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

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 years of 2020-22. 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. 

The researchers found that from 2013-2023:

• Stress levels in staff aged 21-30 have risen by 14 percentage points – with more than half (52%) in 2023 saying they were made unwell through work-related stress over the previous year, compared to 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 to a 1% increase among staff aged 51-65 (rising from 11% to 12%)
• Staff aged 21-30 are 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%)
• The proportion of staff aged 21-30 who do not feel enthusiastic about work has grown from 4% to 7%, but remained unchanged (at 6%) for those aged 51-65. 

In addition, 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 to 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 to 20% in 2013. 

The researchers have called on NHS leaders and employers to urgently investigate increasing levels of stress among younger staff, and to do more to tailor approaches to staff wellbeing, support and retention in accordance with the experiences of different age groups.

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' 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 policy-makers 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.'