals to reduce immigration risk exacerbating NHS staffing shortages unless they are offset by, for example, greater domestic recruitment, a substantial increase in productivity, and/or a recalibration of the government’s expectations as to what can be delivered from a smaller-than-expected workforce.
Currently, around 20% of NHS employees are born abroad. Given that by far the largest proportion of immigrants coming to the UK in recent years work in health and social care, or are the dependants of those workers, any policy that seeks to significantly restrict immigration or initiate large-scale deportation would make it challenging to ensure there are sufficient numbers of staff to deliver care.
Immigration restrictions or changes to policy for existing immigrants are likely to significantly increase vacancies, without significant recruitment of British citizens. However, it is important to be realistic about the potential of domestic recruitment and the timescales. It is telling that the sector is already struggling to retain staff. For example, many of those who come to the UK to train as GPs often leave once their training is finished to find employment elsewhere, partly because of stringent conditions around their right to remain alongside discrimination and other factors. This is a problem that also extends to other clinical roles.
Recommendation
The government should ensure that immigration policy and NHS workforce policy are aligned.
The government should consider carefully the implications of tightly restricting immigration on its policy goals and manifesto commitments to reform and improve the health service to deliver better care for patients and the public. Future workforce planning should be realistic about the prospects for recruitment of British citizens, and about the productivity assumptions underlying overall forecasts. Any major proposals to change immigration policy also be subject to impact assessments considering how they will affect health and care services.
Embed the shift to community
For years, The King’s Fund has called for care to be shifted closer to home, and workforce teams to be built around communities. It is important to recognise that new services are not always necessary to deliver these shifts; in many cases, it is about removing barriers (structural and cultural) that get in the way of people delivering the shifts and improving people’s experience of care.
Both the shift to community and the shift to prevention should be underpinned by stronger collaboration between organisations and greater integration of work. This requires a workforce that is equipped to work across organisational and sector boundaries to provide more holistic care to local communities. There is also a need for roles that facilitate the co-ordination, management and provision of care, such as care navigators, community facilitators and link workers. A key feature of these roles is their boundary-spanning nature – working across different services, organisations and sectors of care. This can bring challenges, such as concerns about overlapping responsibilities and apprehension about encroaching on others’ roles. There must be a strong focus on bringing multidisciplinary teams together, with clear guidance on how skills are deployed within teams and across services, and clarity on roles and responsibilities.
Recommendations
Reconfigure the training system to give equal emphasis to primary and community care as well as acute – working towards training communities rather than training hospitals.
The majority of staff, including clinical and managerial career pathways, are often focused on acute care settings, which are seen to offer better opportunities for pay and progression. For example, large teaching hospitals are often considered to be the most prestigious places to work, and due to their size may offer more opportunities. It is welcome that the 10 Year Health Plan makes a commitment to expose nursing students to neighbourhood settings, but there should be an equivalent requirement for doctors, managers and allied health professions. DHSC should require the regulators, deaneries, Royal Colleges and national schemes, such as the NHS Management Training Scheme, to ensure training pathways mandate and enable meaningful experience in primary and community settings for both managers and clinicians in training. This would enable them to understand, value and confidently work in these settings. Otherwise, the pipeline of future clinical and managerial leaders who are trained and motivated to work in community-based care will be limited. In the longer term, the DHSC and local government should consider reconfiguring the entire training system to create ‘training communities’ rather than training hospitals, encompassing the entirety of neighbourhood health needs.
Pay, conditions and opportunities for progression should incentivise staff to work in community settings.
There is a perception of lower status attached to working in primary and community services, and there are often more opportunities for promotion and advancement in acute settings. Conditions between acute, primary and community settings need to be more balanced so that staff are not incentivised, or restricted to, acute settings. Government should ensure that staff doing the same roles in different settings are subject to the same terms and conditions where possible, particularly addressing the fact that staff directly employed in general practice and settings other than NHS trusts are not subject to Agenda for Change (the pay system for staff in the NHS, excluding doctors, dentists and senior managers). This will mean reform to the GP contract so that funding can reflect that change.
