UK Infection Workforce Report 2026: Strategic Implications for Medical Mycology and Aspergillosis Services

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Executive summary: The 2026 UK Infection-Specialist Workforce Report represents an important strategic shift for medical mycology and fungal disease services. For the first time in a major cross-specialty infection workforce document, medical mycology is clearly positioned within the UK’s core infection infrastructure alongside microbiology, virology, infectious diseases, antimicrobial stewardship and pandemic preparedness.

Although aspergillosis itself is only briefly referenced, the report has substantial implications for fungal diagnostics, specialist workforce planning, networked service delivery, antifungal stewardship, digital diagnostics and the future configuration of tertiary fungal infection services within the NHS.

Background and strategic context

The report was produced collaboratively by major UK infection societies including the British Infection Association (BIA), Healthcare Infection Society (HIS), British Society for Medical Mycology (BSMM), Royal College of Pathologists, Infection Prevention Society and related specialist organisations.

It should be understood within the broader post-COVID strategic re-evaluation of UK infection services.

The report responds to several converging pressures:

  • persistent NHS workforce shortages;
  • rising antimicrobial resistance (AMR);
  • increasing use of immunosuppressive therapies and biologics;
  • ageing populations with greater multimorbidity;
  • expansion of transplantation and oncology services;
  • increased dependence on advanced diagnostics;
  • growing health-security concerns following COVID-19;
  • the NHS shift toward digitally enabled and community-delivered care.

Importantly, the report repeatedly frames infection services as essential national infrastructure rather than purely hospital-based clinical specialties.

This is highly relevant to medical mycology because fungal disease services have historically been vulnerable to under-recognition, fragmentation and workforce scarcity.

Medical mycology enters mainstream infection workforce planning

One of the most significant developments is the explicit inclusion of:

  • mycologists;
  • fungal diagnostics specialists;
  • clinical scientists;
  • and specialist laboratory infrastructure

within the core infection-specialist workforce model.

This reflects a wider shift in perception that fungal disease is no longer a niche subspecialty issue but increasingly central to modern healthcare.

Several drivers underpin this change:

  • growth in immunocompromised patient populations;
  • rising invasive fungal disease burden;
  • azole resistance concerns;
  • complex chronic fungal lung disease;
  • fungal complications during pandemics;
  • and increasing diagnostic complexity.

For UK mycology services, this effectively strengthens the strategic legitimacy of specialist fungal centres, national reference diagnostics and networked multidisciplinary fungal care.

Implications for aspergillosis services

1. Increasing demand is likely inevitable

The report repeatedly identifies increasing immunosuppression as a defining future challenge for infection services.

This has direct implications for:

  • invasive aspergillosis;
  • COVID-associated pulmonary aspergillosis (CAPA);
  • influenza-associated pulmonary aspergillosis (IAPA);
  • chronic pulmonary aspergillosis (CPA);
  • Aspergillus disease complicating bronchiectasis;
  • Aspergillus disease in severe asthma and biologic-treated populations.

The report indirectly supports the view that fungal disease burden will continue to expand alongside modern immunomodulatory medicine.

At the same time, the report warns repeatedly of infection workforce shortages.

For medical mycology, this mismatch between rising demand and limited specialist capacity may become one of the defining challenges of the next decade.

2. Validation of networked tertiary fungal care

The report strongly endorses:

  • regional specialist networks;
  • virtual MDT models;
  • shared specialist oversight;
  • digital consultation pathways;
  • and nationally coordinated expertise.

This closely mirrors the operational structure already used by the National Aspergillosis Centre (NAC) and associated mycology services.

The document repeatedly argues that highly specialised infection expertise should increasingly function through:

  • hub-and-spoke systems;
  • regional advice networks;
  • specialist diagnostics hubs;
  • and digitally enabled multidisciplinary care.

For fungal services, this is strategically important because it implicitly validates the need for:

  • national fungal reference expertise;
  • regional referral pathways;
  • specialist MDT review;
  • centralised antifungal susceptibility testing;
  • and expert interpretation of complex fungal diagnostics.

3. Diagnostics become increasingly central

The report places major emphasis on advanced diagnostics, molecular testing, genomics, AI-supported laboratory systems and real-time surveillance.

This has major implications for fungal diagnostics because aspergillosis remains diagnostically challenging across virtually all clinical syndromes.

Several themes are particularly relevant:

  • greater reliance on molecular diagnostics;
  • expansion of genomic approaches;
  • integration of digital diagnostics with clinical systems;
  • point-of-care testing governance;
  • specialist laboratory interpretation;
  • diagnostic stewardship.

The report repeatedly stresses that diagnostics are not simply laboratory commodities but require expert interpretation within clinical context.

