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.
Covid‑19 caused an unprecedented shock that significantly disrupted health services.12
The one-off emergency cash injection, combined with sharp cuts in elective activity, contributed to a drop of up to 25 per cent in measured productivity.12 As the NHS now works to recover, government funding has been tied to achieving a 2 per cent annual productivity growth target to ensure budgets stretch further.12 Staff costs are the biggest area of NHS expenditure, 13 so ensuring the workforce is able to function effectively is essential for improving system outcomes.
Productivity depends on capability, not just staffing numbers
Despite being the UK’s largest employer,3 the NHS continues to operate with substantial vacancies, particularly in roles requiring greater autonomy, decision‑making, and specialist knowledge.4 Workforce planning has traditionally focused on supply – recruiting and training as many new people as possible within the available budget.8 While necessary, this approach does not automatically increase system capability or productivity.7 Many services are now composed of large numbers of newly qualified or less experienced staff who require time and structured support before they can work independently.7
In healthcare, registered nurses manage competing priorities, incomplete information, and goal conflicts.7 They have to make decisions about when to refer, how to coordinate care across teams and what risks are acceptable in the context of each patient.7 These judgements rely heavily on experience, pattern recognition, and understanding of the health system.7 When services become heavily reliant on inexperienced staff, the learning curve can be steep, and the demand on more experienced colleagues increases, as more situations require supervision or review.7 This overload can result in avoidable pressure on other parts of the system, from acute care to primary and community services.
Task-based models fall short when complexity rises
In the face of rising demand, many organisations have attempted to increase productivity and reduce costs by breaking work down into smaller technical tasks.8 Activity becomes measured in terms of outputs: contacts, procedures, and appointments.8 While some tasks can be standardised, reducing healthcare to a series of timed and counted actions risks overlooking the contextual, cognitive, and relational work that underpins safe, efficient care.8
Research on “taskification” in general practice shows that focusing only on task throughput, without regard to context, can inadvertently increase workload and risk.10 Similarly, in acute care, evidence shows experience, clinical reasoning, and situational awareness are critical in recognising deterioration and acting early.15 Planning workforce performance around measurable units of activity rather than capability often results in sicker patients, more unexpected activity, and reduced system resilience when complexity increases.8
Capability, experience, and patient safety are interconnected
A different view of the workforce is needed – one that treats capability and experience as primary drivers of productivity and safety, rather than optional extras.9 This approach means understanding the mix of skills, expertise, and judgement required to meet demand, not just the number of hands available.9 It also means seeing productivity and safety as two sides of the same coin.7 A workforce that prevents harm, avoids deterioration, and coordinates care effectively is one that saves time, reduces unwarranted activity, and improves outcomes.
This insight has practical implications. Commissioning decisions that appear to save money by reducing specialist nursing posts, particularly advanced practice case managing roles such as district nurses and clinical nurse specialists, can generate higher demand elsewhere – more emergency attendances, admissions, primary care contacts, and community visits – alongside poorer patient outcomes. The costs of additional activity are often diffuse and delayed, falling on different parts of the system to where the initial decision was made. The opportunity is to align financial decisions around capability and experience, not just capacity. In creating the right workforce capability, we can reduce pressure, improve operational capacity and outcomes, and support the three shifts in the NHS 10YHP .
Education as a strategic lever for embedding capability
While crucial for strengthening long-term capability, developing inexperienced staff can be costly and might not deliver efficiency gains right away, given their contribution is limited until they acquire the experience needed for autonomous practice.7 Industry-funded initiatives have helped bridge this gap. Platforms such as Coloplast Professional offer targeted learning, masterclasses, and peer‑to‑peer knowledge exchange focused on stoma, bladder, and bowel care.16 Over the last year, Coloplast Professional has delivered 7,404 hours of education for registered nurses and healthcare professionals in continence care, building their confidence in managing complex situations.16 NHS commissioners could capitalise on these opportunities for free, additional resources as a route to boosting workforce capability, without impacting productivity.
Specialist nurses: a core component of a high capability workforce
In contrast, bringing on board specialist nurses can play a central role in absorbing immediate demand.9 They can deliver returns through reduced unwarranted demand, shorter lengths of stay, fewer complications, and better patient experience.9 However, much of their work – preventing deterioration, coordinating care, supporting self‑management, and resolving risk – is difficult to measure on paper.9 To capture the value of specialist nursing, workforce, and service planning needs a better way of recognising this “hidden work” so they’re not overlooked.9 Specialist nurses are not a luxury; investing in their expertise is imperative for a productive, safe, and resilient health system.9
Stoma formation is often life‑saving, but it is also profoundly life‑changing.17
For the estimated 205,000 people living with a stoma in the UK17 – a number that continues to grow with around 21,000 new surgeries each year 2 – everyday life can be affected physically, psychologically, and socially.19 Skin complications, leakage, discomfort, altered body image, and anxiety about leaving home are all common challenges.18,19 To live well, patients need access to clinicians with advanced expertise who understand the interaction between products, skin health, underlying disease, and social context.
