In evolutionary biology, fitness is relative to environment: a trait has value because it improves an organism's ability to survive and reproduce under a particular set of conditions – to put it another way, it is fit for purpose. Change those conditions and the selection pressures change with them. Features that were once fit for purpose can become less decisive; others gain value.
That is a useful way to think about NHS workforce solutions.
For much of the last two decades, the market rewarded access to labour, speed and the ability to fill urgent requirements. In periods of acute scarcity, trusts and suppliers competed for the same limited resources. Pay and charge rates increased, and frameworks, managed services, neutral vendor arrangements, tighter controls and staff banks evolved in response.
Those models solve real problems. But the environment around them is changing.
NHS agency expenditure peaked at £3.64bn in 2015/16; by 2025/26 it fell to £1.18bn, roughly two-thirds lower. Trusts are now expected to reduce agency use substantially again, alongside year-on-year reductions in bank expenditure and an ambition to eliminate agency by 2029/30. Workforce plans are also being drawn more tightly into activity, productivity and financial planning.
These are powerful new selection pressures. They do not remove the need for commercial workforce partners. They change where those partners can create the greatest value.
As the NHS gets better at controlling the transaction at the end of the process, the opportunity increasingly sits further upstream: identifying demand earlier, understanding why it is forming, deciding whether it can be reshaped, redirected or avoided, and choosing the right response while there is still time to choose.
A temporary staffing requisition rarely begins life as one. Months earlier it may have been a persistent vacancy, retention problem, failing recruitment campaign, service change or project without an established workforce plan.
By the time a requirement reaches a supplier, many of the options that existed have disappeared. The organisation now needs somebody quickly. The next generation of workforce partners will need to operate upstream.
There is a useful parallel in defence. Effective deployment starts long before personnel are mobilised. Readiness depends on situational awareness: understanding likely demand, available capability, emerging risk and the responses that can be brought to bear as conditions change.
Workforce planning increasingly needs the same discipline.
A recurring temporary booking is information; so is an establishment gap, repeated recruitment failure, rising turnover, planned service expansion or recurring demand for specialist capability. Seen together, these signals begin to describe future workforce demand.
Earlier visibility creates more choices. Three months' notice might allow permanent recruitment where three days' notice permits only temporary cover. Recurring demand might justify building internal capability. Requirements might be aggregated. Roles may be redesigned. A project could be commissioned around an outcome through an appropriate statement of work. Temporary labour becomes one deployment option rather than the inevitable destination of unresolved demand.
This is where commercially aligned private-sector partners can become a force multiplier.
Commercial motivation can bring investment, specialist capability, technology, market intelligence, delivery infrastructure and pace. The opportunity is to structure relationships so that commercial success follows the outcomes NHS organisations are trying to achieve.
Resolving recurring demand creates value. So does converting the right requirement into substantive employment, improving root-cause visibility, increasing productivity or delivering contingent labour efficiently where it remains appropriate.
The market is already moving in that direction. The NHS Workforce Alliance's RM6380 Health Workforce Solutions framework is designed around strategic and integrated workforce solutions, spanning managed services, banks, permanent recruitment, workforce planning, technology and statement of work services. Transactional agency supply in isolation is explicitly outside its scope.
That breadth creates room to start with the problem rather than the product.
Workforce solutions should be co-developed around the outcomes an organisation needs rather than constrained by an incumbent model or assumption.
At Fusion People, that is the conversation we are increasingly having: where is demand forming, how early can we see it, which parts can be removed or redirected, what capability is needed to resolve what remains, and how should the commercial relationship be aligned to delivery?
The commercial environment is changing. Businesses with the greatest adaptive value will be those that retain excellence in fulfilment while moving upstream towards the point where workforce demand can still be influenced.
That is where the evolution from workforce supplier to delivery partner begins.
