I’ve spent more than 30 years working on health workforce problems, as a clinician, manager, academic, consultant and expert witness, from inside the system and outside it, in Australia, the UK and internationally.

I started out wanting to know whether what we did made a difference to people. That question kept getting bigger. In the UK, it became a question about who should do the work and why: about support workers, skill mix, teams and the boundaries between professions. Back in Australia, it became a question about how to redesign roles across whole systems, in rural health, primary care and new models of care. More recently, working with governments here and overseas, it became a question about how to plan for need rather than simply for supply.

Over time I’ve come to a fairly simple conclusion. The same workforce problems keep resurfacing, in different countries and after one reform after another, because we usually treat them as problems of supply when they’re really problems of design. Who gets counted, which roles get recognised, how work is classified and paid, and who has the authority to change any of it: those decisions shape the workforce far more than recruitment targets do. When they’re out of step with where care is actually delivered, shortages appear, good innovations stall, and the people trying to do things differently end up carrying the system on their own shoulders.

HealthWorX Futures is where I now work on that problem directly.