The NHS Workforce: A Fragile Foundation for Future Reform

The NHS faces escalating workforce pressures intensified by generational change, burnout and rising tech demands. The essay analyses tensions between Millennial/Gen Z staff and traditional culture, showing how misaligned expectations, limited flexibility and outdated systems fuel dissatisfaction and attrition. It highlights burnout from understaffing, emotional load and admin burden, and assesses how AI, digital tools and smarter scheduling could relieve pressure and build a resilient, future-ready workforce.

Key Points

• The NHS faces persistent shortages, retention issues and rising demand.
• Burnout and stress remain major causes of sickness absence and attrition.
• Staff survey shows stagnant safety culture and rising violence against workers.
• Gen Z and Millennials expect purpose, flexibility and continuous development.
• Technology and workforce plans target workload, retention and productivity.

The National Health Service (NHS), one of the world's largest employers, faces a persistent and critical workforce crisis. Despite employing millions of resolute staff, severe shortages, high vacancy rates and issues with retention are straining the health service, affecting both the quality of patient care and the wellbeing of its staff.

The Scale of the Shortage

The NHS is a vast and complex enterprise, employing around 1.7 million people in England, covering over 350 distinct roles. However, the workforce has not grown fast enough to keep pace with rising demand from an ageing and growing population.

As of June 2025, the NHS vacancy rate in England was 6.9%, a marginal decrease from the previous year (7.7%), but still being tens of thousands of unfilled posts (House of Commons Library 2025). In the 12 months leading to September 2024, the NHS saw one of its lowest staff leaver rates in a decade, with 10.1% of hospital and community staff leaving. However, this comes after a period of sustained high turnover, with many staff citing burnout, poor work-life balance and inadequate pay as reasons for leaving.

Understanding NHS Staff Burnout

Burnout among NHS staff has reached alarming levels (Bailey et al. 2020). With over 372,000 nurses and countless other healthcare professionals working tirelessly, as the demands of the job often exceed the resources available. Long hours, staff shortages and the emotional toll of caring for patients, especially during crises like the COVID-19 pandemic, have left many feeling overwhelmed and undervalued. The Kings Fund (2020) research showed that NHS staff are 50% more likely to experience chronic stress, a known contributor to burnout. NHS England (2025) found that anxiety, stress, depression or other mental health illness was the most common reason for sickness absence, accounting for 28.6% of all sickness absences.

The consequences of burnout are far-reaching. For staff, it can lead to mental health challenges, physical health issues and even decisions to leave the profession altogether. For the NHS, this translates to higher turnover rates, increased absenteeism and a strain on already limited resources. Most importantly, patient care suffers when healthcare workers are unable to perform at their best.

A major contributing factor is staff being subjected to chronic excessive workloads, and a shortage of staff to manage the demands. During the COVID-19 pandemic staff worked selflessly to deliver the best possible care in the extreme circumstances, often cancelling leave, missing breaks and working excessive hours, all which contribute to heightened levels of burnout (NHS Employers 2025). Bevan (cited in Bailey et al. 2020) recognised that the NHS relied upon an enormous amount of goodwill; Bailey and West (2020) recognise that this is still the case. They warn that ‘staff must never again be damaged by being subjected to chronic excessive workloads’ and this level of activity should not be normalised or accepted as a pattern that requires no further attention.

Although this is a NHS England example, the well-documented global picture shows that health systems across the world are not providing enough support for the mental health of the health and care workers, with estimated burnout during the pandemic reaching a range of 41% to 52% (Abdul Rahim et al. 2022).

Each year NHS England ask staff for feedback against the seven-point People Promise (NHS 2021). The 2024 NHS Staff Survey results published in March 2025 by NHS Staff Surveys, showed a stable picture compared to 2023, with no significant movement in the nine main theme scores based on the NHS People Promise. While this suggests improvements made in 2023 were sustained, key areas of concern remain, including increasing incidents of violence against staff and a lack of progress in improving patient safety culture. 

