NHS clinical staff in their early careers have become more stressed and unhappy over the past decade, with over half of young workers now made ill through workplace stress.

Researchers from the health and social care think tank Nuffield Trust analysed data from 20 years of the NHS England Staff Survey to see if the experiences and motivations of clinical staff varied by age.

The study is the first to examine how survey responses have changed over time between different age groups.

All age groups have seen shifts in their feelings about work and pay, especially over the past 10 years of the survey – with clear spikes in stress and dissatisfaction for all generations during the pandemic and recent pay disputes.

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While these levels have started to come down post-Covid, the gulf between the experiences of the NHS’s youngest and oldest workers markedly widened from 2013-2023, with young staff now increasingly unhappy in their jobs.

In the past decade, stress levels in staff aged 21-30 have risen by 14 percentage points – with 52% in 2023 saying they were made unwell through work-related stress, compared with 38% in 2013.

Meanwhile, the proportion of workers aged 51-65 reporting being made ill through work stress has gone down over the same period (from 43% to 40%).

The number of staff aged 21-30 who are unhappy with their pay has more than doubled, from 10% to 22%, compared with a 1% increase among staff aged 51-65 (rising from 11% to 12%).

Staff aged 21-30 are also enjoying their work less, with 15% not looking forward to their jobs in 2023, compared to 12% in 2013 – while the proportion of workers aged 51-65 who say they “rarely or never look forward to work” has fallen (from 13% to 10%).

Early careers demands

Nuffield Trust chief executive Thea Stein said: “The traditionally tough start faced by the youngest staff has got even tougher over the past decade, with Gen Z NHS workers now having to manage exams, early career demands and learning the job in potentially overstretched services alongside escalating cost of living pressures.

“Our findings raise real concerns around the NHS’s ability to retain its youngest workers, who are just at the start of their careers but are increasingly unhappy. The future of the health service depends on these workers. It is vital policymakers and employers now act on what the NHS’s own staff poll shows us about what the next generation of clinicians need to stay and thrive in the NHS.”

As well as looking at pay satisfaction, the researchers examined how overtime levels varied. All staff did more unpaid overtime during the pandemic, but rates in 2023 were similar or slightly lower than 2013 levels for all age groups.

Staff in age groups from 41-50 and 51-65 are the most likely to do unpaid overtime, with 16% of workers in those age brackets doing at least six hours of unpaid work a week in 2023 – compared with 7% of those aged 21-30.

Meanwhile, all age groups are doing more paid overtime shifts than they were in 2013 – especially the youngest, which the researchers surmise is linked to rising financial pressures. In 2023, nearly a third (30%) of staff aged 21-30 did at least six hours’ paid overtime a week, compared with 20% in 2013.

‘Ticking time bomb’

Royal College of Nursing (RCN) general secretary Professor Nicola Ranger described the findings as a “ticking time bomb” for the NHS.

“Young nursing staff are the future of the workforce, but those at the start of their careers are the most unhappy,” she said. “A new nurse today is likely to face extreme pressure in severely understaffed services, with stagnant pay and little prospect of progression.

“In these conditions, it is little wonder so many feel undervalued and overworked.”

A spokesperson for the Department of Health and Social Care said: “NHS staff have been overworked for years, and we understand the stress and moral injury that comes from working within a broken system.

“Through our Plan for Change, we are turning the NHS around and giving staff the tools they need to deliver the best possible care for patients.”

Nuffield Trust’s analysis was restricted to clinical staff including nurses and nursing assistants, medical and dental professionals (including those in training), midwives, paramedics, healthcare assistants, physiotherapists and radiographers.

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