High dropout rates as NHS staff begin their careers are leading to severe strain in the health service, experts have warned as they called for healthcare workers’ student loans to be written off.
There is a “highly leaky” training pipeline in the NHS workforce, according to a report from the Nuffield Trust think tank.
The document highlights worrying levels of students dropping out of university, graduates not taking on NHS roles and the high number of leavers two years into the start of their career.
“This is contributing to publicly funded health and social care services being understaffed and under strain,” the authors wrote.
Our domestic pipeline is only producing about half of nurses, midwives and nursing associates joining the register— Dr Billy Palmer, Nuffield Trust
And they also raise significant concerns about the low levels of home-grown NHS workers.
Nuffield Trust senior fellow and report author Dr Billy Palmer said: “A key symptom of the struggles of our domestic pipeline is our heavy reliance on overseas recruitment.
“Our domestic pipeline is only producing about half of nurses, midwives and nursing associates joining the register. It is actually only accounting for about two in five doctors joining the UK register.
“So clearly we’ve got shortcomings in our ability to have that sustainable UK supply.”
Dr Palmer said the NHS’s Long-Term Workforce Plan, which was published earlier this year, “doesn’t represent a quick fix on the whole” so the authors set out to examine how the NHS could get a “more immediate return”.
The Nuffield Trust research examined data on nearly 200,000 student records to see rates of attrition during university studies, 100,000 staff records to understand early careers retention and the authors also conducted literature searches to try to explain the high dropout rates and what other countries are doing to address the issue.
The report sets out some stark examples, including:
– Around one in eight nursing students in England do not complete their degrees.
– The authors estimate that for every five university nursing places only three full-time equivalent nurses eventually join the NHS.
– One in nine midwifery graduates are not immediately joining their profession after graduation.
– The number of UK nurses joining the NHS appears to have plummeted by around a third in the two years after 2019/20, which is “equivalent to a fall of over 6,000 (UK) nurses joining the NHS”, the authors said, adding: “This does appear to be quite a new and worrying dynamic.”
– In the last two years there have been falls in the number of UK national occupational therapists joining the NHS (a fall of around 18%) while the number of UK national radiographers has fallen by 9%.
– When it comes to early career retention, one in five new nurses leave NHS hospital and community services within two years, which increases to around a third after five years.
– The authors also raised concerns about dropout rates of medical school students, but dropout rates are “relatively small during the first two years training on the job”.
– Around one in four doctors left within two years after completing foundation year training. Over a five-year period this rises to nearly two in five.
– The authors raised particular concern about GPs highlighting that every two GP training posts results in one fully qualified full-time equivalent GP joining the NHS.
The authors suggest that the Government should consider a student loan “forgiveness scheme” for nurses, midwives and allied health professionals – including physiotherapists, paramedics and radiographers – to reduce dropout rates.
Our proposal to write off student debt is affordable, credible and could be implemented straight away— Dr Billy Palmer, Nuffield Trust
Dr Palmer added: “There appears to be undesirable levels of losses across this pipeline
“We recommend that Government need to seriously consider a formal proposal around student loan forgiveness.
“The basis of loans forgiveness is in return for numbers of years of service, you start forgiving or paying off people’s student loans. There are many ways you could do this, the one that we have sketched out is potentially three years of service you write off 30% of loans, seven years 70%, and then the remainder 10 years.
“That has a clear benefit to graduates. Taking a typical nurse for example, it would likely reduce their lifetime repayment from about £28,000 down to about £20,000. So about £8,000 benefit for them if they completed the 10 years because of course they still are repaying some because they will be repaying up to that 10-year point where it’s fully forgiven.”
A scheme for nurses, midwives and allied health professionals including physiotherapists would cost around £230 million a year in England, the authors said.
The authors suggest a similar scheme or an “early career loan repayment holiday” for doctors and dentists.
Dr Palmer added: “These high dropout rates are in nobody’s interest: they’re wasteful for the taxpayer, often distressing for the students and staff who leave, stressful for the staff left behind, and ultimately erode the NHS’s ability to deliver safe and high-quality care.
“Our proposal to write off student debt is affordable, credible and could be implemented straight away.”
A Government spokesperson said: “Office for Students’ data shows those on nursing, allied health and psychology courses have similar, and in some areas better, rates of attainment, completion and progression compared to other subjects.
“We’ve made significant progress in growing the workforce with record numbers of staff working in the NHS.
“The first ever NHS Long Term Workforce Plan, backed by over £2.4 billion in government funding, will deliver the biggest expansion of staff training in NHS history, retain more talented people and harness cutting-edge technology.
“The current student finance system strikes the right balance between the interests of students and of taxpayers.
“We are working closely with NHS England to reduce student attrition rates and ensure they are supported whilst in training.
“This includes a training grant for eligible nursing, midwifery and allied health profession students of at least £5,000-a-year, alongside support for childcare and certain expenses.”