Key National Findings

• Persistent issues with safety culture: Little positive progress was made on patient safety concerns. Many staff still do not feel confident that they will be treated fairly if they report an incident or that their organisation will act on safety concerns.
• Increase in violence and harassment: The overall level of violence experienced by staff worsened, particularly from the public. Incidents of unwanted sexual behaviour from the public also rose and this information represents only the documented cases, excluding the likely substantial number of unreported incidents that remain unacknowledged due to time constraints and prevailing organisational or professional cultures.
• Equality and diversity concerns: Some indicators about equality and diversity worsened. For example, staff's experience of discrimination from the public increased. Inequalities measured by the Workforce Race Equality Standard and the Workforce Disability Equality Standard did not change.
• Ambulance staff experiences: Ambulance workers reported particularly concerning results, with an increase in assaults, harassment and unwanted sexual behaviour from patients/service users.
• Staffing and workload: Concerns persist about staffing levels and workload. Fewer than half of staff said they could meet all the conflicting demands on their time, and only 34% felt there were enough staff to do their jobs properly.
• Modest improvements: Minor shifts were seen in a few areas. Satisfaction with pay improved slightly, due to a better outlook among medical staff. Views on appraisals also improved.

What Millennials and Generation Z Really Want from the Workplace

The millennial generation has reshaped the modern workplace with a fresh set of expectations that prioritise purpose, flexibility and continuous growth over traditional corporate ladders and rigid structures. As the oldest millennials turn forty, they are now influential decision-makers whose values, shaped by a digital-first world and a period of economic instability, are cementing lasting cultural shifts. As the early career staff Generation Z (born roughly between 1997 and 2012) is reshaping workplace expectations. Research and surveys (eg Deloitte 2025, McKinsey and Company 2024) show that Gen Z employees value purpose, flexibility, wellbeing and growth above traditional measures like salary alone. For companies that want to attract and keep this demographic, understanding these new career drivers is no longer optional – it is essential. The common themes in the research work can be categorised and provide a potential start to finding solutions:

Beyond a Paycheque: The Search for Purpose

For many millennials and Gen Z, a job is not just a means to an end; it is a key part of their identity and an opportunity to create a positive impact. Studies consistently show that a keen sense of purpose is a critical factor for job satisfaction and retention (Deloitte 2025).

• Values alignment: Millennials and Gen Z actively seek out employers whose values match their own, with a focus on corporate social responsibility (CSR), environmental sustainability and ethical practices. Many are willing to take a pay cut to work for a company that is making a positive difference in the world.
• Social impact: This generation wants to see bold, tangible action on social and environmental issues, not just empty platitudes. They prefer to work for businesses that integrate these values into their core mission rather than treating them as an afterthought.

Flexibility and Work-Life Harmony

Millennials were at the forefront of demanding greater work-life balance and flexibility, a preference that has been solidified by technology and accelerated by the pandemic. Gen Z share this desire. They define success not by the number of hours spent in the office but by output and overall wellbeing.

• Remote and hybrid work: The traditional 9-to-5 model is outdated for many millennials and Gen Z employees, who favour hybrid or fully remote work arrangements. This allows them to integrate their professional and personal lives more seamlessly and reduces the risk of burnout.
• Wellbeing support: With high awareness of the link between work stress and mental health, millennials and gen Z expect companies to offer comprehensive wellness programmes that include mental health support, flexible time off and employee aid.

The Demand for Continuous Growth

For the millennial and Z generations, a career is a journey of continuous learning and diverse experiences, rather than a single, linear path. They are less attached to the idea of a 40-year career at a single company and will seek opportunities for growth elsewhere if they do not find it.

• Learning and development: Millennials and Gen Z want regular opportunities to upskill and expand their ability. They expect robust training programmes, access to new certifications and mentorship opportunities.
• Faster advancement: This generation expects a faster pace of career advancement than their predecessors, and they are more likely to seek out new roles if they feel their professional growth has stalled.
• Continuous feedback: Millennials and Gen Z favour frequent, honest feedback and guidance over traditional annual performance reviews. This real-time communication helps them track their progress and feel more engaged.

Collaboration, Transparency and Technology

Having grown up with technology and social media, millennials and Gen Z thrive in collaborative and transparent environments where their input is valued and information flows freely.

• Flatter hierarchies: They prefer less rigid, top-down structures and favour a culture of open communication where they can share ideas and collaborate across divergent functions.
• Transparent communication: From company performance to leadership decisions, millennials expect transparency from their employers. This builds trust and gives them a stronger sense of connection to the organisation's mission.
• Tech-savvy workplaces: As digital natives, millennials and Gen Z expect companies to be equipped with innovative technology that streamlines workflows and fosters collaboration. They are often early adopters of new digital tools and can even serve as "reverse mentors" to older colleagues.

Deloitte (2025) projects that Millennials and Generation Z will constitute approximately 74% of the global workforce by 2030. This demographic shift underscores the importance for the NHS to understand and respond effectively to the values, expectations and working preferences of these generations. All tiers of NHS management must therefore recognise and adapt to this evolving workforce dynamic; continued naivety or disregard toward these generational need’s risks worsening existing challenges in recruitment, retention and overall workforce sustainability.

