Fit for purpose?

Workforce policy in the English NHS

March 2016

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Key points

  • Workforce is a relatively neglected area of policy which is often pursued as an afterthought, with important clinical, operational and financial impacts on the front line. 
  • Workforce policy has tended to focus on contractual and financial incentives to encourage NHS staff to improve performance or productivity. Working with the grain of the intrinsic personal and professional motivation of staff is likely to deliver faster and more sustainable change.
  • The key elements of workforce policy – workforce planning, education and training, professional regulation, pay and conditions – are developed and negotiated nationally under close political supervision and to a surprising level of detail. 
  • These nationally conducted elements of workforce policy are part of a complex system encompassing more than 40 national and European Union organisations. Central strategic coordination of these organisations on workforce policy is weak.
  • The solution to the workforce system’s structural problems is not to seek wholesale reorganisation, but to improve opportunistically, and to introduce better strategic coordination. 
  • We recommend the formation of a National Workforce Strategy Board to take forward this new approach.
  • Winning the trust and enthusiasm of the medical profession in particular is likely to be the key to unlocking rapid, radical and enduring change in the NHS. 

Health care is a people business. The 1.4 million people who work in the English NHS are its greatest asset. As modern health care becomes ever more complex, designing effective ‘workforce policy’ – how the health service plans, trains, regulates, pays and supports its people to ensure affordable, good quality care – is one of the central challenges facing our system today. 

This report gives an overview of the components of workforce policy in the English NHS and the bodies which shape it. The report proposes ways in which workforce policy could be strengthened to improve the quality and productivity of care. 

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