The government’s newly published 10-Year Health Plan for England envisages a workforce that is ‘better treated, more motivated, have better training and more scope to develop their careers.’
According to the plan, by 2035, there will be fewer staff than projected in the 2023 Long-Term Workforce Plan, but the NHS will still be the country’s biggest employer. It will also be its best, says the document.
To achieve this, it will ensure “every single member of NHS staff has their own personalised career coaching and development plan, to help them acquire new skills and practice at the top of their professional capability.
Announcing the plan today, prime minister Keir Starmer focused on the delivery of a Neighbourhood Health Service that was open 12 hours a day, six days a week.
Health secretary Wes Streeting described the plan as being one of “change or bust” for the NHS, adding that it was up to the current generation to rebuild the service, “to protect in this century what [Clement] Attlee’s government built for the last”.
Streeting said this meant high quality healthcare, “not according to wealth but according to needs”.
The Conservative party gave a cautious welcome to the plans though shadow health secretary Edward Argar warned they were “sketchy” in part.
Key proposals
The plan will also “make AI every nurse’s and doctor’s trusted assistant” and over the next three years will overhaul education and training curricula with the aim of future-proofing the NHS workforce.
The document says the DoH will work with the Social Partnership Forum to develop a new set of staff standards to outline “minimum standards for modern employment” to be introduced in April 2026.
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Ministers promise to “continue to work with trade unions and employers to maintain, update and reform employment contracts and start a big conversation on significant contractual changes that provide modern incentives and rewards for high quality and productive care”.
Measures will be put in place to tackle the health service’s high sickness rate and managers given new freedoms over performance appraisals and to act decisively where they identify underperformance.
A new College of Executive and Clinical Leadership will be aimed at driving excellence.
On pay, new arrangements will reward high performance from senior managers and see pay increases withheld from executive leadership teams that do not meet public, taxpayer and patient expectations on timeliness of care or effective financial management.
Finally, the plan restates that the focus of NHS recruitment will be to move away from “its dependency on international recruitment, and towards its own communities – to ensure sustainability in an era of global healthcare workforce shortages”.
The ambition is to reduce international recruitment to less than 10% by 2035, alongside the creation of 2,000 more nursing apprenticeships over the next three years. Expansion of medical school places will be focused on widening access to talented students from underprivileged backgrounds.
Sector reaction
For Skills for Health, a not-for-profit organisation, managing director Jon Czul said: “It is encouraging to see that government is being bold in its attempt to transform the NHS workforce in the face of severe fiscal and macro-economic headwinds.
“Making shift patterns work for everybody through providing greater flexibility is a commendable ambition that could unlock much needed labour supply to support NHS services. The move could also help support the NHS to realise valuable cost savings and reduce its spend on bank and agency staff. The day-to-day management of these new arrangements, however, could prove tricky, further complicating the finely tuned balancing act that is NHS rostering.
“At first glance, the introduction of performance-related pay seems at odds with an NHS that seeks to prioritise staff wellbeing and teamwork. The fact that both flexible working and performance related pay are part of the new ‘opt in’ NHS staff contract is telling, and there is likely to be some resistance to the initiatives, particularly with regard to the latter.”
Czul raised the question of overseas workers: “An ambition to train more doctors and nurses at home in order to lessen the NHS’s reliance upon healthcare professionals from abroad could be difficult to deliver over the term of the plan. The commitment to removing bottlenecks in medical training is to be welcomed. However, given the current and historic workforce models, it is worth noting the difficultly ahead to create a service that doesn’t require the skills of overseas workers.
“Another key aspect of the 10 Year Health Plan is the assertion that the NHS Long-Term Workforce Plan grossly overestimated the workforce that the NHS requires. This appears to be predicated on the assumption that digital and AI will be able to streamline many of the inefficient systems and processes that sap productivity.
“The potential of AI is certainly compelling, but its implementation across the service will necessitate significant expansion of the specialist workforce in addition to the roll out of new training across the NHS. There will be fairly substantial upfront costs associated with this and a period of adaptation that will need to be considered.
Professor Martin Green, chief executive of Care England, praised the vision but questioned the details. He said: “This is a plan that talks our language – prevention, personalisation, community-based care. But we’ve heard similar aspirations before, and the challenge has always been implementation. The NHS cannot deliver this vision alone. If adult social care is not put at the centre of delivery – not just as a partner, but as a leader – this plan will falter.”
For Paul Schreier, CEO of healthplan provider Simplyhealth, the NHS needed to learn from the private sector.
He said: “There is much the public sector can learn from private innovation, particularly in relation to the expansion of the NHS App, where private companies are already harnessing digital advancements and tools like AI to improve and personalise health-related services.
“Closer collaboration between businesses and healthcare services can further the objectives of the 10-Year Plan and create a more proactive, community-driven model of care that not only improves health outcomes, but also strengthens our economy to everyone’s benefit.”
Professor Neil Greenberg, president of the Society of Occupational Medicine (SOM) said it was disappointing that occupational health had not been given a proper role.
“The government has a real opportunity to incorporate OH into this 10-year plan to support a healthy workforce across the country. 1.7 million workers live with work related ill-health and access to OH professionals is particularly low among small businesses (18% offer OH services) whose employees could be reached via the new regional services.
“SOM is ready to work with the government, who must recognise that OH is essential in achieving Labour’s Back to Work agenda. OH has a clear return on investment – with four times better returns of people to work than current government programmes.”
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