Poor mental health is strongest driver of nurses leaving the NHS

High levels of sickness absence make NHS nurses more likely to leave their role, but long absence periods due to mental ill health have a stronger effect on likelihood of leaving the NHS than any other reason, including a much bigger impact than physical health.

That’s according to new analysis by the Nuffield Trust, which reveals the key reasons nurses leave the NHS in England. The study set out to unpick what happened to the nursing workforce prior to and during efforts to boost the number of nurses by 50,000 under the previous government.[1] It finds that between April 2015 - June 2023, nurses with more than 84 days of mental health related sickness absence in a three-month period faced over six and a half times the risk of leaving their role compared with those with 0-4 days of mental health sickness absence. Nurses with 5-14 days of mental health sickness absence in a three-month period were over twice as likely to leave than those with little-to-no mental health sickness absence.

The analysis also finds that nurses stuck at the top of their pay bands are more likely to choose to leave their role, indicating concerns about a lack of progression opportunities. For example, the study found that nurses at the top of NHS Band 7 were 25% more likely to leave than those at the bottom of Band 7. Promotion is uneven between professions, with midwives moving up their pay bands faster than nurses.

Nurses from outside the UK or Europe are increasingly leaving the NHS, especially since 2021 (but overall, they are still less likely to leave than nurses from the UK). The analysis found that in 2023/24, the risk of international nurses leaving was around 18% lower than UK nurses, compared with 36% lower in 2020/21.

Overseas recruits were instrumental in achieving the headline 50,000 nurses target (NHS data [2] shows that 88% of the change in the number of nurses between December 2019 and December 2023 was from a net increase in non-UK nurses) and they account for around three in 10 of the NHS nursing workforce in England. So, the authors argue that it is vital that their experience and motivations are well understood and factored into employment and retention programmes, and considered in the development of immigration policies.

The analysis also shows that efforts to boost the number of nurses working in the NHS have not benefited England’s regions equally, with theNorth East and Yorkshire faring the worst. While the previous government's target to add 50,000 more nurses to the workforce was met overall, the analysis uncovers the extent of regional variation in recruitment between January 2020 and June 2023. 

• The South East of England saw the biggest net increase in nurses – by 7,145 (or 15.7%).
• While London had the lowest relative increase (10.1%, equivalent to 6,186 nurses), this was preceded by the highest growth in the previous comparable period (January 2016 - June 2019).
• Meanwhile, the North East and Yorkshire also had low growth in the three-and-a-half year to June 2023 (10.2% or 5,894 nurses), which followed a net fall in the number of nurses (-1.3%) – suggesting that over a seven year period, this region has not made as much progress compared to other areas. 

It is likely that international recruitment drives in different English regions have increased the number of nurses in some areas faster than others.[3] 

The authors of the analysis say that these lessons from the previous nurse recruitment drive must be reflected in the upcoming NHS workforce plan. The data provides a wealth of evidence on which regions and specialties could benefit most from targeted recruitment strategies, and a major opportunity to act on the key reasons why nurses are leaving the NHS.

Nuffield Trust Fellow, Lucina Rolewicz, said:

“The details behind headline nurse recruitment figures cannot be ignored. Efforts to get more nurses working in the NHS should not just be about increasing the overall number, but ensuring that different regions and services can reap the benefits.

“Policies aimed at nurses have often neglected retention, with not enough done to understand why they leave the NHS and what could encourage them to stay. As the government works on its plans to bolster the nursing workforce, this new evidence gives clear reasons to focus on career progression opportunities, support with sickness absence and mental health, and issues particularly affecting overseas nurses’ decisions to leave.”