Chapter 4: NHS staff will get the backing they need

4.1. The performance of any healthcare system ultimately depends on its people – the NHS is no exception. The NHS is the biggest employer in Europe and the world’s largest employer of highly skilled professionals. 1.3 million people across the health service in England are devoting their working lives to caring for others. That is one in every 25 working age adults, three quarters of whom are women. Working in the NHS demands the highest levels of skill and compassion, and the NHS attracts some of the very best people from home and abroad. But, over the past decade, workforce growth has not kept up with need, and the way staff have been supported to work has not kept up with the changing requirements of patients.

4.2. Our staff are feeling the strain due, in part, to the number of vacancies across many roles and in many parts of England. There will always be a background number of vacancies as staff move between employers and advance their careers, but the current number is unsustainable, with the biggest shortfall in nursing [160]. NHS staff have continued to put patients first despite growing demand and rising pressure. We recognise this, and are committed to improving the working lives of all staff over the next few years and beyond.

4.3. To make this Long Term Plan a reality, the NHS will need more staff, working in rewarding jobs and a more supportive culture. By better supporting and developing staff, NHS employers can make an immediate difference to retaining the skills, expertise and care their patients They can, and will, also do more to improve equality and opportunities for people from all backgrounds to work in the NHS.

4.4. New NHS roles and careers will be shaped to reflect the future needs and priorities set out in the rest of this Plan. As we invest in our workforce, we need to ensure the NHS has primary care and generalist skills, to complement what has been a major move to more specialised hospital-based care in recent decades. To date workforce planning has been too disjointed at a national and local level. This will now change as Health Education England (HEE) is better aligned nationally with NHS Improvement which now has lead responsibility for the NHS workforce. Locally, the Local Workforce Action Boards will become more accountable to health service and social care employers.

4.5. The challenge is substantial, but there are real opportunities to make improvements. More people want to train to join the NHS than are currently  in  education  or training. Many of those leaving the NHS would remain if they were offered improved development opportunities and more control over their working lives. 

4.6. This Long Term  Plan sets out a number of specific workforce actions developed by NHS Improvement and others that can have a positive impact now. The Plan also sets out our wider reforms for the NHS workforce which will be finalised by NHS Improvement and the Department of Health and Social Care when the education and training budget for HEE is set in 2019. 

4.7. As a service, we will now take sustained and concerted action to:

  • ensure we have enough people, with the right skills and experience, so that staff have the time they need to care for patients well;
  • ensure our people have rewarding jobs, work in a positive culture, with opportunities to develop their skills and use state of the art equipment, and have support to manage the complex and often stressful nature of delivering healthcare;
  • strengthen and support good, compassionate and diverse leadership at all levels – managerial and clinical – to meet the complex practical, financial and cultural challenges a successful workforce plan and Long Term Plan will demand.


160. NHS Improvement. Quarterly performance of the NHS provider sector: quarter 1 2018/19. Available from: