Ireland now spends more on health than at any point in its history 1, yet access to care remains uneven and contentious 2. This paradox is not unique to Ireland. Many EU and OECD countries have increased health expenditure in the last decade but without proportional gains in universal health coverage (UHC) 3. In these countries, UHC success in the next decade will be determined less by expanding access and entitlements and more by how health systems are organised, how health and care workers are valued and whether they pivot towards a ‘human economy of health and care’ 4. Ireland's Future Health and Social Care Workforce strategy, launched by Minister Carroll MacNeill on 23 December 2025 5, offers an instructive case to explore this policy challenge. Ireland places well in WHO's December 2025 report on UHC with strong service availability and quality, particularly in hospital and specialist care. However, it exhibits gaps in access to primary and community services, out-of-pocket spending remains comparatively high, and unmet need continues to affect lower-income and rural populations 3. A Lancet editorial has suggested it is Europe's outlier in primary health care 6. These challenges are intensifying. Ireland's new strategy highlights rapid population ageing to 2040, with the fastest growth among those aged 80 years and over 7. Epidemiological trends point to rising multimorbidity, chronic disease, disability, and mental health need, increasing demand for integrated health and care services and community-based care. In this context, historical workforce responses predicated on more ‘training’ and recruiting more staff into existing models will be increasingly inadequate. A WHO commissioned synthesis of evidence on workforce planning reinforces this diagnosis 8. In its review of 96 workforce planning tools the report concludes that reliance on crude workforce-to-population ratios or static supply projections fails to capture changing need, productivity, and service design. Many countries are “doing more of the same” in the face of fundamentally different system pressures. This pattern reflects not only technical limitations in workforce planning tools, but deeper governance constraints. As has been argued, many health systems remain locked into tactical responses to workforce pressure because strategic stewardship of health and care labour is politically and institutionally more demanding 9. In this sense, workforce planning failures are less about insufficient evidence than about the inability to translate workforce science into long-term system transformation. In contrast, Ireland's Future Health and Social Care Workforce strategy, represents a decisive break. Its content is one of the most technically aligned national responses to WHO's workforce planning evidence to date: an holistic, integrated approach to review all occupations that constitute the health and care workforce and supporting the uptake and implementation of workforce science on a rolling basis. First, Ireland moves away from ratio-based planning. Workforce-to-population benchmarks are used only as contextual reference points, reflecting WHO's finding that density targets are poorly suited to long-term, equity-oriented planning 8. Instead, Ireland anchors its projections in demographic and epidemiological modelling aligned with Sláintecare 2025+ and its universal care entitlements, evolving models of service delivery and the capacity of the health and care service 10. Second, the strategy incorporates both needs-based and service-based logic, which WHO identifies as the more robust—if demanding—approach for advancing UHC 8. Workforce requirements are derived from anticipated changes in care pathways, acknowledging that system performance depends as much on how care is organised as on how many workers are employed. Third, Ireland aligns national strategy and operational tools. The Framework for Safe Nurse Staffing and Skill Mix, now national policy across acute, emergency, long-term residential, and community settings, seeks to align strategy with workload and service need 11. WHO highlights this vertical integration—from national modelling to local staffing decisions—as a common weakness elsewhere 8. Finally, Ireland employs what WHO terms a “mixed approach” 8: combining quantitative modelling with qualitative scenario development, stakeholder engagement, and explicit attention to productivity and redistribution of tasks through role delegation and/or role substitution. Despite these strengths, Ireland's strategy does not fully transcend a human capital paradigm. Workforce investment is framed primarily in instrumental terms (e.g., enhancing productivity, enabling reform delivery, and relieving system pressures) rather than as a form of social investment grounded in agency, dignity and meaningful work. Previous analyses have shown that such framings may stabilise workforce supply but leave unresolved deeper issues of professional autonomy, value recognition, and long-term sustainability, particularly in ageing and care-intensive systems 12. From a human capability perspective, it represents a partial advance. The strategy recognises that skills, autonomy, and professional development matter, but it does not explicitly frame health and care work as a domain of human flourishing and social value. Nor does it engage substantively with unpaid care, informal labour, or the broader political economy of value distribution within health and care systems—central concerns of a human economy framing. This omission matters because unpaid and informal care function as hidden buffers for formal system inadequacies, allowing workforce shortages and underinvestment to persist without political visibility. Ireland's December 2025 workforce strategy illustrates the current frontier of evidence-informed workforce policymaking in high-income countries: technically mature, closely aligned with international guidance, yet conceptually constrained by a human capital logic. It reflects the evidence-base as articulated by WHO and promotes workforce science. However, it stops short of a deeper reframing of a human economy of health and care—one that values human capability, meaning, and social contribution alongside productivity and efficiency. Recognising this distinction is essential, not to diminish Ireland's progress, but to clarify the unfinished agenda of what remains conceptually and politically unresolved in the future of health workforce policy. The authors have nothing to report. J.C. is the former Director, Health Workforce at the World Health Organisation. The opinions expressed above do not necessarily represent the views of the WHO. The authors have nothing to report.
Campbell et al. (Thu,) studied this question.