Last autumn, Chinese premier Wen Jiabao delivered a speech to the Communist Party congress entitled, 'Hold High the Great Banner of Socialism with Chinese Characteristics and Strive for New Victories in Building a Moderately Prosperous Society in all Respects'.

Quite some pledge.

Pledges seem to have some cachet, commanding a certain status, raising expectations among those to whom the promise has been directed. Politicians like to make them, as do those who fundraise for charities.

The Leitch skills pledge to train staff is now well established. Employers are committing themselves to develop staff skills to at least the equivalent of five GCSEs. This is quite a challenge when much of the UK workforce has no formal qualifications. The motivation is social as well as economic - it is good for staff and makes them more productive. So it's also good for patients.

Over 150 NHS employers have made the pledge - supported by Skills for Health and the Learning and Skills Council. First steps include the identification of those who qualify for support and the application for funds to put it into action. Union learning reps will help to remove barriers.

Alongside this pledge is the national surge to promote apprenticeships across all sectors. If there is one issue over which people are not divided, it is the sense that apprenticeships are a really good thing and should never have disappeared as manufacturing industry declined and educationalists conjured up class-based alternatives.

A Learning and Skills Council survey of employers in February 2008 reported that most feel apprenticeships improve productivity and reduce turnover, training and recruitment costs. Many apprentices go on to management positions. Even Sir Alan "you're fired" Sugar has said he is blown away by their contribution. They work best when quality, simplicity and relevance drives form.

There are over 5,000 apprenticeships in the NHS - up five-fold in the past year or so. The challenge is to get recognition for work-based training which can deliver staff to the gates of higher professional qualifications (such as a nursing degree) faster than the apprenticeship. This will enable the NHS to make its contribution to the national target of over 400,000 apprentices by 2020.

Changing for the Better: guidance when undertaking major changes to NHS services, which accompanied last month's next stage review document Leading Local Change, has a pledge to engage and consult with staff. It emphasises the fact that change should be locally led by clinicians and includes a recognition that all changes need to be assessed for their impact on the workforce and on recruitment in particular.

Everyone agrees with the need for consultation. It is imperative that the engagement described - "listening and learning" - does not impede a healthy pace to reform nor produce a value-for-money solution which does not serve the interests of patients by suiting everyone.