Leadership for implementation is essential to turn health workforce ambition into reform.

Health systems across Europe are transforming service delivery in response to population ageing, multimorbidity, workforce shortages, and fiscal constraints. New models of care, including integrated care, multidisciplinary teams, expanded scopes of practice, community-based services, and digitally enabled care, depend on a health and care workforce (HCWF) that is sufficiently staffed, appropriately skilled, and supported to adapt to changing roles and responsibilities. Yet implementation continues to lag behind policy ambitions. This commentary argues that the principal HCWF challenge is no longer a lack of evidence. Extensive research has identified workforce shortages, retention problems, staffing challenges, skills needs, and planning deficiencies, while numerous policy solutions have been proposed. Rather, the challenge is one of implementation. We argue that leadership for implementation is a critical but underdeveloped dimension of HCWF policy. Leadership is required at three interconnected levels: political leadership to create the conditions for reform, intersectoral leadership to align actors across complex governance systems, and organizational leadership to translate policy into improved workforce experiences, clinical working conditions, and patient outcomes. If the next decade of HCWF policy is to look different from the last, greater attention must be paid not only to what should be done, but also to who will champion reform and lead implementation and how leadership capacity can be developed across health systems.