Topic 7.3 — Workforce Strategy

In one sentence: A workforce strategy is the long-term, evidence-based, partnership-built plan that ensures your organization will have people with the right values, skills, capacity and wellbeing to deliver care over a ten-year horizon — and in digital health and care, it must treat digital capability and wellbeing as first-order design principles, not afterthoughts.

Why this matters in health and care#

Workforce planning (Topic 7.2) answers "how many people, with which skills, do we need next year, and how do we source them?" A workforce strategy answers a bigger and longer question: "what kind of workforce do we want to be over the next decade, and what must change — in culture, roles, learning, leadership and technology — to get there?" It is the difference between filling next year's rota and reshaping the profession.

In health and care this is existential. Services are entirely dependent on people: as the Welsh strategy that anchors this topic puts it, "the delivery of health and social care to the population of Wales is completely dependent on our workforce." The sector faces an ageing workforce, rising and more complex demand, growing health inequalities, higher public expectations, and a global shortfall the World Health Organization has projected at millions of health workers by 2030. Technology adds a second pressure: the pace of digital change outstrips most organizations' ability to absorb it, so a workforce strategy that ignores digital capability will design tomorrow's workforce for yesterday's ways of working.

There is also a hard evidence link that makes workforce strategy a quality and safety instrument, not an HR nicety: staff experience, engagement and wellbeing correlate with the quality and safety of care people receive. Compassionate cultures produce compassionate care. Under-valued, over-loaded staff produce worse outcomes and leave. A workforce strategy is therefore one of the highest-leverage documents a health or care leader will ever own — and, because so much of the workforce sits in social care, private and voluntary providers, and the volunteer and carer community, it is inescapably a partnership document (see Topic 9.0 — Collaborating with Partner Organizations).

Core concepts#

Strategy versus plan. The strategy sets vision, ambition and themes over ~10 years; the implementation plans (co-produced, refreshed on a cycle) turn themes into dated, owned actions. Keep the two artefacts distinct: the strategy is stable and directional; the plans are living and specific.

The whole workforce. In health and care, "workforce" is not just directly-employed staff. It includes statutory, private and voluntary providers, agency staff, volunteers, and unpaid carers. A credible strategy explicitly encompasses all of them, because the person receiving care experiences one system, not an org chart.

Fundamental principles as a golden thread. A good strategy names a small set of principles that must be woven through every theme and plan. In A Healthier Wales, these are wellbeing, Welsh language, and inclusion. Yours will differ (language may not apply; equity, safety and digital inclusion almost always will), but the pattern — a few non-negotiable threads running through everything — is the transferable idea.

Values before roles. Modern workforce strategy is values-based: recruit, induct and lead for shared values, then build competence on top. "Values based recruitment" and a "common induction" recur throughout the Welsh actions for exactly this reason.

Intelligence-led. You cannot reshape what you cannot see. Strategy depends on standardized workforce data, shared definitions across health and care, and modelling capability — a "centre of excellence for workforce intelligence" is the ambition, because today's data is fragmented and non-comparable across sectors.

Best practices#

1. Anchor the strategy in a compelling, evidence-based case for change. Set out the demographic, demand, inequality, financial and technological pressures explicitly, and cite the reviews and evidence behind them (in Wales: the Parliamentary Review, A Healthier Wales, the King's Fund, the WHO workforce projections, the Topol Review). Leaders and staff commit to change they can see is necessary; a strategy that opens with ambition but no diagnosis will not move anyone.

2. Build it in genuine partnership, and say who you heard from. The Welsh strategy was shaped by engaging over 1,000 people and organizations and 200 formal consultation responses, through "social partnership" between employers, trades unions and government. Co-production is not a courtesy — it is what makes the actions deliverable, because the people who must change the work help design the change. Record the engagement so the strategy visibly belongs to the workforce, not to the centre.

3. Express ambition as a clear "strategy on a page" with a dated horizon. Distil the whole thing into one page: the ambition, what will be different, what success looks like, and an implementation timeline. A Healthier Wales sets a 2030 ambition — "a motivated, engaged and valued health and social care workforce, with the capacity, competence and confidence to meet the needs of the people of Wales" — and 32 actions for the first three years, reviewed every three. A memorable, dated ambition aligns thousands of dispersed decisions.