This is especially relevant in aspergillosis where distinguishing:

  • colonisation;
  • allergic disease;
  • chronic infection;
  • and invasive disease

often requires integrated radiological, serological, microbiological and clinical expertise.

The direction of travel strongly supports increasing use of:

  • Aspergillus PCR;
  • galactomannan;
  • beta-D-glucan;
  • fungal sequencing;
  • azole resistance testing;
  • and integrated fungal diagnostics pathways.

4. Antifungal stewardship is likely to expand significantly

Although much of the report focuses on antibacterial stewardship, many principles directly translate into antifungal stewardship.

Likely future developments include:

  • greater scrutiny of long-term azole prescribing;
  • enhanced therapeutic drug monitoring;
  • formalised antifungal governance structures;
  • integrated antifungal stewardship MDTs;
  • enhanced resistance surveillance;
  • increased specialist oversight of complex antifungal therapy.

Environmental azole resistance remains conspicuously under-discussed in the report, despite its strategic importance.

However, the broader AMR framework clearly creates opportunities for antifungal resistance surveillance to become more integrated into national infection strategy.

5. Community and virtual fungal care pathways

The report strongly supports movement of infection care away from hospital-centric models toward:

  • virtual care;
  • community monitoring;
  • hospital-at-home pathways;
  • digitally enabled outpatient care.

For chronic aspergillosis services, this has potentially major implications.

Future models may increasingly involve:

  • virtual multidisciplinary review;
  • remote blood monitoring;
  • shared-care antifungal monitoring;
  • digital symptom tracking;
  • regional specialist outreach;
  • hybrid tertiary-community models.

However, the report also indirectly highlights a major risk:

complex fungal disease management cannot simply be decentralised without maintaining specialist oversight.

Antifungal drug interactions, adrenal suppression, hepatotoxicity, therapeutic drug monitoring and resistance management remain highly specialist-dependent.

Pandemic preparedness and fungal disease

One of the more strategically important aspects is the inclusion of mycology within pandemic preparedness planning.

The report explicitly frames mycologists as part of the national pandemic-readiness workforce.

This likely reflects lessons from:

  • CAPA during COVID-19;
  • critical care fungal complications;
  • emerging fungal threats such as Candida auris;
  • and concerns regarding climate-linked fungal emergence.

The report repeatedly emphasises the need for:

  • real-time surveillance;
  • rapid diagnostics;
  • genomic infrastructure;
  • specialist reference laboratories;
  • and coordinated national infection expertise.

These are all highly relevant to future fungal preparedness strategy.

Strategic gaps and underdeveloped areas

Despite the progress represented by the report, fungal disease remains relatively underrepresented compared with:

  • HIV;
  • tuberculosis;
  • sexual health;
  • virology;
  • and bacterial AMR.

Notably absent or only briefly referenced are:

  • CPA burden modelling;
  • ABPA;
  • SAFS;
  • fungal allergy pathways;
  • environmental mould and respiratory health;
  • long-term fungal rehabilitation;
  • formal antifungal stewardship infrastructure;
  • environmental azole resistance surveillance.

This suggests fungal disease has entered strategic infection discussions but remains insufficiently embedded within national planning frameworks.

Implications for MRCM and specialist fungal centres

For specialist centres such as the Mycology Reference Centre Manchester (MRCM), the report can be interpreted as strong strategic support for:

  • national reference laboratory functions;
  • specialist fungal diagnostics infrastructure;
  • regional and national mycology networks;
  • integrated diagnostics and clinical interpretation;
  • fungal MDT development;
  • specialist workforce expansion;
  • digital fungal consultation systems;
  • fungal surveillance and preparedness activity.

The report also strengthens arguments that fungal disease expertise should increasingly be regarded as:

  • part of national health-security infrastructure;
  • essential to modern immunocompromised care;
  • and central to future infection resilience.

Conclusion

The 2026 Infection Workforce Report represents a meaningful strategic milestone for medical mycology in the UK.

Although fungal disease occupies only a relatively small proportion of the overall document, the inclusion of mycology within core infection workforce planning reflects a broader recognition that fungal disease is becoming increasingly important within modern healthcare.

The report strongly supports several themes long advocated by UK fungal specialists:

  • networked specialist care;
  • advanced diagnostics;
  • integrated multidisciplinary management;
  • digital consultation pathways;
  • workforce expansion;
  • and national coordination of expertise.

The next challenge will be translating this strategic recognition into:

  • sustained workforce investment;
  • expanded diagnostic capacity;
  • formal fungal network development;
  • and improved equity of access for patients with aspergillosis and other fungal diseases.