Waste not, want not: Strategies to improve the supply of clinical staff to the NHS (Nuffield Trust, September 2023)

Summary

This report by the Nuffield Trust looks at workforce training issues in England, arguing that the domestic training pipeline for clinical careers has been unfit for purpose for many years. It presents research that 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. Alongside high numbers of doctors, nurses and other clinicians leaving the NHS early in their careers, this is contributing to publicly funded health and social care services being understaffed and under strain. It is also failing to deliver value for money for the huge taxpayer investment in education and training.

Content

Key facts

• More than 83,000 students accepted a place to study an undergraduate or postgraduate clinical degree (including medicine, nursing, midwifery and the allied health professions) across the UK in 2022.
• £2.6 billion was spent on undergraduate education and training in 2022/23 in England, with a further £2.5 billion spent on postgraduate medicine and dentistry.
• Only half of nurses, midwives and nursing associates (52%) and two in five doctors (39%) joining the UK professional registers were trained domestically in the latest year of data.
• Around one in eight nursing (13%) and radiography (13%) students did not gain their intended degree between 2014 and 2020, compared with 5% for physiotherapy. Attrition was on the rise for nursing, physiotherapy and radiography in the two years before the Covid-19 pandemic – for radiotherapy it was up to one in six (17%) in 2018/19 compared with 13% in 2016/17.
• Only one in 14 nursing graduates (7%) do not begin their career as a nurse after graduating. However, around one in nine midwifery graduates (11%) and one in seven occupational therapy graduates (15%) do not immediately join their respective profession.
• 6,325 fewer new nurses with a UK nationality joined NHS hospital and community services in the year to March 2022 compared with the two years before that (a fall of 32%).
• Around one in five radiographers (17%), nurses (18%), occupational therapists (21%) and physiotherapists (21%) have left NHS hospital and community settings within two years… this is broadly twice the level seen for midwives (10%), although some professions have more alternative
• employment opportunities than others, both inside the public sector (for example, general practice) and outside (for example, private practice and social care).
• The annual leaving rate from NHS hospital and community services flattens out after five years (leaver rates in the subsequent three years vary
• from 1 percentage point for nurses to 5 percentage points for occupational therapists).
• Most medical students successfully graduate and start their first foundation year (which they must complete to become fully registered) but only 30% of those completing foundation training in 2021/22 continued straight into GP or consultant training posts.
• Fewer than three in five doctors (56%) in ‘core training’ remained (even in a different role) in NHS hospital and community services in England eight years later, with half (24%) of this attrition seen in the first two years.