Access to stoma expertise is variable and often insufficient to meet needs
Specialist stoma care nurses (SSCNs) play a crucial role in patient care.17 They provide expert assessment, appliance selection, complication management, rehabilitation, and long-term follow-up for patients and staff.17,18 Their work spans acute wards, outpatient clinics, community settings, and remote support.17,18 Importantly, SSCNs act as a bridge between sectors, ensuring continuity of care and prevention of crises that would otherwise result in GP visits or emergency attendances.17
However, availability of this expertise is highly variable across the NHS.17 Only around 600 SSCNs work across acute and primary care, supporting a large and growing population.17 Where services are fragmented, people living with a stoma may not realise that they could expect more proactive, expert care.4 As a result, preventable issues like poorly fitting appliances, skin problems, or leakage often escalate until they trigger contact with an already overstretched NHS.20 Patients may repeatedly visit GPs, community nurses, or emergency departments, with each presentation bringing cost and workload for the system, as well as distress for the individual.20
Partnership working can strengthen the system
Industry‑funded SSCNs, working to the Professional Code of Conduct set out by The Nursing and Midwifery Council and working as part of integrated teams alongside NHS colleagues, have increased local access to advanced expertise without adding to NHS headcount.18 These registered nurses deliver highly specialist clinical assessment, decision‑making, and intervention that can prevent complications, support safe discharge, reduce unnecessary healthcare use, and empower people to self‑manage with confidence.18
At Queen Elizabeth Hospital King’s Lynn Foundation Trust, Coloplast‑funded nurses working alongside NHS staff supported the care for 1,277 ostomy patients over a defined period.21 This approach helped prevent 153 emergency admissions and avoided 891 appointments across the whole system, generating an estimated saving of around £119,776.21 The collaboration was recognised in the HSJ Partnership Awards 2022 and won highly commended in the category Best Healthcare Provider partnership with the NHS. Preventing these contacts reflects real reductions in pressure on urgent and primary care, as well as ensuring high levels of patient satisfaction.21
National improvement efforts
Stoma care underlines the importance of making the “hidden workload” visible.17 Many of the activities undertaken by SSCNs – teaching patients to self-manage, training other staff, coordinating across sectors – are not always reflected in traditional performance metrics, yet it is precisely this work that underpins the NHS’s ability to deliver the three shifts described in the 10YHP .3 By recognising, measuring and resourcing this expertise, integrated care boards (ICBs) can redesign services in ways that are both clinically and economically sustainable.
The absence of national standards for stoma care contributes to inconsistent provision.17 Unlike cancer or IBD, stoma care currently lacks targets or a best practice pathway, leading to the wide, unwarranted variation we are experiencing at present.17 The Association of Stoma Care Nurses UK (ASCN UK), working with a multidisciplinary taskforce that includes NHS and industry partners, is defining a national standardised approach via a dedicated Getting It Right First Time (GIRFT) workstream.17 The output of this programme should offer a framework within which to commission against clearly defined outcomes and levels of service, rather than viewing stoma care purely as a product cost line. 17 SSCNs have been identified as central to delivering these standards and strengthening workforce capability.17
Stoma care pathways represent a strategic opportunity, not a niche area
Stoma care may appear a relatively small specialty, but it offers a powerful case study in how specialist nursing and partnership working can support system priorities: reducing unwarranted variation, moving care closer to home, and using resources more effectively.3 For NHS payors and system leaders, the implications are clear:
1: Specialist stoma care should be viewed as essential
Well-designed pathways that include SSCNs – whether NHS-employed, industry-funded, or a blend of both – can address inequalities in access to expertise, reduce preventable demand on hospital and primary care, support earlier discharge, and improve patient experience.17,18
2: Partnership can strengthen local capability where NHS staffing is constrained
Coloplast has recently documented the provision to the NHS of 34.4 whole‑time equivalent (WTE) stoma care nurses over a 12‑month period. 22 Working in partnership with NHS colleagues where an agreed transparent referral process is in place, they delivered 20,516 home visits, 13,524 community and primary care appointments, plus 12,972 outpatient appointments.22 While this additional resource supports delivery against local key performance indicators which may not otherwise have been achieved, it enables more timely, proactive care in community settings, directly supporting the shift from hospital to home and from reactive to preventive care.