4. Organize around a small number of themes, each with an outcome statement. Themes give the strategy structure and let dispersed teams find their contribution. The Welsh seven are a strong, transferable template because each is stated as a 2030 outcome ("by 2030, X will be the norm"), not an activity. Aim for five to eight; more fragments effort, fewer over-generalizes.

5. Make "digitally ready workforce" an explicit theme, not a footnote. This is the point most relevant to a digital health organization. The Welsh Theme 4 — "Building a Digitally Ready Workforce" — commits to a digital capabilities framework, embedding digital in undergraduate curricula, and requiring every digital transformation programme to carry an organizational-development plan. That last action is the sharpest: no digital rollout without a workforce/OD plan attached (see Topic 7.5 — People & Organizational Development, and Topic 8.1 — Change Management). It operationalizes the Topol Review's finding that technology adoption is bottlenecked by workforce capability, not by the technology.

6. Treat wellbeing as strategy, backed by frameworks and measures. Wellbeing recurs as a principle and a theme because the evidence linking it to care quality is strong. Concrete mechanisms matter more than sentiment: a Health and Wellbeing Framework with measurable standards; a Staff Governance Framework (the Welsh strategy borrows Scotland's, which enshrines social partnership in a system of corporate accountability for fair treatment of staff); a consistent staff-experience survey and engagement index; and wellbeing/engagement measures built into the organizational performance framework so boards are held to account for them.

7. Design for seamless, multi-professional, multi-agency roles. Future care models are built around "what matters to me" to the person, which cuts across professional boundaries. Strategy should deliberately dissolve the boundaries that cause "gaps and duplication of care" — through competence frameworks for extended skills and advanced practice, common induction, and harmonized regulation and registration across health and social care. For a digital team this is the workforce mirror of interoperability: people, like systems, must work across organizational seams.

8. Invest in education, learning and a "grow your own" pipeline. Shift from uni-professional training to inter-professional, flexible, accessible routes: apprenticeships, work-based learning, recognition of prior learning, and widening access to under-represented groups and rural/remote "grow your own" communities. Embed the new essentials — prevention, quality improvement, research, leadership, digital — into core curricula rather than bolting them on. A strategy that only recruits, without building the training pipeline, mortgages the next decade.

9. Make leadership development collective, compassionate and distributed. Leadership is "needed at all levels," not equated with a few senior posts. Build a talent and succession pipeline, accessible leadership resources (often via a digital portal), and leaders who can work across organizational boundaries — because system transformation and partnership working demand shared, distributed leadership. Compassionate leadership is the causal lever on culture, and culture is the lever on care quality.

10. Close the loop with workforce intelligence and measurable success. Commit to standardized data sets, shared definitions across health and care, modelling capability, and a defined workforce-planning methodology (in Wales, a "six-step" approach — see Topic 7.2). Define what success looks like up front (engagement, retention, skills, diversity, intelligence-led planning) and review the actions on a fixed cycle so the strategy stays "live and valid" rather than becoming a shelf document.

Questions to discuss with your team#

1. Does our workforce strategy treat digital capability as a first-order theme, or is it still buried inside "IT training"? This is the question that most often separates a strategy that will survive contact with transformation from one that won't. The Welsh strategy makes "Building a Digitally Ready Workforce" one of seven themes and — crucially — requires every digital transformation programme to carry an organizational-development plan, operationalizing the Topol Review's finding that technology adoption is bottlenecked by people, not products. Debate honestly whether your current plans would let a shared-care-record rollout stall because care-home staff have no devices, no protected learning time, and no digital confidence. A good answer names a digital capabilities framework, a mechanism that ties funding release to a workforce/OD plan, and someone accountable for it — not a vague aspiration to "upskill." Watch for the comfortable illusion that buying training licences equals capability.

2. Are we genuinely co-producing this with the whole workforce — including social care, the independent sector, agency staff, volunteers and carers — or writing it centrally and consulting cosmetically? In health and care the person experiences one system, but the workforce spans many employers with very different terms, conditions and power. The Welsh strategy was shaped by engaging over 1,000 people and 200 formal responses through statutory social partnership, and it explicitly encompasses statutory, private, voluntary, volunteer and carer workforces — because a strategy the frontline did not help write is one the frontline will quietly ignore. Discuss who is actually in the room when you set direction, whose terms and conditions you are willing to put on the table, and whether your social-care and domiciliary partners see the strategy as theirs. A good answer can point to concrete co-production and to actions that address the pay, workload and recognition issues staff actually raised, not just the ones convenient to fund.

