Should I stay or should I go? - 2: Monitoring influences on NHS staff retention in the post COVID-19 world Winter 2020 to spring 2023

The issue of staff retention in the NHS is not new but has been brought into sharp relief in the post-COVID-19 era of unpreceded staff shortage. While steps have been taken to train new health professionals and recruit from overseas, net gains to the NHS staff complement are at risk of being significantly blunted or defeated in the absence of finding ways to stabilise and enhance the retention of established staff. At the institutional level, what has been widely characterised as a pandemic of early­ exit risks a spiral of inter-related losses becoming endemic. Foreseeable impacts include loss of expertise and institutional memory, degraded capacity to deliver patient care, degraded workforce and work-team stability, loss of return on investment in health professional training, and increased human resource costs to employers (e.g. recruitment and employment of bank/agency staff). All have implications for standards of patient care and the potential to negatively impact on the well-being of staff in-post to the extent that it risks degrading their disposition and/or capacity to remain.

The foundation research on which this report is based, 'Should I stay or should I go? NHS staff retention in the post COVID-19 world: Challenges and prospects', was funded by the Economic and Social Research Council, in response to the UKRI open­ call for COVID-19 relevant social research in spring 2020, supplemented by follow-on funding from the health sector. At its inception the research aims were to provide human resource strategy and policy relevant insight into:

•the impact of the COVID-19 experiences and its legacy on employees' strength of attachment, commitment and capacity to remain in NHS employment;
•the relative salience and strength of push and pull variables on staff stay versus leave intentions and behaviour;
•what might need to change to motivate/enable current employees to remain in NHS employment; and
•the need, nature and scope for intervention to maintain/enhance retention rates.

At Wave Four of our survey, the scope of data gathering broadened from its initial focus on primary impacts arising from COVID-19 in 2020/21 and its legacy to include other features of the post-pandemic work environment, including: staff shortages, workload, job-demands, working conditions, pay and other background climate factors on staff resilience, capacity and disposition to remain.

This report provides an overview of headline findings from the NHS employee survey component of our research. The survey sample covered all staff types, however a central focus was on health professionals and associated care staff, due to the more restricted scope for personnel substitution.

The current report is focused on findings from Wave Four of the survey, conducted in spring 2023, and represents an update on and point of comparison with findings from the three earlier waves (winter 2020/21, summer/autumn 2021 and spring/summer 2022), published in the University of Bath Institute for Policy Research report series in January 2023 (Weyman et al. 2023).

In common with Wave Three, the Wave Four survey was completed by a sample of NHS employees in England. Waves One and Two were completed by UK-wide samples. However, the close alignment of the response profiles across the devolved nation samples in Waves One and Two gives confidence to considering Waves Three and Four findings to have UK-wide generalisability and relevance.