The future of the NHS depends on having the right staff who feel valued and proud to work in the health service

Looking after the NHS workforce is not only an ethical imperative but also a sound investment and must be a top priority, say experts in the third report of The BMJ Commission on the Future of the NHS.

From improving basic working conditions to planning for the impact of AI, the authors set out a bold vision to enhance the stewardship of the NHS workforce.

In the most recent (2023) NHS Staff Survey only a quarter (26.4%) of respondents said there were enough staff at their organisation for them to do their job properly, just over a quarter (25.6%) are satisfied with their pay, and only 42% say they are satisfied with the extent to which their organisations value their work.

Against this background, The BMJ Commission brought together leading experts from medicine and healthcare to identify the key challenges and priorities and make recommendations aimed at ensuring that the vision of the NHS is realised.

Today’s recommendations include making workforce stewardship a key priority at all levels, improving workplace conditions, and improving workforce planning.

Calling for a collaboratively designed national framework for NHS employers to improve working environments for all NHS staff, the report identifies the need for much more effective people management, proactively enforced standards relating to antidiscrimination and anti-racism, and better systems for addressing problematic culture and behaviour.

Stressing the importance of operational management to support the effective running of the NHS, it notes the strong evidence from other areas, such as manufacturing, about the contribution of effective management to organisational success and employee wellbeing.

And the report strongly emphasises the need for workforce planning, new technologies, and new roles to be treated as major, novel interventions that require consultation and rigorous design and evaluation.

“The future of the NHS depends on the people who work in it,” write the authors, led by Mary Dixon-Woods from The Healthcare Improvement Studies Institute at the University of Cambridge.

“But at the moment the NHS simply does not have enough staff to deliver on its goals and commitments: it remains under-doctored, under-nursed, and under-managed in comparison with other countries. Staff are routinely exposed to very challenging workplace conditions, yet organisations demonstrate significant weaknesses in addressing the problems – ranging from adequate toilet facilities and water access through to bullying and harassment.

“Quite apart from the ethical imperative to look after the NHS workforce, there are strong arguments that doing so will improve efficiency, productivity, and patient experience and outcomes,” they explain.

“As the largest workforce in Europe, investing in the staff of the NHS is also a sound investment in population health,” the authors add.

They note that some of their recommendations can be managed at organisational level, while others will need to be led from the top of government and the NHS centre.

However, they conclude: “Much stronger leadership and accountability for people and their development at all levels, from Whitehall downwards, is now needed.”



Notes for editors

Analysis: The future of the NHS depends on its workforce doi: 10.1136/bmj-2024-079474

Further papers will be published in April 2024. All articles will be available at: