While the proportion of staff leaving the NHS and social care appeared to have fallen at the start of the pandemic, the numbers now exiting these services are on the rise. And the situation could get worse. We therefore thought it timely to take stock of what is known and not known about the numbers of staff leaving NHS and social care roles, and the reasons given for moving on.
The analysis, which first looks at NHS staff before moving to social care, uses figures from our NHS staffing tracker but also draws on wider analysis and research to explore the topic in greater detail.
What are the leaving rates for health care staff and how have these changed over time?
The proportion of hospital and community health staff who left the NHS increased last year, but remains relatively low.
In total, around 140,000 of these staff – equivalent to one in nine (11%) – left active service in the year to September 2021. In particular, one in 10 nurses and one in 18 consultants left active service, which includes those going on maternity leave or a career break. But for most staff groups, these rates are generally around pre-pandemic levels after a notable fall in leavers across nearly all professions in the year to September 2020 (see chart). Comparisons over time do of course have to be treated with caution due to, for example, the changing age profile of the workforce.
A similar pattern is apparent in the numbers of key clinical staff leaving their profession entirely, with fewer leavers earlier in the pandemic before increasing in the most recent data. For example:
- The proportion of nurses, midwives and nursing associates living in England leaving their professional register has generally fallen since 2016, although rates between April and September 2021 returned to a level above that seen in the corresponding period before the pandemic. In the year to September 2021, around 19,900 (some 3.5%) of these staff left the register.
- The four months between March and June 2020, which cover the first wave, saw the fewest number of doctors leaving the UK register across the published data. But in the last two months covered (May and June 2021), the number of doctors leaving exceeded levels seen in 2019 before the pandemic.
As ever, the picture varies across the country, with the proportion of staff leaving their roles differing considerably between areas and providers. There are even substantial differences between large regions. For instance, one in eight (12%) of people in roles supporting doctors, nurses and midwives left active service in the year to September 2021 in the South West, compared to fewer than one in 10 doing so in the North East and Yorkshire (see chart).
The data on GPs is even more limited. However, recent data suggest that in the year to December 2021, after removing those transferring between practices, one in 12 (8.4%) qualified permanent GPs (i.e. excluding GPs in training and locums) left. This may represent an over-estimate where GPs move to practices with poor data completion and so therefore may appear as a leaver. Again, leaver rates appear to have fallen towards the start of the pandemic.
Why are NHS staff leaving their role?
Information on reasons for leaving is, regrettably, limited. In particular, the most prominent data on all leavers from roles in NHS hospital and community services includes staff moving within – as well as from – the NHS, and also has lots of missing information.
Relocation and retirements are the most commonly given reasons. But in the last decade, the numbers pointing to work-life balance, promotion and health as reasons to leave have all roughly quadrupled. Those who have left citing a lack of opportunities, having incompatible working relationships, wanting better rewards packages or to undertake further education or training have all more than doubled.
For GPs, burnout, issues around job satisfaction (including time spent on tasks perceived to be unimportant) and physical working conditions have been cited as key factors contributing to increased GP turnover over the past decade. For hospital consultants in particular, pensions taxation is an issue, with half of those who had made definite plans to leave the NHS reporting it as a factor.
A survey of nurses leaving their register in the year to June 2020 suggested that – as in previous years – retirement, personal circumstances and too much pressure were the most common reasons why. Of those nurses that had left after the start of the pandemic, only around 14% said that the pandemic had influenced their decision.
Workplace culture, a new option for this latest iteration of the survey, was the fourth most common. More than one in eight NHS staff (13%) reported having experienced discrimination at work in 2020. On top of this, the NHS staff survey reported that 12% of staff experienced bullying, harassment or abuse from managers in the previous 12 months, and 19% of staff experienced those behaviours from fellow colleagues.
What are the intentions of health care staff around leaving?
An increased proportion of clinicians are reporting their intention to leave the service. This may not come as a surprise given the demands staff have faced during the pandemic, which have led to exhaustion and stress, and which are felt likely to continue given the scale of care backlogs.
A recent survey found that 18% of doctors considered leaving the profession in 2021 – up from 12% in 2019. Moreover, the percentage of doctors taking hard steps to leave the profession has recently increased. There was a rise from 4% in 2020 to 7% in 2021 in the numbers contacting a recruiter, applying for or attending training to prepare for a new role, or applying for other roles outside of medicine.
