Waste not, want not: Strategies to improve the supply of clinical staff to the NHS

For every five nurse training places, only three full-time nurses join the NHS. The rate of dropouts in the staffing pipeline from student to early-career clinician is worryingly high, with significant numbers opting out before or soon after joining the NHS, contributing to an understaffed health service under ever-greater strain. This analysis sets out the scale of NHS attrition and puts forward a 10-point plan to improve retention, including a policy proposal to gradually write off clinicians' student debt over 10 years.

For too long, the domestic training pipeline for clinical careers has been unfit for purpose. This is a major problem for students, graduates, the NHS and the government.

Our research highlights leaks across the training pathway, from students dropping out of university, to graduates pursuing careers outside the profession they trained in, and outside public services. This, alongside high numbers of doctors, nurses and other clinicians leaving the NHS early in their careers, is contributing to publicly funded health and social care services being understaffed and under strain. It also fails to deliver value for money for the huge taxpayer investment in education and training.

Bold policymaking is needed. This report sets out a 10-point plan for improving the attrition during training and early NHS careers, including consideration of a student loans forgiveness scheme - a suggestion we set out in further detail in an accompanying policy proposal jointly authored by colleagues at London Economics and Edge Hill University. We illustrate how such a scheme would gradually write off outstanding student debt, clearing it after 10 years of eligible employment, with the aim of increasing applications to study, reducing attrition during training and improving participation and retention in public services on qualifying.

The estimated cost would be somewhere in the region of £230 million for nurses, midwives and allied health professionals per cohort in England. A similar scheme, or early-career loan repayment holidays for doctors and dentists in eligible NHS roles, should also be seriously considered. We believe this would represent a very sound investment.

Suggested citation

Palmer W, Rolewicz L and Dodsworth E (2023) Waste not, want not: Strategies to improve the supply of clinical staff to the NHS. Research report, Nuffield Trust