Researchers have issued a stark warning that thousands of patients may be dying annually due to the high turnover rates of nurses and doctors within the NHS. They suggest that more than 4,000 deaths in England each year could be attributed to loss of staff, which they believe might be a “conservative figure”.
The experts highlighted that high staff turnover can lead to substandard care, while reliance on agency workers for filling rota gaps results in a lack of continuity and expertise in patient care. The study, published in the British Medical Journal (BMJ) and conducted by the University of Surrey alongside Cambridge University Hospitals Foundation Trust, analysed data from 236,000 nurses, 41,800 senior doctors, and 8.1 million patients across 148 NHS acute hospital trusts in England.
Findings revealed that with every 1.21 percentage point increase in nurse turnover per month (approximately an additional 20 nurses), there was an associated rise of 35 deaths per 100,000 hospital admissions within 30 days. This equates to around 239 additional deaths monthly across the trusts.
For senior doctors, a similar uptick in turnover correlated with an extra 14 deaths per 100,000 admissions or about 96 additional deaths monthly across the trusts. When combined, these figures suggest that an estimated 4,020 additional deaths may occur yearly across the NHS due to staff turnover, over and above the typical monthly turnover rates of 2.35% for nurses and 2.45% for senior doctors at NHS hospital trusts.
Dr Giuseppe Moscelli, an associate professor in economics and lead researcher of the study at the University of Surrey, highlighted that the loss of life was primarily driven by the care of emergency patients. He identified “two big problems” related to staff turnover and its impact on patients.
He explained: “First, the NHS works at capacity, meaning we don’t have over-capacity like other systems, like the US, when they usually have more nurses and doctors.
“This means we tend to have shortages of people, of clinical staff, rather than an abundance of people.
“And when too many people leave in a given month or over a sustained period of time, that actually stretches those existing staff that remain.
“The staff to patient ratio goes down…staff have a higher workload and they have less time to dedicate to patients.
“Losing skilled people diminishes the continuity of care and organisational memory within an NHS trust.
“These nurses and doctors have been trained in how things work and so breaking that teamwork with colleagues is detrimental for patient care.”
Dr Moscelli warned temporary agency staff often find themselves allocated to different departments regularly, “so they don’t have the time to build all the expertise and the relationship in terms of teamwork to deliver the proper care to patients.”
He added: “Our findings underscore the vital role that stable staffing plays in ensuring patient safety. High turnover rates are not simply an administrative issue – they have real, life-or-death implications for patients.”
The data looked at the period 2010 to 2019 but Dr Moscelli said he believed the figures could be higher. He said: “We know, for example, that shortages of hospital nurses and doctors were detrimental for the survival of Covid patients during the pandemic first wave.
“The reason why we used data until 2019 is that we needed to cover a stable period in which we didn’t have any other confounding effects, such as Covid created. But these are probably conservative estimates compared to what might happen now.”
Dr Moscelli urged the Government and NHS England to find strategies “to retain people, to retain skilled clinicians within the NHS”. He added: “As our study shows, and as other researchers are also proving with their studies, the turnover is detrimental for patients, and there is a higher chance of burnout of other workers when too many workers leave the NHS.”
The research found that high nurse turnover had a particularly negative impact on surgical and general medicine wards, while the loss of senior doctors most affected patients suffering infectious and parasitic diseases, mental and behavioural disorders and diseases of the respiratory system.
Patricia Marquis, the Royal College of Nursing’s executive director, has called for immediate government action to retain highly skilled nurses. She stated: “Wherever you look, shifts routinely don’t have enough registered nurses to keep patients safe. This has become normalised and is unacceptable.
“Boosting recruitment into the profession is crucial to patient safety, but so too is giving experienced staff a reason to stay. Unrelenting pressures, low pay and delivering compromised care are forcing thousands of nurses to quit and it is patients who are paying the price.
“Without safety-critical limits on the number of patients nursing staff are responsible for, patients will continue to be put in danger. Nurse-to-patient ratios must be enshrined in law or the cycle that fails everyone will only continue.”
Dr John Dean, clinical vice president of the Royal College of Physicians, said: “This study is a sobering reminder of the human cost of workforce challenge and service pressures. It underscores what healthcare professionals have long understood: a stable, well-supported workforce is essential for patient safety.
“Findings from our own census data show that 47% of consultant physicians reported decreased enjoyment in their job over the past year. Clinical workload, poorly functioning IT equipment, and staff vacancies in their teams were identified as the top factors negatively affecting their wellbeing.
“Long-term solutions are essential, and the upcoming 10-year health plan and 2025 revision of the NHS long-term workforce plan are critical opportunities to make staff retention and wellbeing a priority.”
The study examined the risk of death from any cause within 30 days of hospital admission, and the risk of unplanned readmission within 30 days of discharge after planned hospital treatment. Ruth Thorlby, Assistant Director of Policy at the Health Foundation, stated that the “NHS overall is short of staff and has been for some time”, with nearly one in 10 posts vacant last year.