These doctors who said they were considering leaving their professions, either permanently or temporarily, commonly referred to wellbeing concerns and a wish to have more non-working time. There also appears to have been a group of older doctors who have continued to delay their retirement. While the NHS will have benefited from these doctors postponing their decisions, there is a real risk of significant numbers now retiring.
The picture is also concerning for nurses. While survey responses typically overestimate actual leaving rates, it is worrying that a survey conducted in October 2021 reported that, for every five respondents, one was actively planning to leave their job (19%) and a further two (38%) were thinking about leaving. Of those considering leaving, the most common reasons were due to feeling undervalued, under too much pressure, or exhausted. These nurses also cited low staffing levels as one of the main reasons for considering or planning to leave, highlighting the risk of self-perpetuating downward spirals.
What are the leaving rates for social care staff?
As with NHS staff, the first year of the pandemic saw fewer social care staff leave their roles, before a worrying reversal in this trend. Turnover rates for key social care roles had been increasing before the pandemic, but in 2020/21 returned to around 2017 levels (see chart below). Around three in five of those who leave their roles remain within the sector, although around 152,000 (equivalent to about one in nine or 11%) left the sector in 2020/21.
While leaver rates are not readily available in the period since, staffing levels appear to have tumbled. Our own analysis suggest that the number of staff reported by those providers that submitted data fell by 42,000 in the six months to the end of October 2021. When adjusting for the fact that a changing number of providers submitted data over this period, this estimate increases to somewhere in the region of 50-70,000. These figures equate to around 3% to 4% of the total adult social care workforce.
Why are staff leaving social care roles?
Uncompetitive pay and poor employment conditions appear to be common reasons for leaving social care work. While there is limited direct information from staff on why they leave, a survey of almost 9,000 adult social care settings found that some of the top reasons given by both domiciliary care and care home providers were better pay outside the care sector, better hours and working conditions outside the care sector, and feeling burnt out/stress. Issues around pay and progression are not unexpected, with, as noted previously, "on average, those working between 5-10 years as a care worker [seeing] a 25p increase in their hourly wage from when they started, compared to 95p for those in competing occupations over the same period".
Exploratory analysis by Skills for Care found that the key factors relating to the higher likelihood of a worker leaving their role included a lack of relevant social care qualification, less training, and zero-hours contracts. Leaver rates were particularly high for younger staff (42% turnover for those under 20 years old) and those new to the role (37% turnover for those with less than a year’s experience in the role).
Covid vaccination regulations – now in the process of being reversed – have already contributed to staff leaving. Care home staff had to be double vaccinated by 11 November, and the available data suggest substantial falls in directly employed staff in that sector in the weeks leading up to the deadlines for first and second doses.
Between the regulations being passed (22 July) and the most recent data (20 December), the experimental data published by the Department suggest that the reported numbers of directly employed staff fell by some 22,600, or – after adjusting for non-responses by some care homes earlier in this period – an estimated 26,400. That said, we don’t know how many actually left or did not join because of the policy. But unwillingness to be vaccinated was the second most commonly cited main reason for staff leaving across care homes surveyed.
These vaccination regulations in care homes are also now due to be reversed, but it is unclear what appetite there might be for those who left to return. It is also unclear how many may have already left wider social care or NHS services ahead of the now scrapped 3 February deadline for all front-line staff to have their first vaccination.
The ceiling for domestic supply of some key professions into health and social care is already largely set for the short term. Those starting an undergraduate nursing or social work degree this year will likely not graduate within this parliament, with the election scheduled for May 2024.
That said, we can seek to increase the proportions finishing courses and participating in health and social care services thereafter. These sectors can seek to attract people who already have the necessary requirements, both domestically and from overseas, with retaining as high a proportion of staff as possible also critical to addressing staffing shortages and meeting workforce goals.
Yet, while we have a rough idea, our understanding of the numbers leaving, and the reasons for this, is still limited. This represents a huge missed opportunity for services to learn about how to better retain staff, including the potential implications for diversity, equality and inclusion given that the levels leaving – and the reasons for doing so – vary between staff groups.
A recent national report did recommend organisations and integrated care systems should “understand why people leave the NHS and take system action to address the causes”. This should of course be extended to social care. Such an understanding would also help ensure there is not undue competition for limited staff between services and settings. Certainly, leaders at every level need to urgently understand – and act on – the reasons why staff have left and intend to leave.
Palmer W and Rolewicz L (2022) “The long goodbye? Exploring rates of staff leaving the NHS and social care”, Nuffield Trust explainer.