Staff wellbeing
All respondents say they are concerned about the mental, physical and financial wellbeing of staff as a result of cost of living pressures, and the majority (61%) report a rise in mental health sickness absence. Trusts also report staff struggling to afford to come to work with almost three quarters (71%) saying this has a significant or severe impact on their trust. Around two fifths (44%) say staff are opting out of the NHS pension due to the affordability of the contributions.
Figure 1
Concern about impact of the cost of living on staff
While the cost of living impacts lower paid staff disproportionately, trust leaders are concerned about morale and wellbeing across all roles. This includes those who are higher paid but seeing real terms cuts in their take-home pay due to increases in pension contributions, and those who face higher costs outside of work, such as those with caring responsibilities.
More than three quarters (78%) of trust leaders are extremely concerned about the mental wellbeing of staff given the psychological impacts of the cost of living and the pandemic.
We have examples of staff who … can't afford to travel to work [at the end of the month]. We've had to support staff with food vouchers as they are going without meals. There is a notable [increase] in staff who have opted out of the pension. I'm concerned the energy increases and pension contribution increases for some staff will have a significant detrimental impact.
Figure 2
Impact of cost of living on staff mental and physical health and wellbeing
Trust leaders also report concerns about the physical health of their staff, with 81% saying they are moderately or extremely concerned. Two fifths (42%) of trust leaders say that the cost of living is having a significant or severe impact on staff struggling to afford to eat while on shift Trust leaders describe examples of nurses skipping meals to fund school uniforms for their families, while others are concerned about the health impact of staff living in cold homes in the winter.
Recruitment and retention
The vacancy rate across the trust sector reached an all-time high in September 2022, with 132,139 vacancies across the sector. Three quarters of trust leaders (75%) are extremely concerned that existing workforce challenges will be exacerbated by the recent NHS pay awards not matching inflation.
Trusts also say the rising cost of living is causing staff to look for roles elsewhere with two thirds (68%) of respondents reporting a significant or severe impact from staff leaving the trust for other sectors, such as hospitality or retail, where employers can offer competitive terms. This increased turnover is costly for trusts and is disrupting their ability to manage operational pressures.
Figure 3
Impact of cost of living on retention
For some staff this is the final straw psychologically after two years of COVID-19 and the national narrative swinging (as it was always going to) from 'NHS angels' to 'NHS waste and bureaucracy'.
Recruitment challenges exist across a range of posts. More than two thirds of trust leaders (69%) say the cost of living is having a significant or severe impact on their ability to recruit to lower-paid roles, such as porters, cleaners and healthcare assistants. They also describe increasing recruitment challenges in functions such as IT, HR and facilities where there is direct competition for skills and talent with other sectors.
Half of trusts (48%) say cost of living increases are having a significant or severe impact on new people taking up careers in health and social care, which risks 'baking in' shortages in the long term.
Inflation is having a demonstrable downward effect on number of applications for nursing degrees. This will aggravate an already critical staffing position.
Figure 4
The impact of the cost of living on recruitment 