Niall Dickson on the future of the NHS workforce

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Niall Dickson explains why workforce planning in health is a nightmare.

Workforce planning in health is a nightmare. It can take 15 years to produce a consultant and we have no idea how many we will need in 2022.

Demand for one kind of specialist can increase because of advances in knowledge while demand for others can decline. Meanwhile junior doctors used to be the only people who could change a drip.

Now many such tasks can be performed by nurses. Nor is it easy to predict how many will want to do these jobs. And this is no longer a domestic market. To thousands of doctors and nurses in Europe, UK salaries look very attractive.

Yet some of these difficulties are of the government's own making. Doubling the number of medical students - just as the French were planning to cut their intake - may have been overdoing it. And the Department of Health agreed huge pay increases for consultants. Part of the problem is that parts of the NHS have failed to tackle underlying financial issues and are having to cut back now, just as they need more trained staff to meet ambitious targets for waiting times.

There is no simple answer. Planning must have a role: it is a waste of money and clearly unfair to lure highly motivated young people into professions and then discard them. But we have to recognise the real limitations of central planning. The future must lie in local employers working with professional groups to estimate local demand as best they can, with guidance at national level. Some more flexibility around what we train staff to do might help - and more flexibility around local pay would help shortages in some parts of the country.

But finally, perhaps we need to recognise the harsh reality that no one, not even doctors and nurses, can be guaranteed a job for life.

This article was originally published in The Evening Standard, 4 January 2007, Page 6