A new University of Bath Institute for Policy Research (IPR) report into NHS workforce retention indicates that more frontline workers are actively trying to leave the NHS now than at the height of the Covid-19 pandemic in winter 2020/21.

The report, ‘Should I stay or should I go? NHS staff retention in the post Covid-19 world’, highlights a rising trend in numbers of NHS staff applying for non-NHS jobs since the emergence of the Covid-19 pandemic.

One in 10 (all-staff) reported having ‘completed an application for a non-NHS job in the previous six months’, in winter 2020/21. By spring 2022 the proportion had risen to one in seven.

However, the overall rate masks notable variability across different segments of the NHS workforce. The rate for ambulance paramedics and early career staff in spring 2022 was one in four.

The findings are based upon on three waves of survey data from over 17,000 NHS staff* gathered between late 2020 and summer 2022. These provide insight into what impacts on NHS employee motivation and capacity to stay or leave the NHS over the period since the emergence of the Covid-19 pandemic.

Other headlines include:

  • The influence of a number of previously identified positive effects on NHS staff retention, appear to have weakened since 2020. 44% cited job security in winter 2020 falling to 37% by spring 2022. Intrinsic job satisfaction from caring for patients dropped from 39% to 35% (over the same period).

  • The most important reasons why staff leave NHS employment are, respectively: stress (66%), shortage of staff/resources (62%) and pay (55%). Pay has become markedly more salient since 2020 (winter 2020, 37%; spring 2022, 55%).

  • ‘Abnormally high staff shortages’ and, ‘Not enough time to do my job properly’ were the highest ranked sources of worry amongst staff in spring 2022. Relatedly, there is evidence of significant rates of under-reporting of worries and concerns to line-managers.

  • More than one in three NHS staff reported one or more symptoms of burnout most days or every day in spring 2022, largely attributed to their work.

  • Ratings of confidence in any improvement in working conditions over the next 12 months (beyond spring 2022) ranged from low (for funding, workload, and staffing levels) to modest across all of the criteria explored.

  • Approximately 50% of the workforce see themselves as remaining in NHS employment for the next five years but approximately a third aspire to exit to alternative employment or retirement by 2027.

  • The proportion of (all) staff who ‘…would recommend working for the NHS to others’ shows a negative trend, with a drop of 10 percentage points (61% to 51%) between late 2020 and spring 2022. Among nurses the proportion recommending working for the NHS in spring 2022 was 41% (down from 54% in late 2020).

Lead author, Dr Andrew Weyman of the University of Bath’s Department of Psychology, explains: “The gathering of focussed, robust evidence on reasons why staff leave and what might need to change is of central relevance to informing future NHS human resource intervention strategy and policy aimed at stabilising and enhancing rates of staff retention.

“Identified drivers of employee exit from NHS employment are, for the most part, not new or pandemic specific. Rather, they present as latent incubating issues that have been amplified by the workload and working conditions imposed by the Covid-19 pandemic and its secondary impacts.

“Employee ratings of almost all variables explored have at best remained stable and on a number of issues, notably staff shortages, intrinsic job-satisfaction, morale, stress and mental health, worsened since 2020. By analogy, the pandemic does not present as a speed-hump effect followed by a return to normal, but as a benchmark heralding a new and more negative normal.

“Tackling staff retention to create a sustainable healthcare system is a key priority for the NHS in the post-Covid-19 world. Pay is important, but improvement on that issue alone is unlikely to stem rates of exit in the absence of action to reduce workload, stress: workers feeling undervalued, unsupported, and exhausted.”

Writing in the report, the authors argue that a key challenge now for NHS policymakers and employers is aligning identified priorities for change to address staff retention with their scope for influence over fundamental elements in the short, medium and long term.

*Insights for the report come from surveys conducted between December 2020 and July 2022. The core data is from three surveys of 1500-2200 YouGov panel members who work in the NHS, weighted to represent all staff. In 2021 only, this was supplemented by a sample of over 10,000 staff from 12 NHS Trusts and members of major trade union. In addition, 65 depth interviews were carried out between June 2021 and March 2022.