The Milburn Report: NHS chief people officers can make a real difference

Alan Milburn’s interim report on young people and work dropped like a stone into the pond of public policy. Its ripples should change the way we see young people and work. Titled ‘Young People and Work’, the 217- page report lays bare a sobering reality: nearly one million 16 to 24-year-olds in the UK are not in education, employment or training (NEET). That’s one in eight young people, a figure projected to hit one in six (around 1.25 million) within five years without urgent action. We know that good work is fundamental to reducing health inequalities, so this report should change the way we channel our resources, intellect and priorities.

Alan Milburn, the former Health Secretary turned social mobility champion, doesn’t pull punches. He calls it a “record of failure” and warns of a generational fault line. The human cost is stark: aspirations thwarted, confidence eroded, futures on hold. Economically, it’s devastating – an estimated £125 billion annual burden to the taxpayer, more than we spend on education. 

The report dismantles lazy myths about a “snowflake generation.” Most NEET young people want to work. The problem runs deeper: a perfect storm of structural failures. Health, particularly mental health and neurodevelopmental conditions, has become central. The proportion of NEETs citing work-limiting health issues has surged. Entry-level jobs have thinned, apprenticeships dropped sharply, and recruitment processes feel dehumanising.

Education systems often fail to prepare young people for the world of work, with inadequate careers guidance and work experience. The welfare system amplifies detachment rather than bridging back to participation. And critically for those of us in health, the NHS itself is part of the problem. Fit notes and processes that label young people as “unfit” rather than focusing on their abilities. 

"This isn’t just about social value; it’s talent pipeline development. Investing here builds loyalty and diversity."

The report notes that becoming NEET often starts early, children who are not school-ready at 4-5 are nearly three times more likely to be NEET later. Disadvantage, geography, special educational needs and disabilities (SEND), and family circumstances increase the risks. Yet other countries show that these issues can be addressed with the right focus. As chief people officers (CPOs), we know we can make a difference here.

For CPOs in the NHS, this isn’t just another policy paper. It’s a call to leadership. The NHS is one of the UK’s largest employers. We shape careers, influence communities, and sit at the heart of the health system that the report so rightly critiques. We have both a responsibility and a tremendous opportunity to act. 

Here are my five practical ideas that CPOs can drive right now:

1. Champion inclusive entry routes and apprenticeships.

The NHS has scaled apprenticeships successfully before. Let’s double down. Work with other trusts and local partners to create more Level 2/3 pathways explicitly targeting at-risk young people, including those with SEND or from disadvantaged backgrounds. Move beyond clinical roles into support services, admin, estates and digital. You should own the numbers, set bold targets and track progression, not just starts. Make apprenticeships a genuine first step, with proper pastoral support baked in. 

For those NHS organisations that still pay the apprenticeship wage, rather than the wage for the job, I would review whether your organisation is really living its values. That may sound harsh to some, but we are either trying to resolve health inequalities or we are just talking about them. 

To support this shift, visit  our website for good practice, tools and resources to support the provision of employment, training and skills opportunities for young people.

2. Reform how we handle health and work conversations.

Influence the culture around fit notes and occupational health. Train managers and HR teams to ask, “what can you do?” rather than defaulting to exclusion. Pilot early intervention programmes with primary care and mental health services that keep young employees or recruits connected to work. The NHS should model best practice: reasonable adjustments, phased returns, and holistic support that prevents short-term health issues from becoming long-term detachment. As CPOs, we can lead this shift from treatment to enablement. There is some great work already going on in some systems.

3. Build genuine partnerships with local communities and schools.

Don’t wait for national policy. CPOs should lead outreach by creating meaningful work experience programmes that go beyond shadowing. If you have not got a work experience programme that you are proud of and that offers plenty of supported opportunities, now is the time to get a programme. For good practice and resources, look at our work experience hub. I’m almost certain that boards would support more activity in this area. We also offer mentoring schemes, career talks that demystify NHS roles, and pre-employment training for NEET cohorts. Target areas with high NEET rates in your footprint. Collaborate with local authorities, further education colleges, and youth charities. This isn’t just about social value; it’s talent pipeline development. Investing here builds loyalty and diversity.

4. Humanise recruitment and reduce barriers.

Review your hiring practices. Introduce more human touchpoints early on, skills-based assessments over rigid experience requirements, and inclusive application support. Consider “NEET-friendly” pathways with guaranteed interviews or taster days, link in with your local Job Centre Plus as they can support you. 

CPOs can set the tone: make the NHS a place that takes calculated risks on potential, supported by strong induction and development. 

5. Lead the narrative and data inside your organisation.

Use your influence on boards to make youth participation a strategic priority. Track internal metrics on young employee retention, progression, and health outcomes. Share stories of success. Advocate for system-wide changes including better alignment between health, education and employment support. As people professionals, we excel at balancing compassion with pragmatism. This crisis needs exactly that: head and heart HR.

The Milburn report is diagnostic; solutions come later this year. But we don’t need to wait. The NHS employs hundreds of thousands and touches every community. By acting decisively, we can help turn the tide on a lost generation while strengthening our own workforce. 

This isn’t just about filling rotas. It’s about living our values – compassion, inclusion, and making a difference. Young people today aren’t less capable; they just face a tougher landscape. Young people that didn't go to university aren't always less ‘academic’. It’s often that they have not had the opportunities others have had. We can change that. As CPOs, we can make such a difference to the lives, aspirations and careers of so many individuals and really make an impact on the health inequalities of local communities, what a privilege that is.