The quiet release tells its own story

What the 10-Year Health Plan People report says about workforce transformation and how it sets the scene

The People Working Group report supporting the Government’s 10-Year Health Plan arrived quietly, shortly before Christmas, as one of a series of enabling documents rather than a headline act in its own right. That was not an accident. This was never intended to be a fully formed workforce plan, nor a set of operational instructions. It was designed to do something more subtle and arguably more important: to frame the workforce challenge the NHS now faces, and to set the direction of travel for the Long-Term Workforce Plan due in the spring.

Read in that context, the report is not evasive. It is preparatory. It describes a workforce that remains deeply committed to purpose, but increasingly constrained by systems, structures and employment models that no longer fit the way healthcare needs to be delivered. Many staff still love their work, but feel deeply frustrated by their jobs. That distinction matters, because it tells us the problem is not motivation, professionalism or values, but design.

The report also recognises that change will not happen in neat stages. While it references three broad phases of reform, fixing the foundations, supporting transition and building a framework for the future, it implicitly accepts that all three must run together. There is no luxury of sequencing one after the other. The NHS has to stabilise the present while reshaping the future, and do so under conditions of ongoing pressure.

What follows is best read as a map of the terrain the LTWP will need to navigate, rather than a set of answers in itself.

1. The future of work: staff standards as foundations, not benefits

The opening section of the report is clear that workforce transformation begins with experience. Staff standards are positioned not as optional employment benefits, but as core operating conditions. Access to rest, safety, flexible working, development and support are framed as prerequisites for change, not rewards for delivering it. This reflects a deeper truth the report surfaces well. Staff are being asked to work differently, across boundaries, with new technologies, in more preventive and community-based models of care. That is incompatible with an employment experience that feels transactional, inconsistent or insecure.

Importantly, the report acknowledges that previous attempts to articulate this, most notably through the NHS People Promise, have not delivered consistently. The proposal to replace it with clearer staff standards and transparent reporting is less about culture change in the abstract and more about establishing trust.

For the LTWP, the implication is clear. Workforce reform cannot be built on unstable foundations. Retention, engagement and confidence are not separate from transformation. They are conditions for it.

2. Leadership: enabling change, not compensating for systems

Leadership features prominently throughout the report, and rightly so. The scale of change implied by the three big shifts requires leaders who are comfortable operating across systems rather than within organisational silos. The report emphasises inclusive, relational and adaptive leadership, drawing on existing reviews and evidence. It highlights the role of boards in setting ethical direction, middle managers in translating strategy into practice, and clinical leaders in shaping new models of care.

Crucially, leadership here is not presented as a substitute for reform, but as an enabler of it. The report does not suggest that better leadership alone can overcome structural barriers. Instead, it signals that without capable leadership, even well designed reforms will struggle to land.

The challenge for the LTWP will be to ensure that leadership development sits alongside, not instead of, changes to incentives, accountability and employment models.

3. Education and training: preparing people for how care will be delivered

The report is explicit that the way the NHS trains its workforce must change. Static, front-loaded education models designed around fixed professional roles are poorly suited to a system that increasingly requires adaptability, generalist skills and multidisciplinary working.

Education and training are positioned as lifelong, flexible and increasingly community-focused. This includes greater exposure to prevention, primary care and neighbourhood-based services, as well as more fluid movement between roles over the course of a career. There is also an important signal here about sustainability. The report challenges the assumption that workforce growth alone can solve capacity problems. Instead, it emphasises training the workforce the system actually needs to deliver the three shifts, rather than continuing to train predominantly for hospital-based models and then retrofitting those skills elsewhere.

For the LTWP, this points to a fundamental shift away from planning for scale alone and towards planning for capability, mix and deployment.

4. Hospital to community and treatment to prevention: redesigning work, not relocating it

The move from hospital to community care is often described as a transfer of activity. The report takes a more sophisticated view. It recognises that this shift requires a redesign of work itself, not simply a relocation of staff. Extended multidisciplinary teams, shared data, distributed leadership and different relationships with patients and communities are all central to this vision. The workforce must be able to operate across settings, blur traditional organisational boundaries and engage with prevention as a core function rather than an adjunct.