In addition, the DHSC should ensure that staff working in community and primary care settings have the same access to continuing professional development, research and teaching opportunities as staff in acute settings. DHSC and NHS providers should consider how salary scales for primary and community services posts can reflect the complexity and risk profile of that work, rather than size of budget. They should also ensure structural adjustment that rewards clinical experience and expertise with pay and progression to higher bands and more advanced and specialised roles, not just people management and budgetary responsibilities. Commissioning approaches should also be considered to ensure that wherever possible staff are provided with stable employment contracts when working in neighbourhood and community settings.Recognise the need for more generalist skillsets to meet community needs.
The 10 Year Health Plan recognises the need for more generalist and holistic skills in relation to the delivery of a neighbourhood health service. Neighbourhood health service teams need to strike a balance between supporting the holistic needs of a person and ensuring access to specialist support where required. It is important that curricula are reformed to promote this way of working, but also that roles focused on more generalist and holistic support are understood and valued appropriately. It is also important that staff have the time and resources they need to properly support the holistic needs of their patients.
Provide guidance on how to build effective multidisciplinary teams that focuses on the ‘how’ rather than the ‘who’.
There is no magic formula for the ‘right’ team structures in general practice or neighbourhood teams. But fundamentally, evidence shows that in any team there are a few important requirements. Those establishing neighbourhood health teams need a clear understanding of their population’s needs, the skills and expertise required to meet those needs, and robust arrangements for partnership working with hospitals and other care providers, including the voluntary sector. New roles introduced to deliver the model of care must be carefully recruited and embedded within teams, ensuring the right mix of staff, eg, administrative staff, data analysts and managers to support frontline clinicians. All staff should be actively involved in redesigning workflows to secure engagement and buy-in.
Estates must be fit for purpose to enable training and to accommodate multidisciplinary team working.
Many general practice estates are currently considered to be unfit for purpose, in poor condition, or too small to facilitate additional staff. Financial rules for different sectors and organisations often hamper collaborative use of the public sector estate. For example, GP rent reimbursement rules have restricted the ability of GP practices to host community or secondary care services. Local authorities have also faced challenges in balancing their remit to maximise revenue from their estates with providing affordable access to the estate for voluntary, community and social enterprise (VCSE) services. Local public services should be able to use their facilities and estates to support joined-up, integrated working locally between partners, and the DHSC, the Treasury and the Ministry of Housing, Communities and Local Government should review relevant contracts and rules to better allow and support this. New neighbourhood health centres should be built with these needs in mind.
Embed the shift to prevention
The shift to prevention will have a range of implications for the workforce. First, to bring about the shift to prevention, NHS staff will need training, support and time to take on a more preventive and holistic approach, and to make earlier interventions when issues arise. Second, the shift to prevention is also likely to increase and/or shift pressure on the NHS. For example, greater use of screening tools results in more people coming forward and identification at an earlier stage. This is likely to result in greater demand on staff and services that reside within the community, including community pharmacy and those provided by the local authority and VCSE sector.
Recommendations
Recognise that shifting upstream will shift demand and will require more community staffing.
Early intervention and preventive action may ultimately reduce pressure on acute services, but will shift demand and pressure elsewhere – to community or education services, for example. The prevention shift is therefore strongly intertwined with the shift to community, and its success depends on increasing the capacity of the community sector. This must not just be about overall numbers but about how to redistribute existing roles. DHSC should provide guidance for local areas on how to pool skills available along pathways and work closely with third parties, including the VCSE and social care sectors, to make better use of existing resources. As an example of how this has already been considered in the system, Barts Health NHS Trust Community Led Prevention Team and Transformation Partners in Health and Care (TPHC) have produced a toolkit on the work Barts Health undertook to implement new social prescribing pathways as part of its approach to embedding prevention.Train all staff to better identify risk factors to enable early action.
