Workforce issues
Training and capability To ensure that one of the main shifts required by the 10-Year Plan can happen, from hospital care to community support, there has to be a fundamental change in skills and practice from many different professionals. There was a public consultation of ideas
to add to the forthcoming Workforce plan, by Health Education England (now closed). They highlighted that what they would like is a plan that “aims to create a sustainable workforce that is fit for the future, ensuring the NHS has the right people, in the right roles, with the right skills, so that every patient receives world-class care whenever they need it. It will support staff to work flexibly, grow their skills, and feel fulfilment in their careers.” There is no doubt that the move away from hospital care to care in the community requires very different skills and capabilities. This shift has been heralded by many government reports over many years but has never been fulfilled. At present, the training curriculum of
many healthcare professionals is focused on developing specialty knowledge and skill in the acute sector. The more generalist areas of knowledge are dealt with after qualification and not as part of becoming a newly qualified healthcare professional. If care is to shift towards primary and community care, the emphasis in training must change. Payment bands must also be equalised across the sectors. There is also a perception among healthcare
professionals that specialised care achieved in hospitals is somehow more valuable and difficult than community care. This has to be part of the massive and fundamental culture
change necessary to deliver the shift, and it will not be until doctors, nurses and many other allied healthcare professionals experience care in the community, during their training and beyond, that the cultural shift can occur. There is additional change which will help
towards the major change in care delivery. Certainly, in the initial stages, there will need to be staff who can work across the boundaries between acute and primary care, who have contacts and relationships in all areas, for the system to work for patients. The integrated care boards have started this but relatively few staff work in an integrated way and, in order to deliver the 10-Year Plan, many more will need to do so in a sustainable way. Budgets for staff will also need to be equalised and centralised to deliver this. Embedding the shift to digital will require
a different set of professionals to work in healthcare, both in the community and also in hospitals. Not only will there need to be extensive focus on digitalising the sector, but at the same time, training needs of the staff and patients will need to be considered and managed. The current state of digital access in hospitals is one that does not support clinical services, the hardware is ancient, the software is often ‘clunky’ and difficult to navigate. Few systems talk to each other and without a shadow of doubt do not link effectively to systems either between the community or in the acute sector. Many patients are expected to join in digitally with their professionals, but do not have the skills to do so. It should not be assumed that anyone requiring care can search the internet and then communicate their needs effectively
on-line. The demographic is not skilled in this area and is disenfranchised by the assumption that they are.
It is also true that many professionals do not
have good digital skills either, so if there is going to be a big shift in this direction, there will have to be comprehensive and sustained training programmes.
Conclusion The delivery of high-quality safe care by competent and confident professionals is undertaken by well trained and comfortable staff in areas of care, which they know well. The shifts of care in the 10-Year Plan will be difficult to achieve, unless there is a great deal of emphasis on future proofing the workforce in many different ways, while changing the culture of the NHS. It reminds me of Tony Blair, when bringing
in another fundamental change to healthcare, who stated that the changes were like: “turning a high seas shipping tanker around”. It needed time, space and great skill in order to manage the process. Transforming the NHS as indicated in the
10-Year Plan will need all of the 10 years, some fundamental changes, and a great deal of change around staff management. This should start at the top of each Trust, include the board but extend to all of the clinical leaders too, who effectively manage the service and the people. Emphasis must be made on retaining the skills and knowledge of the current professionals and treating them with care and compassion. Strategically, there needs to be greater focus on workforce planning and managing the new ways of working. The latter will need an ability to be flexible and adaptable to the changes. Staff will be at the centre of the delivery, so the Workforce Plan being developed will need to be transformative to meet the shifts in care. It is anticipated with bated breath.
CSJ
References 1. Department of Health and Social Care. 2025 Ten Year Health Plan for England: fit for the future Accessed at:
https://www.gov.uk/government/ publications/10-year-health-plan-for-england- fit-for-the-future
2. Kings Fund 2025 Securing the NHS workforce for the future our recommendations for action. Accessed at:
https://www.kingsfund.org.uk/ insight-and-analysis/long-reads/securing- nhs-workforce-future-recommendations- action
3. NHS Constitution. Synthesised from: NHS England, King’s Fund,
CareLearning.org, NHS Employers, Tavistock Consulting, Culture & Leadership Programme evaluations
March 2026 I
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