Lord Darzi’s independent investigation into the state of the NHS concluded that the service is in a “critical condition”.1
A growing and ageing population, rising multimorbidity, and widening health inequalities are driving demand faster than capacity can expand.1 While these reasons are commonly cited, one that is less considered is the changes to workforce capability over the last 10 years. Although the NHS workforce has expanded, much experience has been lost.2 The result is a health system under immense pressure, with more people waiting longer for care and too many avoidable hospital admissions.1
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In response, the NHS 10-Year Health Plan sets out a clear strategic ambition.3 Three major shifts – from hospital to community, from analogue to digital, and from sickness to prevention – describe what must happen if the health system is to improve outcomes, while staying sustainable within the government’s fixed financial envelope.3 In practice, delivery of this plan will be impossible without increasing workforce capability. The plan requires frontline expertise: an accessible, knowledgeable, decision-making, risk-holding workforce able to manage complexity, prevent deterioration, and support the health system to function efficiently and safely.
However, England faces more than 100,000 NHS vacancies, including more than 25,000 in nursing alone.4 Nursing is the largest profession in healthcare, and registered nurses do far more than provide direct care – they organise, prioritise, refer, and effectively act as “care traffic control” across pathways.5 Missed, delayed, or uncoordinated care can be catastrophic for patients and the health system.6 While the recruitment of registered nurses remains difficult, many specialist, highly experienced nurses are retiring and being replaced with lower-paid, less experienced workers, if at all.7 These circumstances are reducing the level of specialism, clinical knowledge, and expertise within the NHS, creating a high “rookie factor” and problems such as failure demand and ineffective care.7
Traditional workforce planning has focused on boosting headcount and the volume of activity completed.8 Yet evidence shows that simply adding more hands or dividing work into isolated activities does not automatically improve productivity or safety. 7 When work is overly fragmented, the relational, cognitive, and contextual elements of care become obscured.9 When this “hidden workload” isn’t explicitly planned for, it falls disproportionately on a shrinking pool of highly skilled staff, worsening burnout, and fuelling inefficiencies.10
The core question is no longer just “how many staff do we have?”, but “do we have the right capability and experience in the right places to reduce risk, avoid deterioration, and keep people well at home?” Specialist nurses, including those who have been industry-funded, are crucial to filling this capability gap.
Digital technology, embedded within clinically led services, play a complementary role in strengthening this capability. Rather than replacing NHS provision, telehealth and digital prescribing can support earlier intervention, self‑management and timely escalation – resolving issues remotely where appropriate and reducing avoidable contacts across the system. These tools can equip the workforce, empower patients, and make better use of scarce resources.11
For commissioners seeking to translate policy rhetoric around the plan’s three shifts into concrete change, while optimising the workforce, improving access to care, and addressing health inequalities, digital is a tangible opportunity to unlock capacity and improve outcomes without compromising safety, but only if designed around the needs of those doing the work.
This feature explores the value of specialist nursing and digital solutions, offering practical insights for commissioners and system leaders seeking to redesign services, address unwarranted variation, and use finite resources more effectively.
Read the detailed report here.
