New report examines NHS staff leaving patterns

Individual characteristics such as age, time in post, nationality and sickness absences are strongly related to the reasons for staff leaving the NHS acute sector, according to a new report from the Institute for Fiscal Studies.

With the NHS struggling with understaffing, one way of increasing staff numbers is through improving retention of existing staff. However, relatively little is known about the drivers of retention in the NHS.

The IFS report, which is funded by the National Institute for Health and Care Research’s Health and Social Care Workforce Policy Research Unit, examines the factors associated with whether staff leave the NHS acute sector.

The report uses the Electronic Staff Record, the monthly payroll of NHS staff, to analyse the leaving rates of consultants, nurses and midwives, and health-care assistants between 2012 and 2021. Among the IFS’ findings are:

•  The patterns of leaving by age differ between men and women in all staff groups: leaving rates peak for women in their 30s but at a much older age for men
• Nurses and midwives born in the EU were 43% more likely to leave in any given month than their British counterparts, while non-EU nurses and midwives were 28% less likely to leave than those from Britain. EU nurse retention rates have fallen since 2016, but the fact that fewer nurses are now being recruited from the EU – and more are coming from outside the EU – could lead to a boost in overall retention rates if retention rates among different nationality groups continue along historic trends
• Even short health-related absences are associated with a much higher leaving rate over the subsequent three months for both consultants and nurses and midwives

Retention rates vary significantly across trusts: for example, the average monthly leaving rate of healthcare assistants was nine times higher at the trust with the worst retention rates than at the trust with the highest retention rate.

However, much of what drives variation in retention rates between different trusts remains unexplained. Even when controlling for a whole range of plausible factors, only up to a fifth of the variation in retention rates across trusts in different staff groups can be explained. This makes targeting policy interventions to improve retention very challenging.

Max Warner, research economist at the IFS, said: ‘Improving retention of high-quality staff would help the government meet its manifesto commitment to increase the number of NHS nurses, and would also help the NHS to tackle the backlog in elective care resulting from the pandemic. Our analysis shows that many different factors are associated with whether an individual staff member decides to leave the acute sector, including staff demographics, sickness absences and local economic conditions.

‘But much of what determines retention remains unexplained – there are large persistent differences between trusts, and much of the variation in trust-level leaving rates remains unexplained. Further research is needed to understand other drivers of retention, and how policymakers can reduce leaving rates.’

Photo by Hush Naidoo Jade Photography