One approach that is often recommended to embed prevention across the workforce is the Making Every Contact Count approach. Another approach to prevention that may be more effective is a pathway approach. This means staff would be trained to identify a person’s risk factors as early as possible along the pathway, so that they are then able to identify the services that person should be connected to – for example, identifying where older people may be at risk of falls and making interventions to reduce this risk, as recommended by the National Institute for Health and Care Excellence (NICE).Create expectations for leaders, managers and staff to prioritise prevention and remove barriers to them doing so.
In a system that is under increasing pressure, it is becoming more difficult for patients to access services early. In this context, demand management also takes increasing precedence and can limit a broader, more holistic approach to addressing people’s needs. It is essential that local systems create an expectation of prioritising prevention by building preventive measures into accountability frameworks. In addition, demand thresholds should be reviewed across care pathways at local and national level to enable early intervention. This could start with consideration across the cardiovascular pathway as part of the new modern service framework.
Embed the shift to digital
When it comes to building the digital workforce, the key challenge is attracting, training and retaining staff with the right skills. Previous workforce plans have not had a strong enough or specific focus on developing a digitally enabled workforce and investing in digital skills development. This workforce plan must be different. NHS leaders and managers must be equipped with strong digital literacy, not just to understand technology, but to harness its strategic potential in transforming patient care, improving system efficiency, enabling innovation across services and transforming roles.
Recommendations
There is a need for better evidence generation on the skills and roles needed for new technologies.
It is essential that new technologies are piloted to validate their value, but there is typically insufficient research and focus on the skill mix needed for transformation and the impact on productivity on the workforce. For example, much of the focus of research around surgical robotics is on how to train staff rather than on the numbers and workforce mix needed to realise the impact of technology on efficiency and outcomes. Cross-organisational initiatives (eg, between DHSC and NICE) are needed to ensure that guidance on evidence generation explicitly addresses workforce considerations, such as skill mix and the number and variety of roles needed for new technologies.
DHSC should build horizon-scanning functions and capabilities.
Digital workforce planning is challenging because different technological innovations need different skillsets and team mixes, while at the same time technologies are changing roles and responsibilities. This is compounded by inherent uncertainty when it comes to predicting future technological development. Therefore, DHSC must build up horizon-scanning capabilities – either directly or, for example, through a dedicated Digital, Data and Technology (DDaT) Workforce Observatory (building on existing observatory models, such as the Social Prescribing Observatory). This should allow ongoing and continual review of workforce gaps and capabilities, rather than a one-off.
DHSC should review pay structures and career paths for specialist digital data and technology staff (DDaT).
The wider market for workers with DDaT skills is highly competitive, and the NHS faces considerable challenges in recruiting and retaining staff with specialist skills in this area, with around 1 in 10 positions vacant. The DDaT graduate scheme has made limited progress in developing a pipeline of staff with these skills into the NHS, but it is vital that these staff do not leave the sector once trained. A survey of trust leaders in March 2022 on barriers to filling vacant DDaT roles found that over half reported pay scales and banding issues to be barriers to recruitment. The financial reward structures for the digital and data workforce in the NHS should be reviewed so that they remain sufficiently competitive with the wider labour market.NHS England/DHSC should improve digital skills and confidence of staff, managers and leaders by encouraging expansion of peer support.
Technology funding has largely focused on funding the technology itself through capital spending, rather than the revenue funding needed to develop staff skills and allow time for the workforce to best use it. Strategic communication from NHS England and the DHSC that focuses on a ‘how to’ approach to technology, complemented by increased peer support, would help address variation. A peer support offer could take the form of networks but could also be formalised into fellowships. Specific initiatives should be specifically targeted at areas with lower assessments of digital maturity.
