REAL Supply Research Unit: PhD Studentship Opportunities 2026/27

England faces a major demographic challenge: an ageing population is driving rising demand for care at the same time as the number of young people available to enter health and care training is projected to fall. To meet future needs, the NHS Long-Term Workforce Plan calls for substantial expansion of training places across nursing, midwifery, medicine and allied health professions. But large, non-marginal increases in recruitment inevitably draw in individuals who might not otherwise have chosen or been selected for these careers. Little is known about how this could change the characteristics of the future workforce - or the quality and sustainability of care they will deliver.

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Ensuring a stable health and social care workforce is essential for meeting the needs of an ageing population. Yet both sectors face persistent shortages, high vacancy rates and difficulties in retaining staff. Over the next 15 years, the NHS and adult social care workforce will need to expand substantially, but doing so requires a clear understanding of how wages, job security, shift patterns, career development and wider working conditions shape people’s decisions to join, remain in, or leave these professions. While pay is often assumed to be the primary lever, evidence suggests that non-financial aspects of work may be equally or even more important - particularly in a system where national pay frameworks limit local flexibility.

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International migration has long been essential to sustaining the UK’s health and adult social care workforce. Foreign-born and overseas-trained staff now make up a substantial share of doctors, nurses, dentists and care workers, and recent years have seen unprecedented inflows driven by high vacancy rates and ageing population needs. Yet this reliance raises important questions for long-term workforce sustainability. Migration responds to global labour market dynamics, changing conditions in source countries, and UK policy choices on pay, working conditions and immigration rules. At the same time, the UK is also a source country: growing numbers of nurses and doctors - particularly younger and overseas-trained staff - are leaving to work in Australia, New Zealand, North America and elsewhere, citing pay, working conditions and quality of life. 

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Health and adult social care services depend on a diverse workforce performing a wide array of tasks. As the population ages and multimorbidity rises, the question of how best to combine different roles, skills and technologies becomes central to the productivity and sustainability of the system. Skill-mix - the configuration of skills within and across occupations - shapes how tasks are delivered, how teams function, and how effectively services meet demand. Yet despite widespread policy interest and ongoing role innovations (such as advanced nurse practitioners, physician associates and multidisciplinary primary care teams), evidence on the optimal blend of skills and on the consequences of changing skill-mix remains limited. 

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New technologies and ways of working - whether digital tools, clinical equipment, or redesigned care pathways - have the potential to improve quality, efficiency and outcomes across the NHS and social care. Yet the pace at which beneficial innovations spread, and outdated or low-value practices are phased out, varies widely across organisations and regions. Slow or uneven adoption can delay patient benefit and widen inequalities, while slow disinvestment can waste scarce resources. Despite decades of policy emphasis on innovation, we still lack a clear understanding of why some innovations diffuse rapidly while others stall, and how system design, incentives and organisational behaviour shape these patterns. 

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Public expenditure on health and social care in England has risen steadily over the past decades, driven largely by growth in the workforce and the rising cost of labour. With demand for care expected to continue increasing, questions are emerging about whether technology could play a larger role in delivering services more efficiently. Automation - the use of machines, robots, and artificial intelligence to perform tasks traditionally done by humans - offers one potential route to improving productivity, but the sector’s reliance on skilled, judgement-intensive, and interpersonal tasks has historically limited uptake. 

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In England, primary dental care and adult social care (ASC) are largely delivered by independent providers, yet a substantial share of demand is publicly funded. Local authorities and the NHS wield significant market power, often keeping fees below sustainable levels. This has contributed to market failures, reducing service availability, stressing the workforce, and increasing reliance on unpaid care. 

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The NHS faces ongoing challenges in balancing immediate healthcare needs with investments that improve future health outcomes. Long-term investment - such as preventative medicine, capital infrastructure, and preparing for climate change - often requires upfront resources, with benefits that may take years or decades to materialise. Decisions about where to allocate funding are influenced by fragmented responsibilities, short-term political cycles, and incentives that can discourage preventative or capital-focused spending. 

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