3. Are we weighting retention as heavily as recruitment, and can we prove wellbeing is improving? "Many of our future workforce are with us today": a strategy that chases new hires while current staff leave through the back door never closes the gap, and in a sector with an ageing workforce and rising agency spend the maths is unforgiving. The evidence linking staff wellbeing and engagement to care quality and safety means retention and wellbeing are clinical issues, not HR ones — yet they are the easiest to reduce to warm words. Discuss whether you have a wellbeing framework with measurable standards, a consistent staff-experience survey that spans the NHS and the care market, and wellbeing/engagement measures built into the board's performance framework so leaders are actually held to account. A good answer shows you can see engagement where turnover is worst, and that a named leader owns moving it.

4. Have we designed for roles that cross professional and organizational boundaries, or are we still planning profession by profession and employer by employer? Future care is organized around "what matters to me" to the person, which rarely respects the lines between professions, trusts, councils and providers — yet most workforce planning still happens in uni-professional, single-employer silos that reproduce the very "gaps and duplication of care" the strategy is meant to dissolve. This is the workforce mirror of interoperability: people, like systems, have to work across the seams, which means competence frameworks for extended skills and advanced practice, common induction, and harmonizing regulation and registration across health and social care. The tension is that boundary-crossing roles threaten established professional identities, pay structures and regulatory turf, so the honest debate is about who gives ground and how you manage the safety and accountability questions that follow. A good answer points to specific redesigned roles or advanced-practice pathways, names the regulatory and terms-and-conditions obstacles you are actually tackling, and shows how a digital programme (a shared record, remote monitoring) is being used to enable the new roles rather than merely digitizing the old ones.

5. Is this a living strategy with owned, dated plans and a real review cycle, or a document that will age out on a shelf? The strategy is meant to be stable and directional over ten years while the implementation plans stay living, specific and refreshed on a cycle — but the failure mode is a handsome vision published once, with no owned actions, no dates, and no mechanism to keep it "live and valid" as demand, technology and finances move underneath it. Discuss whether every theme translates into dated actions with a named owner, whether you have committed to a fixed review rhythm (the Welsh model refreshes its actions every three years), and who has the authority and the standing forum to renew them. The trade-off is honesty about capacity: a strategy that promises constant refresh but has no resourced team behind it is as hollow as one that never revisits itself. A good answer can show the separation between the durable strategy and the living plans, point to the last review that actually changed something, and name the board or partnership that holds the cycle.

6. Can we actually see our whole workforce — across health and social care — well enough to steer this strategy? You cannot reshape what you cannot see, and in this sector the data is fragmented and non-comparable across NHS, local-authority and independent providers, so a strategy built on partial or incompatible workforce intelligence is steering half-blind. Debate whether you have standardized data sets, shared definitions that mean the same thing to a trust and a care home, and the modelling capability to test scenarios rather than just count last year's headcount — the ambition of a "centre of excellence for workforce intelligence" exists precisely because today's picture is so poor. The tension is that better intelligence costs money and cooperation that independent providers have little slack to give, and that data-sharing across employers raises real information-governance questions. A good answer shows where you can already compare workforce data across sectors, is candid about the biggest blind spots (usually the domiciliary and care-home workforce), and names who is investing in closing them.

In practice: a health & care example#

An Integrated Care System (ICS) covering three NHS trusts, five local authorities, and a large independent-sector care market is rolling out a shared care record and a suite of patient-facing digital services over five years. Early pilots stall: clinicians distrust the new record, care-home staff have no devices or digital confidence, and turnover in the domiciliary workforce erases every training cohort within months.

The ICS responds by writing a ten-year workforce strategy rather than another training plan. It opens with a shared case for change (demand, ageing workforce, digital opportunity) built from a joint engagement exercise across all partners — including care providers, unions and carers — so the strategy is co-owned. It sets a dated 2035 ambition and six themes, one of which is explicitly "a digitally-ready workforce." Under that theme it mandates that every digital programme business case must include an OD and workforce plan (devices, protected learning time, digital champions, capability uplift) before funding is released; without it, the spend control board declines the case. A wellbeing theme introduces a common staff-experience survey across NHS and social care so, for the first time, the ICS can see engagement in the care market — which turns out to be the real driver of the turnover that was defeating training. Within three years, adoption of the shared record rises not because the technology changed, but because the workforce was designed to receive it.