3: Procurement decisions must consider whole‑system value
Investment in specialist input that reduces unwarranted variation and prevents avoidable activity can support financial sustainability while delivering better outcomes.20 By contrast, care pathways associated with higher rates of stoma product complications can drive increased community contacts, emergency use and higher overall system costs. Prescribing the product that is clinically appropriate and suits a patient’s preference, accommodating their own individual circumstances and needs, becomes critical.23
The NHS’s digital and data ambitions sit at the heart of the 10YHP and underpin several priorities around improving healthcare access, a more effective workforce, and strengthening prevention.3
For patients living with long‑term conditions, including complex stoma, bladder, and bowel-related needs, digital tools offer routes to more proactive, personalised care closer to home.11 At the same time, they can help reduce avoidable demand on NHS services and ensure specialist expertise is targeted where it delivers the most value.
Aligning digital services with local system priorities
Telehealth and digital prescribing deliver the greatest value when aligned with system‑level priorities.11 ICBs can deploy these services to strengthen “upstream” support, reduce unplanned contacts, and drive better use of clinical time. Programmes can be targeted to key pressure points – such as discharge from hospital or treatment changes – and integrated into local pathways to support operational objectives.11,24
Telehealth as a structured, productivity-enhancing clinical service
Telehealth has evolved far beyond simple phone contact. When designed as a clinical service, it creates a systematic, data-enabled way to monitor patient needs, deliver timely interventions, and promote confident self‑management.11,24
Coloplast’s telehealth service, for example, demonstrates the impact of this approach.25,26 It provides ongoing specialist support for people with intimate, often stigmatised conditions that can be difficult to discuss in generalist settings.25 The service offers continuity and acts as a safety net, ensuring emerging issues are identified early and managed effectively.26 A team of 68 people, supervised by a senior nurse, manages on average 28 calls per person per day.24 Staff complete six months of training before handling patient calls, and regular audits – including review of recorded calls – maintain adherence to escalation protocols.25
The Care Quality Commission has described the service as a “lifeline”, with data showing a significant proportion of patients would have otherwise engaged NHS services.26 In other words, each issue resolved remotely represents an avoided GP appointment, community nursing visit, or urgent care attendance, freeing up clinical time and improving patient flow. For system leaders, telehealth offers a practical way to improve access and capacity.11,24 It complements, rather than replaces, NHS provision, and can support people after hospital discharge, during treatment changes, or when managing complex long‑term conditions at home.11,24 When integrated into local pathways, telehealth can reduce “upstream” demand and prevent avoidable deterioration while enabling more efficient use of specialist staff.
Online prescription services: a critical component of modern pathways
Alongside telehealth, digital prescription management is increasingly important for patients managing long‑term conditions.27 A well-designed online prescription service does far more than digitise a process.28 It supports timely clinical oversight, reduces complications through the early identification of issues, strengthens self-management, and helps minimise unwanted variation or inappropriate prescribing.27,28 These benefits align closely with NHS goals around improving access, reducing unnecessary appointments, and shifting care closer to home.3
The Sefton Stoma Prescription Service illustrates the impact of this model. 6 Run by Coloplast-funded specialist nurses, the service allows patients to order stoma and continence supplies online with clinical review where required.30 From October 2019 – October 2020, the service achieved a 69 per cent reduction in avoidable GP appointments, and prescribing costs were reduced by £16,564, despite a 60 per cent rise in patient demand.2 This combination of improved outcomes and reduced system cost earned recognition through the ABHI Innovation in HealthTech Award.28 As part of Coloplast’s wider e-prescription offering, which processes in excess of 1 million prescriptions every year,31 the Sefton service shows how digital prescribing can improve product optimisation, release system capacity, and improve patient outcomes and experience.
Data-driven insight for providers and commissioners
Data and analytics tools enable more informed local planning and improvement. Coloplast’s Stoma Dashboard uses Hospital Episode Statistics (HES) data to provide an NHS‑aligned view of stoma care activity in England.32 While this specific tool cannot be distributed, insights from it on areas of unwarranted variation, unmet need, and potential improvement can be discussed with Coloplast to enable local providers and commissioners to deploy resources more effectively and make financially sustainable decisions.32
Combining digital tools with specialist nursing expertise to deliver whole-system impact
Digital solutions are most powerful when paired with specialist clinical expertise. Telehealth benefits from senior nursing oversight to ensure safe referral and complex decision‑making, while digital prescribing helps embed specialist recommendations consistently. Data insights enable specialist nurses and service leads to design quality improvement initiatives, shape workforce decisions, and refine pathways.
In this way, digital tools can complement specialist expertise, enabling health systems to get more from the workforce they have. For budget holders, it is essential to view these services through a whole-system lens: investment in one part of the pathway often generates benefits elsewhere – such as avoided appointments, fewer complications, better self‑management.
