Among the wild cheering that accompanied most of Lord Darzi’s next stage review plans, there was a markedly more muted response to the workforce strategy.

The NHS has struggled with workforce planning for its entire 60 years. The strategy revealed last month in A High Quality Workforce was published in the aftermath of the Modernising Medical Careers debacle. Change was clearly needed, but managers now fear that strategic health authorities are usurping the role of employers.

The case for trusts to be in the driving seat of workforce strategy is compelling. They are the ones that understand the mix of staff, skills and training required to provide current and future services, and will be the first to identify changing demands, whether from patient choice, movements in health demographics or clinical innovation.

Trusts in charge would be a more responsive and less bureaucratic approach than what is on offer - primary care trusts submitting plans to their SHA masters, to be subsumed into a grand regional plan developed a long way from the action.

Further rebellions

The fracas that erupted between human resources directors and NHS London could presage further rebellions against SHA control of workforce planning and training, as managers put the entreaty to “look out not up” to practical effect.

There is more at stake here than the workforce strategy. The willingness of the Department of Health to recognise the force of argument on this issue will be an important test of its professed willingness to listen to the front line.

Shifting its position on workforce would be a powerful signal that the DH is serious about devolution. If it does not, trusts would be forgiven for thinking that the strategic health authorities are emerging as the new face of central control.

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