Ethnicity, mental health and age predict NHS workers’ plans to quit

The national study, published in The Lancet Regional Health – Europe, investigated the contexts and reasons why staff may wish to leave the NHS workforce.

It found that 43% of NHS workers have considered leaving their role or taking early retirement, of whom 6% had already taken action.

The team analysed survey responses from UK healthcare workers collected over winter 2023-2024 to identify factors associated with intentions and actions to leave the healthcare workforce.

Data were collected as part of the I-CARE study (InCreAsing Retention of healthcare staff from Ethnic minority groups), which builds on the UK-REACH (United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers) longitudinal cohort study.

Professor Manish Pareek, one of the lead researchers from the University of Leicester, said: “The 3,282 people who took part in our study have given us vital insight and evidence about which groups are at greatest risk of leaving the NHS workforce and why.

“What is most concerning that nearly half of healthcare workers we talked to had considered or taken steps towards leaving healthcare.

“Those most likely to report intending to leave were aged between 50 and 60, Asian, and are working in dental and nursing roles. There was also a clear association between poor mental health and intending to leave the NHS.

“Sadly, we also found that discrimination and harassment by colleagues and patients were associated with planning to leave.”

Staff whose questionnaire scores identified them as being at risk of clinical depression or anxiety had three times the odds of intending to leave, and those identified as at risk of PTSD had twice the odds. The more burnt-out staff were, the greater their chances of intending to leave.

Discrimination from patients was associated with intending to leave, as was discrimination from colleagues; but staff who reported discrimination from both colleagues and patients had over three and a half times the odds of wanting to leave, compared to staff who didn’t experience discrimination.

Feeling valued by their employer, by the Government or by patients, were strongly associated with retention. Those who felt valued by employers and by patients were less likely to intend to leave, and the more undervalued staff felt by employers, patients or the Government, the greater their odds of wanting to leave.

The NHS is estimated to need an extra 314,000 staff by 2023/31 in order to be able to deliver care at 2018/19 standards. To address this, the UK Government and the NHS have pledged to increase recruitment and also retain 130,000 staff by 2039. But these goals are unlikely to be met without boosting retention of staff significantly.

Professor Katherine Woolf, one of the lead researchers from UCL Medical School, said: “Good patient care relies on having a healthcare service that it is properly staffed, and the NHS is the largest and most diverse employer in the UK.  

 “Our findings from I-CARE so far suggest that the NHS needs to implement policies that better tackle workforce discrimination and enable staff to benefit from effective mental health support and provide supportive and collaborative environments and opportunities for personal development.

“The I-CARE study has support from NHS Employers along with healthcare professional regulators. This group has been engaged with the study throughout and will work with the study team to co-design policy reforms and training materials, and support their implementation.

Professor Pareek added: “I-CARE is part of the overarching UK-REACH study and the    latest questionnaire is now open for completion by all UK-REACH cohort participants.

“It will help us to further our understanding of these important issues and we encourage all healthcare workers who are part of the cohort to respond. We are also currently recruiting new participants who joined the healthcare workforce since January 2021, and who may or may not still be working in healthcare in the UK.

“We’ll also soon be carrying out more interviews and focus groups with staff and NHS managers, with the ultimate aim of developing interventions with NHS policy-makers, staff and patients that encourage valued colleagues to stay.”

The I-CARE study team also includes researchers from the Ethox Centre at Oxford Population Health and universities of Surrey and Glasgow and London North West University Healthcare NHS Trust.

The research is part of the UK-REACH I-CARE study, funded by the National Institute for Health and Care Research (NIHR).

For healthcare staff interested in completing the survey, please visit UK-REACH to register and complete the questionnaire. 

Links 

• Professor Katherine Woolf's academic profile
• UCL Medical School
• UCL Faculty of Medical Sciences

Image

• Credit: Kayode Fashola on iStock.

Media contact 

Dr Matt Midgley

E: m.midgley [at] ucl.ac.uk