To provide for the future we need to support an empowered and affordable NHS workforce with the right skills and in the right numbers. We have identified six priorities.

Lead cultural change by example and support staff engagement

Patient experience is significantly influenced by frontline staff’s own experiences in the workplace, and empowered staff are more likely to raise and resolve issues of concern and seek improvement. Staff engagement cannot be nationally mandated – it must be led by provider boards and needs the active involvement of employees at every level.

Recognise that the NHS relies on dynamic, capable, and diverse local leadership

The NHS workforce – its leadership and managers in particular – are too often denigrated. Leaders in the NHS are part of a highly complex and safety critical operation under intense personal and professional scrutiny. However, despite a proven correlation between high-performing healthcare organisations and the longevity of their leadership, the average length of tenure for an NHS provider chief executive is just 700 days. The NHS needs to do more to attract talented individuals to their boards, ensure a diverse and representative workforce and to create a pool of current and potential leaders at every level who are appropriately supported by the entire NHS system.

Make pay, terms and conditions fit for purpose

The current NHS pay, terms and conditions were designed for a different time. The pay bill can no longer keep up with resourcing requirements – let alone the extended demands of integrated care models and seven-day services – while terms and conditions are also inflexible and do not fairly reflect performance.

Base staffing decisions on local clinical judgment, not blunt national targets

Sufficient staffing is a driver of care quality, but prescriptive staffing ratios are not a panacea. They place considerable strains on local budgets as agency staff are recruited at a premium to meet them. Empowered clinical staff, with the right mix of skills and experience are best placed to determine the appropriate skills mix to meet the needs of their patients.

Let NHS providers drive workforce planning

The clinicians and managers developing models of care on the ground have the best insight into current and future workforce needs. An overemphasis on national level workforce planning is a false economy, with serious clinical and financial consequences. NHS providers must have a strong voice in workforce planning and commissioning of education and training, with central support for creating a flexible workforce and overcoming structural barriers to recruitment.