I attended a Health Foundation webinar on NHS productivity. What struck me most was the link to workforce planning.

Yesterday I joined the first of the Health Foundation’s NHS Productivity Commission webinars, exploring what the NHS might learn from other health systems internationally.

The discussion ranged widely. We heard OECD-level perspectives on demographic and fiscal pressure, reflections on the role of artificial intelligence, and detailed insights from cancer services across several countries. All valuable in their own right.

But the strongest and most consistent message, at least for me, was this:

Productivity and workforce planning can no longer be treated as separate policy conversations. In every system under pressure, they are now tightly bound together.

Productivity is no longer optional. And it is not just a finance issue.

The OECD perspective was direct and difficult to argue with.

Across high-income health systems, demand for care continues to rise as populations age and live longer with multiple conditions. At the same time, the working-age population is shrinking in many countries. Health and social care already account for a very significant share of total employment.

The implication is not ideological. It is structural.

We cannot train our way out of this challenge indefinitely. Nor can we simply spend more. Workforce growth remains essential, but it can no longer be the only plan.

In that context, productivity stops being a technical or financial concern and becomes a central part of workforce strategy.

Measurement shapes behaviour. And ours is still weak.

A second point that matters deeply for workforce planning is how productivity is measured.

Most of the indicators used across health systems still focus on volumes of activity, consultations per clinician, bed days per staff member, procedures per theatre session. In many countries these metrics show stagnation or decline.

At the same time, quality has improved in several areas, and patients are presenting with greater complexity. In other words, staff are often delivering more demanding care, even as headline productivity measures appear to worsen.

The issue is not that measurement is impossible. It is that we have been slow to move beyond narrow activity-based proxies, particularly outside hospitals.

Without better adjustment for complexity and outcomes, workforce planners risk drawing the wrong conclusions about both performance and need.

The persistent myth of productivity as “working harder”

One of the most important clarifications made during the webinar was also one of the simplest.

Productivity is not about asking staff to work harder.

In healthcare, that misunderstanding is especially damaging. It feeds defensiveness, fuels burnout and undermines trust. Staff hear the word productivity and assume criticism or cost cutting, not system improvement.

Yet historically, productivity improvement is what has allowed working hours to fall while living standards and service quality improved. In healthcare, it should mean designing work in ways that allow highly trained professionals to focus on what only they can do.

Seen this way, productivity is not a threat to the workforce. It is one of the few viable ways of sustaining it.

Why jobs are the wrong unit of analysis

A theme that cut across several contributions was the need to rethink how work itself is organised.

Healthcare remains heavily structured around job titles and professional categories. That made sense in a more stable delivery environment. It makes far less sense in a system facing rapid technological change, rising complexity and constrained supply.

If we cannot clearly describe the tasks that make up care pathways, we cannot make informed decisions about:

• which tasks genuinely require registered professionals

• which tasks could be undertaken differently or by different roles

• which tasks could be automated or supported by technology

• and which tasks add little value and should be redesigned out altogether

This is the point at which workforce planning and productivity genuinely merge. Planning becomes less about counting heads and more about understanding work.

Technology will not rescue us unless the system changes around it

There was plenty of discussion about artificial intelligence and digital tools, but also a strong note of realism.

Technology does not deliver productivity in isolation. It only does so when workflows, roles and decision-making structures are redesigned around it.

Two points stood out. First, the often overlooked risk of inaction. While we talk extensively about the risks of using AI in healthcare, the risk of not changing fast enough receives far less attention.

Second, the capability gap. Productivity gains depend not just on tools, but on the digital confidence of the workforce and the quality of the underlying data infrastructure.

For workforce planning, this implies that digital capability can no longer sit at the margins. It needs to be embedded in education, development, appraisal and leadership expectations.

Cancer services as a reminder of system dependency

The cancer examples provided a useful corrective to simplistic workforce narratives.

In several systems, limited progress was not due to a lack of specialists alone, but to constraints elsewhere. Diagnostic equipment, theatres, ageing infrastructure and weak integration across services all limited what the workforce could deliver.

The lesson is straightforward. Workforce plans that are not explicitly linked to capital, estates and data are unlikely to translate capacity into outcomes.

The real bottleneck is implementation

Perhaps the most sobering observation was that none of these ideas are particularly new.

We have known for some time that task redesign, role flexibility, better data and smarter use of technology are essential. The problem is not a lack of insight, but the difficulty of implementing change at scale.

Local innovation often fails to spread. New roles can provoke resistance when their human and professional implications are not thought through. Policy cycles move faster than organisational change.

One promising theme was the idea of national direction combined with local adaptation. Not rigid prescription, but a set of tested approaches that systems can tailor to their starting point.

What this means for the NHS

Taken together, the message for the NHS is clear.

A credible workforce strategy now has to start with the work itself, not just the workforce numbers. It has to treat capital and data as enablers of workforce productivity. It has to invest in digital capability as a core professional skill. And it has to take implementation and scaling as seriously as policy design.

The NHS does not have the option of choosing between workforce planning and productivity reform. Demography, supply constraints and fiscal reality mean the two now rise and fall together.

That, more than anything else, was the lesson I took away from looking beyond our own system.