Base planning on realistic productivity assumptions and direct investment to ensure gains can be realised
Some very strong claims are being made about the potential of technology and productivity. Although it is true that technology may benefit many parts of the system, it is important to account for benefits and detractors. While a specific technology can improve parts of a pathway or process, it may be detrimental elsewhere. Transitions to new technologies are disruptive, and in the short term may require more staff time rather than less.
Technology pilot projects are being trialled over a small number of sites, but when rolled out widely into a system with lots of variance gains may not be realised immediately to their full extent. It is important that any decisions about workforce numbers based on productivity gains are phased in and assumptions are stress tested.
Recommendations
Planning assumptions should be analysed and verified by an independent body, and progress against workforce supply expectations should be reported against regularly.
When used for workforce planning, assumptions regarding productivity gains from new technologies must be realistic and err on the conservative side. The risks of undersupply of staff – reduced capacity to meet need and the subsequent impact on patient care – are greater than the risks of oversupply. Staff must not be expected to pick up the slack indefinitely if there are insufficient workforce numbers. Biennial reviews of overall numbers should be recalibrated and updated based on observed productivity gains and the supply of staff available, not just hoped for gains. Alongside biennial reviews, there should also be more regular updates on workforce composition and supply levels against staffing projections.Investment is needed to ensure productivity gains are realised.
There must be concurrent investment in the tools, estates and technologies staff need to deliver high-quality care and to realise the ambitious productivity assumptions this plan will be based on, and planners should be able to demonstrate how the investment is sufficient. This must include investment in the basics, such as IT equipment that works, alongside new and innovative technologies.
Conclusion
The previous NHS Long Term Workforce Plan gave insufficient attention to three major areas: culture change and a greater prioritisation of staff health and wellbeing; the need to secure staff engagement for buy-in to the changes; and whether underlying productivity assumptions were achievable. The current government has described the 2023 Long Term Workforce Plan as a work of ‘fiction’ – if the next workforce plan is to avoid the same label, the government must demonstrate a credible approach to resolving each of these three issues.
Delivering high-quality care is only possible if staff receive the practical and emotional support they need. A relentless focus on staff wellbeing and compassionate leadership is not a ‘soft’ alternative to cost-effectiveness and productivity; it is the necessary foundation for both. There is well-evidenced good practice from aviation, military and other high-reliability sectors about looking after the workforce which demonstrates that prioritising staff wellbeing, psychological safety, and structured support systems is essential for sustaining high performance and resilience in complex environments. Creating the conditions where NHS staff can thrive drives improved performance, improves patient outcomes, and delivers better value to UK taxpayers.
Transformation will only be possible with staff buy-in and, ultimately, ownership to deliver the changes. Delivering meaningful reform demands bold, transformative change. Previous attempts to introduce new roles or change ways of working have been unsuccessful without active staff engagement to gain support. This plan must not repeat those mistakes. The success of the 10 Year Health Plan is dependent on whether the workforce is supported and authorised to deliver it, and whether staff take the opportunities that a longer-term and more strategic approach to workforce planning can provide. This requires policies and investment into training, retention and leadership, as well as reconfiguration, to ensure that staff have the skills and capabilities to deliver change, as well as investment in the tools, buildings and technologies staff need. And staffing levels must be reviewed regularly, based on observed delivery not just hoped for productivity levels.
Most importantly, the plan must centre staff health and wellbeing and improving staff experience, or staff will be unable to deliver the improvements to patient care and achieve the required levels of productivity that are sorely needed. Without this, the ambitions of the government’s 10 Year Health Plan will not be realised for patients and the public.
Acknowledgements
The authors would like to thank the following for their invaluable advice and support in the writing of this long read: Alex Baylis, Nicola Walsh, Beccy Baird, Pritesh Mistry, Shilpa Ross, Helen Gilburt, Katie Purbrick-Thompson, Siva Anandaciva, Kate Pearce and Megan Price.
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