This has profound implications for professional roles, training pathways and employment models. Staff cannot support prevention and community-based care if they remain tightly bound to single organisations, narrowly defined scopes of practice or inflexible contracts.

The report does not attempt to resolve these tensions. It does, however, surface them clearly.

5. Analogue to digital: technology with staff, not to them

Digital transformation is treated not as a technical upgrade, but as a workforce issue. The report highlights the productivity and morale impact of outdated systems and poor infrastructure, and makes a strong case for involving staff in the design and procurement of technology. This is an important shift. Technology procured for organisations rather than with staff has too often added burden rather than reduced it. If digital tools are to support productivity, prevention and new ways of working, they must align with how staff actually deliver care.

The report also links digital capability to education and training, recognising that future workforce models depend on confidence with data, automation and digital collaboration.

6. Anchor systems and widening the definition of workforce

One of the more subtle but important themes in the report is the widening of what is meant by “the workforce”. It recognises that the future health system relies not only on those directly employed by NHS organisations, but also on carers, volunteers, community organisations and wider system partners. This challenges traditional workforce planning models that focus narrowly on contracted headcount. It also reinforces the role of local systems as anchors within their communities, with flexibility to innovate in response to local needs.

Not everything needs to be answered nationally. The report implicitly supports a model where national frameworks enable, rather than constrain, local experimentation.

7. Productivity: beyond growth as a default solution

Productivity is explicitly acknowledged as unavoidable. The report is clear that simply growing the workforce indefinitely is neither affordable nor sustainable, and that reliance on international recruitment cannot remain the default solution. Instead, productivity is linked to prevention, technology, skill mix, deployment and employment models. This is less about working harder and more about working differently.

The report does not yet specify how contracts, incentives or system design will change to support this. That task is left to the LTWP. But the direction is clear. Productivity has moved from the margins to the centre of workforce thinking.

8. Professionalism and regulation: making boundaries more permeable

Finally, the report touches on one of the most sensitive areas of reform: professional boundaries and regulation. It signals a future where roles are more fluid, scopes of practice more adaptable, and movement across settings more normal. This is essential if staff are to support integrated care, community delivery and prevention. It also requires regulators, educators and employers to work in new ways.

The report is cautious here, but deliberate. It recognises that professionalism remains a strength of the NHS workforce. The challenge is to evolve it, not dilute it.

What this tells us about the Long-Term Workforce Plan

Taken as a whole, the People Working Group report does not answer every question, nor was it intended to. What it does provide is a clear indication of the issues the Long-Term Workforce Plan will have to confront if it is to be credible. Those issues include affordability, productivity, workforce mobility, reduced reliance on international supply, redesigned education and training, more permeable professional boundaries, and employment models that support how care will be delivered in the future, not just how it has been delivered in the past.

In that sense, this report succeeds on its own terms. It sets the frame. It surfaces the tensions. It signals the scale of reform required.

The real test will come with the LTWP. That document will need to move from framing to engineering. It will need to make choices, not just state principles.

This report gives us a strong clue about what is coming next, and about the workforce challenges that will define the next decade of health and care reform.

Addendum: People Working Group membership

Co-chairs

• Gavin Larner, Department of Health and Social Care

• Alison Griffin, London Councils

Group members

• Professor Alison Machin, Council of Deans of Health

• Dr Alistair Blair, Northumbria Healthcare NHS Foundation Trust

• Beverley Tarka, Haringey Council

• Danny Mortimer, National Social Partnership Forum and NHS Employers

• Emma Challans-Rasool, Proud2bOps

• Hayley Grafton, University Hospitals of Leicester NHS Trust

• Helga Pile, National Social Partnership Forum and UNISON

• Dr Ify Okocha, Oxleas NHS Foundation Trust

• Janet Wilkinson, NHS Greater Manchester Integrated Care

• Dr Jeanette Dickson, Academy of Medical Royal Colleges

• Jo Lenaghan, NHS England

• Dame Linda Pollard, Leeds Teaching Hospitals NHS Trust

• Dame Marie Gabriel, NHS North East London Integrated Care Board and NHS Race and Health Observatory

• Professor Meghana Pandit, Oxford University Hospitals NHS Foundation Trust

• Dr Nishma Manek, Granta Medical Practices and NHS England

• Richard Bradford, InHealth Group