The Nuffield Trust reports that there has been a dramatic fall in nursing graduates joining the NHS after training, with 6325 fewer new nurses with a UK nationality joining its hospital and community services in the year to March 2022 compared with the same period 2 years before (a fall of 32%) (Taylor et al, 2025).
NHS workforce challenges and strategies to improve retention and sustain a pipeline have been hot topics for some time. There is significant work in progress to understand opportunities to deliver improvements. The Nuffield Trust explored the relationship between age, staff experience and what it means for workforce retention and policy (Taylor et al, 2025).
Also of interest is the work of the Scottish Ministerial Nursing and Midwifery Taskforce, whose recent publication (2025) offers some timely and valuable recommendations for consideration.
The Nuffield Trust (Taylor et al, 2025) reviewed NHS staff survey data (NHS England, 2025) over the past 20 years from England, exploring the generational differences between NHS staff. The data showed that age and generational factors influence the experiences and motivations of staff. Although the popular narrative suggests that younger workers have radically different attitudes to older workers, the survey identified only two instances where there was a large difference between the experiences of younger staff and other age groups. Older staff are increasingly distinct in their responses compared to other age groups. However, achieving work-life balance is a crucial concern for all. Stress levels are high across all age groups, with a notable increase among the youngest NHS staff (21 to 30-year-olds). There appear to be financial pressures on younger staff, with the survey identifying an increase in the proportion of younger workers taking on more paid overtime:
‘From 2013 onwards, the proportion of workers aged 30 and under doing six or more, or 11 or more, hours of additional work grew at a much higher rate than was the case in other age groups.’
The survey appears to suggest that job satisfaction increases with age, with older NHS workers more likely to report that time ‘always’ passes quickly when working, indicating higher job satisfaction. There is a growing proportion of full-time workers aged 65 and over, and their motivations for working beyond pensionable age may differ from those who have retired. This group is also increasingly male. Those aged 65 years and over now make up a greater proportion of full-time workers than they did 10 years ago.
The importance of autonomy was a key theme with staff of all ages, reporting that they have frequent opportunities to show initiative in their roles. This shift predates the NHS England 2020NHS People Plan to promote staff autonomy, suggesting a broader cultural change.
Focused on attracting, recruiting and retaining nurses and midwives in Scotland, the Scottish Ministerial Nursing and Midwifery Taskforce (2025) reported key learning themes, including the aim to build a sustainable and skilled nursing and midwifery workforce, with attractive and varied career choices over the entirety of their working life in Scotland.
The taskforce considered the changing demographics and increasing demands on services. Scotland's ageing population and the increasing burden of chronic conditions necessitate a robust and adaptable nursing and midwifery workforce:
‘The Scottish Burden of Disease Study forecast the future burden of disease in Scotland to increase by 21% over the next 20 years …’
Scottish Ministerial Nursing and Midwifery Taskforce, 2025
The taskforce undertook a huge listening exercise, resulting in 44 recommendations, including placing the emphasis on improving workplace environments, such as creating more flexible working. Flexible working patterns were viewed as a crucial factor in supporting retention.
The importance of a supportive workplace culture was emphasised, with factors such as traumatic events, poor workplace culture, inefficient IT systems, and increasing task expectations contributing to staff leaving the professions. Also of importance were career development opportunities, consideration of models of education and enabling nurses and midwives to participate in leadership development to improve autonomy.
The Scottish taskforce report has proposed a detailed road map for addressing the key issues. The Nuffield review of NHS staff survey data provides a more granular picture of how different age groups experience the health service, and their motivations. The challenge now is to take forward the insights and recommendations that emerged to improve staff wellbeing, recruitment and retention across the UK.