Who Is Planting the Seeds?

I attended a conference recently where much of the discussion centred on growth.

More clinical trials.

More trial sites.

More innovation.

More translation.

More workforce development.

More technology.

More artificial intelligence.

More investment.

It was an optimistic vision of the future.

Yet I left with a question that nobody seemed particularly interested in answering. Who is going to do the work? Walking through the exhibition hall, I was struck by the number of companies offering solutions to workforce challenges.

Trial management services. Recruitment support. Site support. Training providers. Technology platforms. AI tools. Workforce solutions.

This is not a criticism. Markets often identify problems quickly and develop useful responses.

But it left me wondering whether we were discussing the symptoms rather than the cause. Entire businesses have emerged to help fill gaps within the research ecosystem. What does that tell us about the state of the ecosystem itself?

At the same conference, there was considerable enthusiasm for opening new clinical trial sites, particularly in regional and rural areas. It is a worthy ambition. More access to research is a good thing. Yet when I asked who would be working on these trials ten years from now, the conversation became noticeably quieter. Not because people disagreed.

Because the question was harder. New sites are important. New technology is important. New funding is important.

None of these things are a substitute for people.

A competent research nurse cannot be produced by a strategy document. A trial coordinator is not created by a framework. A governance officer is not generated by artificial intelligence. A skilled investigator does not emerge from a leadership breakfast. Competence is built through education, mentorship, supervision, mistakes, observation, and experience.

Most importantly, it is built through time.

Lots of time.

At one point, I was told that universities and government do not work well together when it comes to producing workplace-ready researchers, many of whom may spend much of their careers as clinicians. Perhaps.  But that does not answer the question. If our future research workforce depends on both sectors, then their inability to work together is not an explanation. It is the problem. The workforce still has to come from somewhere.

What struck me was how often workforce discussions focus on supporting existing capability rather than developing future capability.  We celebrate leadership programs, fellowships, scholarships, and targeted training opportunities. These are valuable and important. But they largely operate downstream.  They work with people who are already in the system.  The bigger question is whether we are planting enough seeds.  Research capability should not be treated as a niche skill acquired years into a career.

If research is central to modern healthcare, then research literacy should sit alongside communication, teamwork, critical thinking, and professional practice as a core graduate capability.

This is not simply about teaching students how to write a literature review. Nor is it about ensuring every graduate completes a quality improvement project. Both have value. But neither is a substitute for understanding how research actually works. Research involves uncertainty. It involves asking questions to which nobody yet knows the answer. It involves ethics, governance, study design, recruitment, consent, data collection, analysis, interpretation, implementation, and communication.

It involves navigating complexity, ambiguity, and failure.

Too often we treat research as an academic exercise rather than a professional capability. A literature review teaches students how to evaluate existing knowledge. Research teaches them how new knowledge is created. The two are not the same.

Not every graduate needs to become a researcher. But every graduate should understand how evidence is generated, how uncertainty is managed, how research differs from treatment, and how ethics, consent, and data governance operate. These are not specialist skills. They are foundational skills. Because if you wait until somebody is 35 years old and already working in the system before introducing them to research, you’ve already lost years of potential capability building. By that point we are often trying to retrofit capability into an already established workforce rather than cultivating it from the beginning.

We talk frequently about workforce development, yet much of that discussion focuses on supporting people who are already in the system. Far less attention is paid to creating a generation of graduates for whom research capability is simply part of being a health professional.

The metaphor that kept returning to me throughout the conference was agriculture. Imagine a farming community worried about future food shortages. In response, it invests in better tractors, improved irrigation, more efficient harvesting equipment, crop monitoring technology, consultants, optimisation strategies, and AI-enabled farming tools.

All sensible investments. All potentially useful.

But none of them answer the most fundamental question.

Who is planting the crop?

The challenge is not that we ignore workforce development. In fact, we talk about it constantly. There are workforce strategies, training initiatives, leadership programs, fellowships, mentoring schemes, capability frameworks, and countless discussions about building capacity. The problem is that many of these initiatives focus on improving the yield from crops that have already been planted. They support people who have already entered the system. They optimise existing capability. They improve productivity. What they do not necessarily do is increase the number of seeds being planted, or the variety. Workforce development does not begin with a training course.

It begins long before that. It begins in schools, universities, placements, internships, and early career opportunities. It begins when curiosity is encouraged rather than deferred. It begins when research capability is treated as a core professional skill rather than a specialist pathway. An experienced clinical researcher is not created at the moment they attend a leadership program. They are the result of years of cumulative investment. The same is true for research nurses, trial coordinators, governance officers, data managers, and clinician researchers. Yet many of our systems reward demonstrated productivity rather than future potential.

We fund the established investigator. We invite the recognised leader. We celebrate the visible success. Meanwhile, the next generation waits for someone to notice them.

The orchid flask sitting on my shelf contains no flowers. Only potential.

Its value lies not in what it is today, but in what it may become.

The same is true of people.

Every accomplished researcher, clinician, leader, and innovator was once an unproven possibility. Someone invested before the outcomes existed. Someone provided mentorship before the publications. Someone created opportunities before the track record. Someone planted the seed. A healthy research ecosystem cannot focus exclusively on harvesting.

At some point it must make a deliberate decision to plant. A strategy can be written in months. A competent workforce takes decades.

One operates on the timescale of policy. The other operates on the timescale of people.

Perhaps that is why so many systems struggle. Not because the ideas are bad. Not because the intentions are wrong. But because capability cannot be rushed. Before we build another framework, launch another initiative, or announce another strategy, perhaps we should ask a simpler question.

Who is planting the seeds?

Because, regardless of how efficient the machinery becomes, there is eventually nothing left to harvest if nobody invested in growth.