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Why it matters

There’s no explicit requirement that Joint Forward Plans outline workforce plans. But ICBs will be responsible for workforce planning within their Integrated Care System (ICS), and NHS England has indicated that plans should include actions to increase the workforce.  

Since NHS England published the NHS Long Term Workforce plan in 2023, it's not been clear how much local and regional workforce priorities have been factored into national ambitions and targets. There’s no information about how national ambitions translate into local allocations, or how funding will be divided between national decision-making bodies and ICS. 

Any positive effect of the NHS Long Term Workforce plan on workforce supply may not be seen until the late 2020s, because a key component of the plan is increasing student numbers for in-demand qualifications. In the meantime, it’s important that ICBs are supported to carry out recruitment and retention interventions that contribute to both local priorities and national ambitions. 

How we collected evidence

• We reviewed legislation, guidance and plans at a national level to identify where roles and responsibilities have been allocated and clarified
• We analysed all available ICS Joint Forward Plans, along with publicly shared workforce plans and priorities.
• We reviewed ICS websites and board papers to pull together a comprehensive picture of workforce planning at regional level.
• We compared the types of information contained in the plans to identify the coverage of local workforce plans.

What we learnt

Most ICBs don’t have specific workforce planning in place. There’s a lack of clarity around the role of ICBs in workforce planning. Several plans simply refer back to the NHS People Plan, or make no reference to independent workforce planning at an ICS level.

The regulatory and statutory requirements of workforce planning for ICBs are unclear. This may be causing uncertainty about who is responsible for workforce planning under the new ICS structure. Many ICBs appear to still be developing their approach to commissioning and planning.  

Some ICBs are a lot further ahead in their planning and development than others, risking unequal outcomes between regions. Some ICBs have fully developed and published workforce plans separate to their Joint Forward Plans and Integrated Care Strategies, while others only have draft Joint Forward Plans available, or do not have them published with working links.

Across all plans, it’s difficult to see what level of workforce modelling is taking place, even in plans that do outline concrete actions. Most plans do not include any data on the workforce needs of the region, and very few plans include specific metrics for monitoring progress.

The precise role ICBs should be playing in workforce planning in their region is unclear.  

Each ICB is required to complete a Joint Forward Plan, and its seems the general intention is that these should include actions for workforce planning. But this is not a concrete requirement in any available guidance.  

Further to this, NHS England’s Long Term Workforce Plan makes patchy reference to ICBs, and doesn’t make clear the interconnectivity between ICB’s individual workforce plans and the wider Long Term Workforce Plan. It’s not clear how NHS England will consider regional workforce planning in its wider national strategy. It’s also unclear to what extent ICBs must follow the Long Term Workforce Plan when designing their own workforce plans. 

We recommend that NHS England develops and publishes clear guidance on how workforce planning is delegated to ICBs and set firmer deadlines for all ICBs to develop and publish an actionable workforce strategy. Without this, ICS run the risk of having no local plan to combat acute workforce shortages and may be left reliant on national-level workforce strategies that do not take into account particular regional issues or policy levers.

Many ICBs simply have placeholder text in their Joint Forward Plans indicating that workforce planning is still to take place. This could be due to them being unclear of their role in workforce planning. It could also be due to the requirement to publish Joint Forward Plans within 12 months of the ICBs being established.  

While it appears that some ICBs began developing plans prior to their new structure being established by statute, others were clearly unable to take this approach and appear to have worked at pace to publish their Joint Forward Plans. For a number of ICBs, their first-year actions related to workforce planning are simply to develop further strategies. 

The staffing crisis within the nursing workforce is urgent, and nurses cannot afford to wait up to 5 years before their ICB develops actions to address it.  

We recommend that ICBs are supported to urgently expedite their workforce planning, by issuing clearer guidance on the role of ICBs in planning and guidance on the relation between the NHS Long Term Workforce Plan and regional-level workforce planning.

Where ICBs have identified actions relating to workforce supply, these actions predominantly focus on recruiting new staff to the regional workforce. While this is a key component to meeting staff shortages, there also needs to be an increased focus on retaining existing staff and improving their working conditions. 

Some Joint Forward Plans outline actions to improve working conditions in sections outside of their workforce supply plans, but these actions are often limited to the practical performance of a role (e.g. providing staff with more skills training) rather than staff wellbeing. 

Alongside the development of plans to increase staff numbers, ICBs need to take a much greater focus on the wellbeing and working conditions of their existing staff. 

While equity, diversity and inclusion initiatives are often present in other plans from ICBs, it is important to include them in workforce supply planning rather than treating them as separate issues. 

Integrated Care System leaders should:

• Provide clear roles, responsibilities and commitments for workforce planning and supply within their ICS, to ensure transparency and accountability for workforce decision-making.
• Champion the need for national decision-makers to set clear roles and responsibilities for workforce plan delivery, so that ICS leaders can be clear on what actions fall within their remit.
• Make sure there is a nurse at executive level within their governance structure to provide professional, strategic and operational guidance to corporate boards and commissioners on nurse staffing (see the RCN Workforce Standards).
• Urgently fast-track delivery of workforce plans, to allow for scrutiny and discussions about additional funding or support.  
• Work with local staff groups to identify retention challenges, and design corrective interventions, alongside efforts to increase recruitment.  

Services providers should:

• Ensure nurse leaders are involved in workforce planning and setting staffing establishments and developing individuals within their workforce.
• Use the RCN Workforce Standards to support a safe and effective nursing workforce.

The relevant RCN Workforce Standards are:

• Executive nurses are responsible for setting nursing workforce establishment and staffing levels. All members of the corporate board of any organisation are accountable for the decisions they make and the action they do or do not take to ensure the safety and effectiveness of service provision. 
• Setting the nursing workforce establishment should explicitly inform the organisation’s financial planning and be funded by revenue allocation rather than fitting a prescribed financial envelope. 
• Decisions on nurse staffing must be recorded. Discussions must detail the workforce requirements of the organisation/service in order to provide staffing for safe and effective care. Nurse staffing should be a standing item for scrutiny and discussion at every board meeting. 
• Each organisation should have a board-approved risk management and escalation process in place to enable real-time nurse staffing risk escalation and mitigation with clear and transparent procedure to address severe and recurrent risks.