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Workforce sustainability in UK health and care services

A Lancet Commission analysis examining workforce shortages, recruitment and retention challenges, and the need for long-term workforce planning across the UK health and social care system.

Key messages 

  • workforce shortages across health and social care threaten the sustainability of services 
  • recruitment and retention difficulties are linked to low pay, poor working conditions and limited career progression 
  • a long-term workforce strategy integrating both health and social care planning is required 
  • international recruitment remains an important component of workforce supply 
  • continued policy inaction is likely to widen workforce gaps and affect service quality and outcomes. 

Policy implications 

  • development of a long-term national workforce strategy that includes social care alongside the NHS 
  • improved pay, conditions and career pathways to support recruitment and retention 
  • workforce planning that accounts for demographic changes and rising demand for care 
  • ethical and sustainable approaches to international recruitment. 

Gaps 

  • limited analysis of the contribution and pressures placed on unpaid carers within the workforce system 
  • the paper focuses on national workforce planning rather than regional variation in workforce pressures 
  • further research is needed on how workforce strategies can be implemented across both health and social care systems. 

Commentary 
This paper examines the structural drivers of workforce shortages across the UK health and social care system. It highlights how long-standing issues in workforce planning have left services vulnerable to rising demand and demographic change. Recruitment and retention challenges, combined with workforce ageing and increasing service pressures, contribute to persistent staffing gaps. 

A key theme is the difference between workforce planning in the NHS and social care. While the NHS has national workforce planning mechanisms, social care remains more fragmented, with workforce planning largely shaped by local authority budgets and provider capacity. This creates variation in staffing stability and service provision across the system. 

Financial pressures also influence working conditions and career opportunities. Lower pay and fewer structured progression pathways in social care contribute to high turnover and recruitment difficulties, reinforcing the cycle of workforce shortages. 

In terms of care inequities, the paper highlights how workforce shortages can translate into uneven access to services. Areas with greater financial pressures or fewer available staff may experience more service disruptions and reduced continuity of care. At the same time, inequities within the workforce (particularly around pay and conditions between health and social care) reflect broader financial imbalances across the system. These dynamics demonstrate how funding structures influence both workforce stability and the distribution of care. 

Overall, the report argues that sustainable workforce planning requires coordinated policy across health and social care. Without long-term investment and strategic planning, workforce shortages will continue to affect service availability and contribute to financial and structural inequities in care provision.

The costs of care in residential homes for older people

A study examining care work in residential homes for older people, focusing on working conditions, care routines and the relationship between workforce culture and quality of care.

Key messages 

  • quality of care in residential homes is closely linked to available resources 
  • workforce culture shapes daily routines and philosophies of care 
  • care workers play a central role in translating organisational priorities into practice 
  • time pressures influence how care is delivered to residents 
  • divisions of responsibility within care homes affect staff experience and care outcomes. 

Policy implications 

  • resourcing levels directly affect the capacity to deliver high-quality care 
  • workforce culture should be considered alongside staffing numbers 
  • clearer allocation of responsibilities may support safer and more consistent care 
  • time allocation per resident is a critical factor in care quality. 

Gaps 

  • limited exploration of how responsibilities are divided across staff roles 
  • need for further research on time pressures and their impact on care delivery 
  • findings are based on residential care settings only 
  • wider system-level influences on care home resourcing are not examined. 

Commentary 
This study provides a detailed account of how care work is organised and experienced within residential homes for older people. By focusing on everyday routines and interactions, it shows how care quality emerges from the interaction between resources, organisational culture and staff practice. 

The findings emphasise that good care is not solely a function of individual commitment. Workforce culture and material conditions shape what care workers are able to do, how time is prioritised and how responsibilities are distributed across teams. 

From a care equity perspective, the study highlights how under-resourcing and time constraints can create uneven care experiences for residents. When staff are required to ration time or negotiate unclear responsibilities, some residents may receive more attentive care than others. These dynamics reflect broader inequities in how care is funded and organised, rather than individual failings of workers. 

Overall, the paper stresses the importance of viewing workforce conditions as central to equitable care. Ensuring fair allocation of time, clarity of roles and adequate resources is essential if residential care homes are to provide consistent and dignified care for all residents.