Sector lenses#

Startup#

A 30-person digital-health startup rarely writes a ten-year workforce strategy — but it should write a one-page version, because its whole valuation rests on scarce talent (clinical-safety engineers, ML specialists, a part-time Caldicott Guardian) it cannot easily replace. The transferable moves are: name two or three workforce principles (e.g. clinical credibility, learning culture, wellbeing so people don't burn out in a high-growth sprint); decide build/buy/borrow deliberately (a fractional Clinical Safety Officer rather than an unfilled full-time post); and treat retention as survival, because losing the one person who understands your DCB0129 safety case is an existential risk, not an HR metric. Strategy here is lightweight and founder-owned, but the values-before-roles and retention-over-recruitment lessons apply at any size.

Small business#

An established small provider — a GP practice, a community pharmacy, a care home or a domiciliary-care agency — is the workforce this strategy most often assumes but least resources: real patients and clients, a handful of staff, no dedicated HR or IT function, tight cash, and the same statutory and clinical-safety duties as a large trust. Its "strategy" is realistically a page in the practice or business plan that names a couple of workforce priorities (values-based recruitment, retention of hard-to-replace staff, basic digital confidence) and a "grow your own" instinct — training an existing healthcare assistant or care worker rather than competing for scarce hires it cannot outbid. The sharp risk is being on the receiving end of someone else's digital rollout — a shared care record or an electronic prescribing system — with no protected learning time and no OD plan, which is exactly where system pilots stall; so the transferable move is to insist that any programme it is asked to adopt comes with devices, training time and support attached, and to lean on partnership and shared resources (the ICS, the primary care network, the local authority) it is too small to provide alone.

Enterprise#

A large NHS trust or integrated care system is the natural home of a full workforce strategy: tens of thousands of staff across statutory, private, voluntary, agency, volunteer and carer workforces, a decade-long transformation, and a board accountable for safe staffing. Here the Welsh model transfers almost wholesale — a dated ambition, five to eight outcome-based themes, an explicit "digitally-ready workforce" theme that gates every transformation programme on an OD plan, a common staff-experience survey spanning the NHS and the care market, and a workforce-intelligence function with standardized data. The hard part is genuine social partnership across many employers with different terms and conditions, and resisting the temptation to write the strategy centrally and "consult" cosmetically.

Government#

A national body (HEIW, Social Care Wales, NHS England, a devolved government) writes workforce strategy as system stewardship: it sets direction for a whole nation's workforce it does not directly employ, so its levers are commissioning, education funding, regulation, registration and standards rather than line management. A Healthier Wales is exactly this — a "once for Wales" strategy delivered through education commissioning, a national careers service, harmonized regulation, and a workforce-intelligence centre of excellence, co-produced in statutory social partnership and reviewed on a fixed cycle. The distinctive obligations are legislative alignment (the Well-being of Future Generations Act's long-term duty), equality-impact assessment, and delivery through regional and local plans the centre can influence but not command.

Common failure modes#

• A vision with no diagnosis. Ambition statements untethered from an evidenced case for change inspire no one and guide nothing. Lead with the pressures.
• Written to the workforce, not with it. Strategies drafted centrally and "consulted" cosmetically are quietly ignored. Genuine social partnership is the deliverability mechanism.
• Digital as a bolt-on. Treating digital capability as an IT training issue rather than a core workforce theme guarantees that transformation programmes will be bottlenecked by people who were never developed to use them.
• Directly-employed staff only. Ignoring the private/voluntary providers, agency staff, volunteers and carers designs a strategy for a fraction of the actual workforce the person experiences.
• Strategy as a static document. No implementation plans, no owned actions, no review cycle — so the strategy ages out. Separate the durable strategy from living, dated plans.
• No shared data. Fragmented, non-comparable workforce data across health and care makes the whole strategy un-steerable; underinvesting in workforce intelligence undercuts everything else.
• Recruitment without retention. "Many of our future workforce are with us today": a strategy that chases new hires while current staff leave through the back door never closes the gap.

