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New proposals for reorganisation of healthcare staff in England

BMJ 2011; 342 doi: (Published 22 March 2011) Cite this as: BMJ 2011;342:d1839
  1. Jennifer Dixon, director
  1. 1Nuffield Trust, London W1G 7LP, UK
  1. jennifer.dixon{at}

Extensive, rapid, and risky

Last year’s white paper Equity and Excellence: Liberating the NHS proposed extensive reform of the NHS.1 Away from the current parliamentary debates on the resulting Health and Social Care Bill, the Department of Health is still seeking responses to proposals in some key areas. One of these is how the healthcare workforce might be developed in the future.2

The workforce is central to the current NHS—1.4 million people are employed in 300 roles and cost more than 60% of the £107bn (€123bn; $174bn) NHS budget. How intelligently the supply of staff, their education, training, and development are planned and managed is crucial for the future viability of the NHS. Previous experience suggests substantial room for improvement. The Health Select Committee in 2007 noted the shortage of skills and data on which to plan supply, lack of coordination in planning across professional silos, poor engagement from local NHS organisations for whom these matters were a secondary consideration, lack of integration with financial planning and plans for future service development, and the lack of a long term view.3

The new proposals cover both planning the supply of and the education, training, and future development of healthcare staff in England, except for public health staff (for which there will be a separate consultation). The rationale for change includes the points made by the select committee, but also that planning has been too “top-down,” siloed by profession, inflexible, and not driven enough by local employers. It argues that this has resulted …

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