Creating a sustainable workforce: The long-term sustainability of the NHS

This note sets out the Nuffield Trust’s views on key questions concerning the House of Lords Committee’s investigation of the sustainability of the NHS over the next fifteen years. It updates oral evidence given to the Committee on 8 November 2016 by Candace Imison, Director of Policy.


Published: 05/01/2017

Download the briefing [PDF 306.6KB]

Key points:

  • The pressures on the NHS workforce are as great, if not a greater, threat to the future sustainability of services as the pressures on finances.

  • There are serious and growing gaps in the NHS workforce, in both numbers and skills.
  • These threaten the quality of care and the NHS’s capacity to deliver improvements in productivity.
  • A striking feature of the gaps in the clinical workforce is their concentration in the areas where the needs are greatest, and where new models of care are seeking workforce expansion. Thus they undermine the capacity to deliver these new models of care.
  • Despite planned expansions in training numbers, a wide range of factors could magnify the current gaps in the clinical workforce, in particular, the pressures on the workforce created by the current productivity challenge. The falling morale in many staff groups and subsequent loss of skilled and experienced staff will not be easy to repair.
  • While the NHS has invested billions of pounds in training doctors, nurses and other clinical staff, it has invested little in the skills and capacity to plan, develop and manage this highly skilled workforce. Despite a huge productivity challenge, this position has not changed, in fact it has deteriorated, with raids both on training and continuing professional development budgets.

There are opportunities to address these challenges, making better use of the NHS’s most valuable resource, its human capital, but none are quick fixes, and each is hampered by the current constraints on NHS funding. These include:

  • Improving retention, both in training and at work, through improved staff management.
  • Providing more flexible training pathways and investing in continuing professional development.
  • Changing skill mix to tap the full potential of staff and deliver more patient-focused care. This requires careful planning and implementation. There is an urgent need for more evidence in this area.
  • Improving our approach to workforce planning. The focus should be on developing a flexible approach that does not seek long-term predictive precision but can identify potential medium-term issues, and, most importantly, enable the current workforce to evolve and adapt to the inherently unpredictable health care environment. A core foundation for this should be a deep understanding of the skills gap in the current workforce. This is currently lacking.
  • Making better use of information technology to support more flexible working and improve productivity. This will require service improvement and organisational development as well as technological capacity, and may take many years to achieve, but the benefits could be considerable.

Suggested citation

Nuffield Trust (2016) The long-term sustainability of the NHS: Creating a sustainable workforce. Nuffield Trust briefing.