Can non-monetary interventions improve staff retention? Evidence from English NHS hospitals


Speaker:Giuseppe Moscelli, University of Surrey
Date: Friday 26 November 2021
Time: 14:00
Location: Xfi, Conference room 2

Further details


In many hospital care systems, nursing staff are recognised as a major input for the delivery of hospital care. In the English National Health Service (NHS), there are approximately 680 thousand professionally qualified clinical staff, with an almost 3:1 ratio of nursing staff to doctors. While the nursing staff is a significant component of the clinical workforce, English NHS has witnessed increasing leavers rates for nursing staff from 12.3% in 2012/13 to 15% in 2016/17. This has a direct impact on the organisation of work and, indirectly, on patient outcomes that have been highlighted in official policy documents.



A key policy response was the launch in July 2017 of the Retention Direct Support Programme (RDSP) by NHS Improvement (NHSI), which is a governing body responsible for overseeing the NHS Trusts, providing leadership and support to wider NHS. This programme aimed to reduce turnover rates and to improve retention of nursing staff in Acute Trusts and clinical staff in Mental Health Hospital Trusts. The RDSP was rolled out in 5 cohorts at different times, and Trusts were allocated to cohorts based on their past turnover rates and trends. The programme required Hospital Trusts to come up with their own retention strategies in an action plan, which was agreed upon with NHSI. NSHI monitored each Trusts’ progress in the 12 months following the start and provided targeted support where needed.



We use Electronic Staff Records from 2015 to 2019, and exploit the differential timings of the programme start dates to evaluate the RDSP’s effectiveness on nursing retention by implementing recent methodological advances in the difference-in-difference literature with staggered treatment adoption, i.e. Callaway and Sant’Anna (2020), and Sun and Abraham (2020) estimators.



Overall, we find that the programme has improved nursing retention by 0.78 percentage points (pp), i.e. it helped retaining on average 1,686 nurses and midwives who would have left their Trust otherwise. We find heterogenous treatment effects across cohorts and over time. Trusts in Cohort 1, having the lowest average retention in the past 5 years, benefited the most from the programme with an average 0.95 pp increase in nurses’ retention. Surprisingly, Cohort 4, which had the highest past retention among the treated cohorts, has experienced the second-highest improvement in retention by 0.91 pp in 12 months. The RDSP improved the nursing retention in Cohort 2, but we do not find any significant impact on Trusts allocated to Cohort 3.

Our findings suggest that non-monetary interventions in the form of support programmes can lead to improvements in hospital workforce retention in English NHS. The RDSP impact might be limited in alleviating the nursing workforce challenge in the long run, but programmes like the RDSP provide viable and sustainable ways to prevent the ‘heating’ of workforce pressures in publicly funded healthcare systems