A Path to Recovery

In June 2023, NHS England published the first-ever NHS Long Term Workforce Plan, an ambitious attempt to address the crisis by focusing on three areas: train, keep and reform. Key targets include (NHS 2023):

• Training: Doubling the number of medical school places to 15,000 annually by 2031, expanding nursing training places and introducing more apprenticeship roles.
• Retention: Improving flexible working, offering better support for staff nearing retirement and enhancing professional development opportunities.
• Reform: Increasing the use of modern technology and expanding the number and role of associate-level professionals.

The plan has been met with both praise for its long-term vision and scepticism over its feasibility. Experts at the Institute for Fiscal Studies (Harvey-Rich et al. 2024) have raised concerns about the high productivity targets and the significant fiscal decisions needed to fund the projected pay bill increases. Since the pandemic they report an estimated short fall in productivity of 11% in acute hospital care, but the service seemingly requires more staff and money to deliver the same activity, this in turn has triggered the Secretary of States Commitment to improve productivity estimating the need of 2% over the next 12 months.

This NHS workforce plan will be superseded by the 10-year workforce plan which will build on the recently published 10-year health plan (NHS 2025) and is to set out how a new workforce model will deliver the plan with staff who are aligned with this future direction. A call for evidence went live on September 26,2025, and this new workforce plan will be published in spring of 2026 (Department of Health and Social Care 2025)

The future of the NHS hinges on its ability to effectively train, recruit and keep its workforce. While initiatives and plans are in place, the scale of the challenge is immense. Success will depend on securing adequate, long-term funding and, crucially, improving staff morale and working conditions to stem the tide of leavers. The health service's ambition to provide high-quality care is fundamentally reliant on the dedication and wellbeing of the people who deliver it. The NHS needs to consider who are they trying to attract and keep across the professions.

The Future of Workforce is Here

Millennial and Gen Z-driven expectations have fundamentally changed the nature of careers. For companies to remain competitive, they must adapt by fostering cultures that prioritise purpose, flexibility and development. By meeting these needs, organisations can build a more engaged, productive and resilient workforce that will define the future of work for years to come. Making these positive changes will not only attract early careers staff but go some way to addressing the needs of the current workforce.

The Path Forward for Employers

To successfully engage this next generation of talent, employers must rethink outdated practices and embrace a more adaptive, human-centric approach.

• Be authentic and transparent: Companies must clearly define their purpose and values and then live up to them. Gen Z can spot "greenwashing" or insincere messaging from a mile away. Having open communication, encouraging staff to have a voice without fear of judgement. Setting up groups to enable peer support, where staff can share experiences and offer mutual support. Celebrating the contributions of healthcare workers, through recognition and appreciation.
• Invest in personalised growth: Offer flexible, skills-based career paths rather than rigid ladders. Provide continuous, accessible learning opportunities that resonate with Gen Z's desire for rapid development. In essence, the Agenda for Change (AfC)  and medical career pathway system's traditional structure and the demanding NHS environment create a significant mismatch with the modern workplace expectations of Gen Z, contributing to recruitment and retention issues which have been described as a "ticking timebomb" for the health service. The NHS needs more flexibility built in to allow recognition of transferable skills, making transition and change more accessible.
• Advancement: Gen Z values clear career pathways and opportunities for rapid professional development, and many would quit a job if their long-term career planning was not taken seriously. The rigid, hierarchical nature of the NHS and the AfC system can be seen as an obstacle to this, with limited scope for quick upward mobility. Gen Z staff report elevated levels of unhappiness with their salaries, a dissatisfaction that has more than doubled in the last decade among young workers. Many are put off from joining the NHS due to low entry-level pay, especially when compared to the cost of living and potential earnings in other sectors. Furthermore, while AfC includes pay increments linked to length of service and progression, the pace of movement through the pay bands can be slow. Gen Z, who value the ability to "earn more money" and achieve financial independence quickly, often find this progression restrictive.
• Prioritise holistic wellbeing: Go beyond standard benefits by offering robust mental health support, flexible work options and a culture that respects personal boundaries. Invest in counselling, stress management and wellness programmes, both physical and mindfulness, promoting the overall wellbeing and personal insight and growth.
• Empower managers as coaches: Train managers to provide regular, constructive feedback and function as mentors who invest in their team's development. Also developing the skills required to recognise and prevent burnout. Encourage regular check ins, with supervisors routinely assessing staff wellbeing. Ensure transparent policies and procedures to allow implementation of clear pathways in times of crisis. Empowering managers with the capacity to manage effectively, while reducing both endogenous and exogenous bureaucratic constraints, will enable them to focus on leadership and developmental coaching rather than administrative compliance. Streamlining regulatory and procedural requirements not only enhances managerial autonomy but also fosters a culture of trust, accountability and adaptive leadership within the organisation.
• Listen and adapt: Ease a two-way dialogue where Gen Z employees feel heard and involved in decision-making processes. Creating an inclusive environment where all generations can learn from each other is key to a thriving workplace. Gen Z is generally less accepting of traditional hierarchies and values transparent leadership and accountability. Perceived lack of accountability for workplace issues like discrimination or poor working conditions can lead to frustration and a lack of confidence in the system. A key example of working to resolve this is the Commonwealth Leadership Institute: Health. Bringing together people from across the globe in person or virtual workshops to share and innovate (The Commonwealth 2024).

