The NHS nursing workforce – have the floodgates opened?

Despite the constant pressures and chronic shortages, the number of nurses leaving the NHS had flatlined over recent years. Now our analysis of new data shows there has been a large increase in nurses leaving the NHS, and that this trend is being driven by younger workers.

The last year's data (June 2021 - June 2022) saw a 25 per cent increase in the number of NHS nurses leaving their role, with an additional 7,000 leaving compared to the previous year. The largest increase in numbers leaving was seen among the younger nurses, two thirds of leavers were under 45 years of age.

Vacancies have always been high

The NHS had persistent and severe workforce shortages before the Covid-19 pandemic. This sat behind the previous government’s decisions to invest in creating more nurse training places, re-introduce a maintenance grant for nursing students and incentivise international recruitment.

These measures did increase recruitment of nurses, but at the same time demand for nurses grew, in part because of the Covid-19 pandemic, as well as the ongoing recovery from it. This meant that while the number of nurses went up, the number of vacancies did not decrease.

What is now concerning is that the most recent data shows that in the first months of 2022/23 the NHS saw a sudden uptick in vacant nursing posts. There are now 46,000 vacant nursing posts, a record high.

Are more nurses leaving?

We know that the number of nurses being trained and in post has been increasing. So why is there a sudden increase in vacancies?

In part, growing vacancy rates are being driven by increased demand for nurses across the NHS. However, our new analysis suggests that the issue is being exacerbated by an increase in the number of nurses choosing to leave the NHS. Over the past 12 months, more than 34,000 nurses left their role in the NHS, an increase of 25 per cent on the previous year. This is not an isolated or incidental increase, if we look at the data over successive quarters, we find that a clear trend is emerging where a steadily growing number are choosing to leave. Throughout the pandemic and its peaks during 2020 and 2021, the number of nurses leaving remained at a similar level to that seen pre-pandemic, which suggests this is a new trend of nurses leaving who otherwise would not have done, rather than a backlog of resignations.

What is more, the current rate of increase is not driven by people retiring. It is in fact younger nurses who are leaving their roles in the NHS in the greatest numbers. Two-thirds, or nearly 23,000, of those who left over the past year were under 45 years of age, an increase of 26 per cent on the previous year.

To try to understand why more nurses are choosing to leave, we can look to the most recent NHS Staff Survey which shows that 34 per cent of nurses often thought about leaving, 52 per cent had felt unwell as a result work related stress and 40 per cent felt burnt out because of their work.

Bleak prospects for winter

It may have been repeated ad nauseum, but that’s only because it’s true: workforce shortages across the NHS are a key rate-limiting factor in working through the elective backlog and making improvements on key performance indicators.

Unfortunately, as we enter the winter months, our analysis suggests that shortages are worsening and the workforce crisis is intensifying.

The summer months have already seen all the wrong records broken in terms of the NHS’s operational performance. As we enter winter and demand rises, as it inevitably does in the colder months, and the impact of gaps in the workforce is amplified, it would seem almost certain that waiting times and access will get worse.

No silver bullets, but some stop-gap measures before the long road ahead…

Training, sourcing and recruiting nurses takes a long time. There will not be enough nurses in the NHS to meet actual levels of demand this winter, nor have there been in any recent winter.

For this winter, the government has limited stop-gap measures at its disposal, all of which it can and should use. For example, work has already begun on shoring up supply of international recruits to help bolster the nursing workforce.

Resolving the workforce crisis, developing a sustainable supply of nurses into the NHS while boosting retention by improving the NHS offer to its staff will take years. A multi-year, fully funded workforce plan is needed to ensure we don’t find ourselves in the same place in Autumn 2023.