Telehealth, digital prescribing, and data‑driven tools will not replace specialist nursing, but shape how this expertise is deployed. Combining specialist clinical capability, structured telehealth, and actionable data can support the NHS 10YHP’s three shifts: moving care closer to home, using digital technology more effectively, and focusing on prevention.3 In doing so, these digital solutions demonstrate their power in driving NHS productivity – improving patient outcomes while making better use of constrained NHS resources.
Coloplast has spent more than 60 years working with people living with stoma, continence, and other intimate healthcare needs.
The company’s focus has always been on helping patients manage their conditions safely and independently.
As a longstanding and responsible partner to the NHS, Coloplast contributes specialist expertise, data, and clinical insight that support workforce capability, reduce unwarranted variation, and help the NHS deliver the three shifts set out in the 10YHP: more preventive care, more community‑based care, and increased use of digital solutions.
Coloplast’s approach is based on partnership, shared learning, and supporting NHS staff to deliver high‑quality care at a time of significant operational pressure.
References
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2 Nuffield Trust. January 2025. In the balance: Lessons for changing the mix of professions in NHS services. Available at: https://www.nuffieldtrust.org.uk/sites/default/files/2025-01/Nuffield%20Trust%20-%20In%20the%20balance_WEB.pdf Last accessed: March 2026
3 NHS England (2025) The NHS Long Term Plan. London: NHS England. Available at: https://www.longtermplan.nhs.uk Last accessed: March 2026
4 NHS Digital (2025) NHS Vacancy Statistics England, April 2015 – September 2025: Experimental Statistics [online], NHS Digital. Published 27 November 2025. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015—september-2025-experimental-statistics Last accessed: March 2026
5 Coloplast. Stoma Care Nurse Specialist: The hidden value of this expert nursing role and service. Available at: https://www.coloplast.co.uk/Global/UK/Stoma/HCP/SCNS_The_hidden_value_of_this_expert_nursing_role.pdf Last accessed: March 2026
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9 Maxwell E, Leary A. In praise of professional judgment. The BMJ Opinion. 26 May, 2020. Available at: https://blogs.bmj.com/bmj/2020/05/26/elaine-maxwell-alison-leary-praise-professional-judgment/ Last accessed: March 2026
10 Rasmussen, A.N., McDermott, I. and Spooner, S. (2025) Taskification in general practice: a solution to, or an aggravator of, the workforce crisis?, Journal of Health Services Research and Policy, published 19 November 2025. Available at: https://research.manchester.ac.uk/en/publications/taskification-in-general-practice-a-solution-to-or-an-aggravator-/ Last accessed: March 2026
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12 Moody, N. and Powell, T. (2025) NHS productivity (Research Briefing CBP 10313), House of Commons Library, 23 July. Available at: https://researchbriefings.files.parliament.uk/documents/CBP-10313/CBP-10313.pdf Last accessed: March 2026
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14 NHS Providers (2024). 10 facts about the NHS workforce. Available at: https://nhs-providers.uksouth01.umbraco.io/media/jali5exq/10-facts-about-the-nhs-workforce.pdf Last accessed: March 2026
15 Corrao, S. and Argano, C. (2022) Rethinking clinical decision making to improve clinical reasoning, Frontiers in Medicine, 9:900543. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9492972/ Last accessed: March 2026
16 Coloplast. Data on file.
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18 Coloplast (2024) Excellence in Stoma Care: The value of Stoma Care Nurse Specialists – Practical guidance for commissioners and leaders in health and social care. Available at: https://www.coloplast.co.uk/Global/UK/Stoma/HCP/Excellence_in_Stoma_Care_Final.pdf Last accessed: March 2026
19 Burch, J. (2025) Barriers to adapting to life with a stoma. British Journal of Community Nursing, 30(3). Available at: https://www.britishjournalofcommunitynursing.com/content/professional/barriers-to-adapting-to-life-with-a-stoma Last accessed: March 2026
20 Rolls N, Trevatt P, Perrin A, Squire S. Stoma care crisis: the urgent need for nationwide pathways and patient-centric policies. British Journal of Nursing, 2025, Vol 34, No 16 (Stoma Care Supplement). https://doi.org/10.12968/bjon.2025.0189 Last accessed: March 2026
21 Coloplast. Data on file.
22 Coloplast. Data on file.
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24 Soares-Pinto I, Braga A, Santos I, Ferreira N, Silva S, Alves P. eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study. JMIR Hum Factors 2023;10:e39826. URL: https://humanfactors.jmir.org/2023/1/e39826. DOI: 10.2196/39826
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30 Coloplast. Data on file.
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