The Role of Technology in Staff Retention

One promising avenue is the strategic use of technology to enhance staff capability and experience, reduce workload and foster a supportive working environment.

Digital technology has the potential to revolutionise the way NHS staff work, making their roles more manageable and rewarding. By streamlining processes, improving communication and offering flexible working solutions, technology can directly address some of the key factors contributing to staff dissatisfaction and attrition. As already discussed, the workforce of the future and the emerging leaders of today have grown up with digital tech and expect it in the workplace.

Reducing Administrative Burden

Administrative tasks often consume a sizeable part of healthcare professionals' time, detracting from patient care and increasing stress. If implemented correctly, technologies such as electronic health records (EHRs), automated scheduling systems and AI-powered documentation tools can simplify these processes. For example, AI transcription tools can reduce the time spent on clinical notes, and automated rota systems can ensure fair, efficient scheduling, reducing conflicts and last-minute changes. By freeing up time, staff can focus on caring for patients, leading to greater job satisfaction.

Enhancing Communication and Collaboration

Fragmented communication is a common pain point in healthcare settings. Digital platforms that enable seamless communication between teams, such as secure messaging apps or integrated care platforms, can improve coordination and reduce frustration. These tools ensure that staff feel supported and connected, even in high-pressure environments.

Supporting Flexible Working

Flexible working is increasingly recognised as a key factor in staff retention. Technology can enable remote consultations, virtual meetings and digital training sessions, allowing staff to balance their professional and personal lives more effectively. For instance, telemedicine platforms can allow clinicians to conduct virtual appointments. On the other hand, e-learning modules can provide on-demand training, reducing the need for rigid schedules.

Promoting Health and Wellbeing

The wellbeing of NHS staff is paramount. Wearable technology, mental health apps and digital wellbeing platforms can provide staff with tools to check and improve their physical and mental health. Additionally, data analytics can help find early signs of burnout, enabling prompt interventions.

Overcoming Challenges

While the benefits of technology are clear, the NHS must address several challenges to fully realise its potential:

• Training and adoption: Staff need adequate training to use innovative technologies effectively. User-friendly interfaces and ongoing support are essential.
• Infrastructure: Reliable IT infrastructure is critical to ensure smooth implementation and minimise disruptions.
• Engagement: Staff should be involved in the choice and design of technological solutions to ensure they meet their needs and preferences.
• Drive for innovation: The drive for innovation within the health sector must undergo a paradigmatic shift, from being predominantly commercially-driven to being genuinely healthcare-driven. The current emphasis on market-oriented technological development has contributed to escalating costs, systemic inefficiencies and an unsustainable trajectory of growth. To ensure long-term viability, innovation must instead be directed toward addressing genuine clinical and societal needs rather than perceived market demands. This reorientation is critical for healthcare organisations, as the alignment of technological advancement with authentic patient and system priorities is essential to achieving sustainable, equitable and value-based healthcare.

A Vision for the Future

By embedding the Gen Z and Millennials needs and wants and embracing technology, the NHS can create a more sustainable and supportive working environment. This not only benefits staff but also translates into better patient care, as a motivated and well-supported workforce is more likely to deliver high-quality services (Bellet et al. 2023).

Investing in technology is not just about innovation: it is about valuing the people who make the NHS what it is. By reducing pressures, fostering flexibility and promoting wellbeing, technology can play a pivotal role in keeping the talented individuals who are the heart of the NHS.

Conflict of Interest

None.