Poor retention of diverse staff poses major threat to NHS

The retention of diverse staff should be an essential part of the NHS workforce plan claims a new report involving University of Leicester and UCL researchers.

Not only that, the report says that without international workers, the healthcare system is at risk of collapse.

The report makes a series of policy recommendations for government, emphasising that staff retention should be a core element of the NHS Workforce Plan, and that the plan should be designed to meet the needs of a healthcare workforce that is increasingly diverse. Researchers warn that without this, we could see more NHS staff decide to leave the UK, which could leave the healthcare service on its knees.

The report’s four key recommendations aim to improve NHS staff retention policy, targeted primarily at the Department of Health and Social Care whose NHS Workforce Plan is forthcoming in Spring 2026.

One of the report’s lead authors, Professor Katherine Woolf (UCL Medical School), said: “Retention needs to be foregrounded in workforce planning, and that means designing the plan with the needs of diverse groups of staff already in mind. There shouldn’t be a plan that talks about retaining diverse staff without addressing racism - these issues must be brought together and treated as integral rather than as an add-on.

“The idea that experienced staff can easily be replaced is unrealistic. When someone has 20 or 30 years of clinical experience, you can’t simply substitute them with newly trained graduates. We really need people to stay, including international staff, because if they leave the healthcare service risks falling over.”

Surveys conducted between 2021 and 2024 found that around half of healthcare workers were intending or taking action to leave their roles, with nursing and midwifery staff among those most likely to do so. Staff from many ethnic minority backgrounds were also more likely to leave the NHS compared with white UK nationals.

The number of healthcare workers thinking about leaving rose from about 30% in 2021 to 47% in 2024. Research suggests that intentions to leave are closely linked to workplace discrimination, poor mental health, feeling undervalued and dissatisfaction with pay.

The report comes after a parliamentary roundtable was held at Westminster in December 2025, during which senior academics from UCL and the University of Leicester explored strategies to retain NHS staff, particularly those from diverse and ethnic minority backgrounds.

The event was hosted by Sarah Owen MP, Chair of the House of Commons Women and Equalities Select Committee, who brought together experts and policymakers to share evidence-informed research that could help develop policies at national and local levels.

Both Professor Katherine Woolf and Professor Manish Pareek of the University of Leicester attended the roundtable, which formed part of the I-CARE study - a major three-year research project, funded by NIHR, aimed at improving the retention of NHS staff from ethnic minority and migrant backgrounds.

Professor Manish Pareek, who co-leads the I-CARE study and the report, said: “The NHS workforce is already highly diverse and increasingly so among UK-trained staff. Workforce planning must reflect that reality and ensure equity and anti-racism are embedded at its core. If people continue to leave, particularly those with significant experience, this creates gaps that cannot be quickly filled and poses a serious challenge to service delivery.”

The report details four main recommendations for national policy going forward:

• Build on current work to make retention a core plank of NHS workforce planning. This should include improvements to training, career development, staff health, and employment conditions, as set out in the government’s 10 Year Health Plan for England.
• Where government policies may have negative consequences for NHS staff retention, ensure these are identified and mitigated against.
• Design the NHS Workforce Plan to meet the needs of a healthcare workforce that is diverse and increasingly able to deliver healthcare to all patients.
• Recognising, understanding and tackling the many ways in which racism affects staff should be core to NHS retention policies and practices, not treated separately. 

It also highlights eight core themes for local retention of diverse NHS staff such as anti-racism and speaking up, inclusion and belonging, equitable progression and recruitment, and mental health support.

Professor Ibrahim Abubakar, UCL’s Vice Provost (Health), also contributed to the report, as well as Dr Elaine Kelly, Deputy Director at the Health and Social Care Workforce Policy Research Unit, and Professor Habib Naqvi MBE, Chief Executive of the NHS Race and Health Observatory.

Professor Abubakar said: “Migrant workers have long been central to the NHS, yet increasingly polarised debates risk sidelining their contributions while making it harder to retain talent. We need urgent action on workload, rewards and policy barriers such as visa costs, or the NHS will struggle to attract and keep the staff it depends on.”