Maturity model#

Checklist#

• The strategy opens with an evidenced, referenced case for change (demography, demand, inequality, finance, technology).
• It was co-produced in social partnership and records who was engaged.
• There is a "strategy on a page": dated ambition, what will be different, what success looks like, implementation timeline.
• It is organized around 5–8 outcome-based themes, each stated as a future state.
• A small set of fundamental principles (e.g. wellbeing, inclusion, digital/language) is woven through every theme.
• There is an explicit "digitally-ready workforce" theme, with a capabilities framework and the rule that every digital programme carries an OD/workforce plan.
• Wellbeing is backed by a framework, a staff-experience survey/engagement index, and board-level performance measures.
• It covers the whole workforce: statutory, private/voluntary providers, agency, volunteers, carers.
• It invests in a learning pipeline (inter-professional, apprenticeships, widening access, grow-your-own) and distributed compassionate leadership.
• It commits to standardized workforce data, modelling capability, and a defined planning methodology.
• Retention is weighted at least as heavily as recruitment.
• The strategy is separated from living implementation plans with owned actions and a fixed review cycle.

Key sources#

• Health Education and Improvement Wales (HEIW) & Social Care Wales, A Healthier Wales: Our Workforce Strategy for Health and Social Care (2020) — the anchor for this topic: vision, ambition to 2030, seven themes (Engaged/Motivated/Healthy Workforce; Attraction & Recruitment; Seamless Workforce Models; Building a Digitally Ready Workforce; Excellent Education & Learning; Leadership & Succession; Workforce Supply & Shape), 32 actions, and the fundamental principles of wellbeing, Welsh language and inclusion. https://socialcare.wales/cms-assets/documents/Workforce-strategy-ENG-March-2021.pdf
• Welsh Government, A Healthier Wales: Our Plan for Health and Social Care (2018) — the Quadruple Aim (population health/prevention; experience & quality of care; workforce wellbeing/capability/engagement; value from funding).
• Welsh Government, Parliamentary Review of Health and Social Care in Wales (2018) — the case for change.
• Health Education England, The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future (2019) — the digital-workforce evidence base. https://topol.hee.nhs.uk/
• NHS England, NHS Long Term Workforce Plan and the NHS People Plan / People Promise — the England counterparts, for comparison and transfer.
• NHS Education for Scotland, Staff Governance Standard — the model the Welsh Staff Governance Framework builds on. https://www.staffgovernance.scot.nhs.uk/
• The King's Fund and The Health Foundation — workforce trends, retention and the NHS workforce challenge.
• Well-being of Future Generations (Wales) Act 2015; Social Services and Well-being (Wales) Act 2014 — the statutory frame for long-term, integrated, preventative workforce thinking.
• World Health Organization, Health Workforce — global shortfall projections. https://www.who.int/health-topics/health-workforce

References#

1. Workforce planning — Wikipedia — https://en.wikipedia.org/wiki/Workforce_planning
2. Human resource management — Wikipedia — https://en.wikipedia.org/wiki/Human_resource_management
3. Employee engagement — Wikipedia — https://en.wikipedia.org/wiki/Employee_engagement
4. Well-being of Future Generations (Wales) Act 2015 — Wikipedia — https://en.wikipedia.org/wiki/Well-being_of_Future_Generations_(Wales)_Act_2015
5. Health Education and Improvement Wales (HEIW) & Social Care Wales, A Healthier Wales: Our Workforce Strategy for Health and Social Care (2020) — https://socialcare.wales/cms-assets/documents/Workforce-strategy-ENG-March-2021.pdf
6. Welsh Government, A Healthier Wales: Our Plan for Health and Social Care (2018) — https://gov.wales/healthier-wales-long-term-plan-health-and-social-care
7. Welsh Government, Parliamentary Review of Health and Social Care in Wales (2018) — https://gov.wales/parliamentary-review-health-and-social-care
8. Health Education England, The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future (2019) — https://topol.hee.nhs.uk/
9. NHS England, NHS Long Term Workforce Plan (2023) — https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/
10. NHS Education for Scotland, Staff Governance Standard — https://www.staffgovernance.scot.nhs.uk/
11. The King's Fund, What's your problem, social care? The eight key areas for reform (2019) — https://www.kingsfund.org.uk/publications/whats-your-problem-social-care
12. World Health Organization, Health Workforce — https://www.who.int/health-topics/health-workforce