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The impact of workforce turnover on productivity and health outcomes in the hospital sector

LSE Principal Investigator: Alistair McGuire
Start Date: 01 June 2019
End Date: 30 November 2025
Funder:The Health Foundation (UK)
Regions: Europe
Keywords: NHS, staff retention, efficiency, patient health outcomes

We aim to examine the impact of staff leaving or joining on productivity and health outcomes, and determine whether reliance on temporary staff is cost effective.

Staff retention in the NHS has become a challenge. Recent figures show an increasing trend in nurse shortages and a relatively high turnover for nurses and other medical staff. It is important to assess the costs of these changes in the NHS workforce and their impact on health care service delivery.

This project focused on whether staff decisions to join or leave an NHS organisation have a disruptive effect on operational efficiency and patients’ health outcomes.

A team of economics researchers based at London School of Economics and Political Science, and City, University of London, used the most recently available data on Hospital Episodes Statistics, turnover and bank staff from NHS Digital to investigate the relationship between turnover and efficiency.

First, they focused on determining changes in productivity and patient health due to workforce turnover. This analysis differentiated between internal moves (across NHS trusts) and external moves to or from non-NHS organisations, and considered how the effects are influenced by clinical staff group (nurse or doctor), grade and specialty.

Second, the impact of bank staff on hospital productivity and health outcomes was analysed to determine whether reliance on this temporary staff group is cost effective.

Given the current lack of evidence-based research in health and social care on whether staff turnover worsens productivity and patient health, the results of this study made a significant contribution to NHS workforce planning and efficiency improvement.

Findings

The project constructed one of the most comprehensive datasets to date linking NHS workforce flows to local labour market conditions, combining five major data sources (HES, NHS Digital Workforce data, ESR, LFS, ASHE, BSD, MWSS) and matching all English hospital Trusts to local labour market characteristics at multiple geographical levels.

Preliminary analysis shows:

  • Local labour market conditions strongly shape turnover.
    A 10% increase in outside (private‑sector) wages is associated with a 1.83% increase in nursing turnover, indicating that external employment opportunities are a major driver of attrition.
  • Turnover negatively affects hospital performance.
    Early results suggest detrimental effects on both mortality and waiting times, and ongoing refinements aim to strengthen the causal estimates.
  • COVID‑19 accelerated NHS staff attrition.
    Pandemic‑related pressures increased staff exits, particularly among nurses and midwives, illustrating how prolonged exposure to stressful environments exacerbates pre‑existing workforce shortages.
  • High turnover disrupts efficiency.
    Descriptive work indicates interruptions in efficiency measures when turnover is high, revealing operational vulnerabilities tied to staffing stability.
  • Methodological advances.
    The team developed a new NHS Turnover Index to standardise definitions of turnover across time and staff groups.

Additional strands of work continue to examine the role of private healthcare providers in competing for health‑care labour and the implications of staff movement across NHS and non‑NHS organisations.

Outputs

Conference & Workshop Presentations

  • The impact of workforce turnover on NHS hospital efficiency — European Health Economics Association Conference, Oslo (July 2022)
  • The impact of workforce turnover on NHS hospital efficiency — Policy Evaluation Group, Spanish Health Economics Association (May 2022)
  • NHS staff turnover and hospital efficiency — UK Health Economists’ Study Group Summer Meeting, Sheffield (June 2022)
  • Staff retention and A&E performance: Evidence from the English NHS — Healthcare Workforce Workshop, Surrey (June 2023)
  • Presentation to Health Foundation REAL Centre monthly meeting (September 2023)
  • Staff Retention and A&E Efficiency: Evidence from the English NHS — UK Health Economists’ Study Group Winter Meeting, Manchester (January 2024)
  • Outside wage dynamics, turnover and hospital performance – Evidence from the English NHS — REAL Workforce Workshop, York (November 2024)
  • Outside Wage Dynamics, Turnover and Hospital Performance – Evidence from the English NHS — UK Health Economists’ Study Group Winter Meeting, Bristol (January 2025)
  • Outside Wage Dynamics, Turnover and Hospital Performance – Evidence from the English NHS — LSE Seminar Presentation (May 2025)

Further publications forthcoming