Burnout Isn't Just a Wellbeing Problem, It's a Balance Sheet Problem

Nearly one in three NHS staff say they feel burnt out because of their work, and the modest recovery seen after the pandemic has stalled. The real story is not just how staff feel, it is what that feeling is costing the health service.

Every March, NHS England publishes the results of the world's largest workforce survey, and every March, the headlines are some version of the same story: staff are stretched, staff are tired, staff are thinking about leaving. It would be easy to read this as background noise, a permanent feature of a large public organisation under permanent pressure. But the 2025 results are worth pausing on, because they mark a change in direction, not just a continuation of an old problem.

The recovery has stopped

After the acute strain of the pandemic years, most of the NHS Staff Survey's wellbeing measures improved steadily between 2021 and 2024. Burnout fell from 34.3% to 30.3%. Work-related stress fell from 46.8% to 41.7%. Then, in 2025, both indicators ticked back up, and other measures of engagement, such as willingness to recommend the NHS as a place to work, fell to their lowest level in years.

The direction of travel matters here as much as the level. A workforce recovering from a shock looks different, economically and organisationally, from a workforce whose improvement has run out of road. The 2025 figures suggest the NHS has moved from the first category into the second.

It is also worth resisting the temptation to treat 2021 as the natural baseline for comparison, since it flatters the trend. NHS Employers' own analysis of the 2021 survey recorded 46.5% of staff often or always feeling worn out at the end of a shift and 39.4% often or always frustrated by their work, both of which were themselves elevated relative to pre-pandemic norms. Widen the lens further and the picture gets less reassuring, not more: Nuffield Trust research tracking staff experience back to 2003 found clear generational divergence opening up over the past decade, with younger staff, particularly those aged 21 to 30, reporting sharply rising stress and dissatisfaction even as older cohorts' experiences stayed comparatively stable. In the 2023 survey, over half of NHS staff aged 21 to 30 reported feeling unwell due to work-related stress in the previous year, and nearly a third of that age group were working six or more hours of unpaid overtime a week, up from a fifth a decade earlier. Whatever is driving burnout in today's NHS, it is not simply a pandemic hangover that time will resolve on its own.

Why burnout is an economic problem, not only a clinical one

It is tempting to treat staff wellbeing as a separate issue from health system performance, something to be addressed once the "real" problems, waiting times, funding, capacity, are dealt with. That framing gets the relationship backwards. Burnout is not a side effect of NHS pressure, it is one of its primary transmission mechanisms into cost and poor care.

The pathway is fairly direct. Burnt-out staff take more sick days. NHS sickness absence rates in October 2024 were 18% higher than the equivalent pre-pandemic month, and more than a quarter of all days lost to sickness are now linked to anxiety, stress or other mental health issues. Burnt-out staff are also more likely to leave, which drives up recruitment and agency staffing costs, and more likely to make errors, which has direct implications for patient safety and, eventually, litigation costs. Occupational health research outside the NHS specifically has found burnt-out employees are markedly more likely to take sick leave, more likely to be actively looking for another job, and more likely to end up needing emergency care themselves. None of this shows up neatly on a single line of the NHS budget, but all of it shows up somewhere, in the growing agency staffing bill, in the cost of repeated recruitment campaigns, and in the compensation and clinical negligence claims that follow from care delivered under unsustainable pressure.

There is also a presenteeism cost that is easy to overlook because it does not appear in absence statistics at all. More than half of NHS staff, 56% in the 2025 survey, say they have gone into work in the past three months despite not feeling well enough to perform their duties, a figure that has been above 50% in every survey since 2021. Presenteeism of this kind does not reduce the wage bill the way absence does, but it plausibly reduces the quality and safety of the care being delivered while staff are there, which is arguably the more expensive outcome for a health system to absorb.

The unevenness of the burden also matters for where policy attention should go. Ambulance staff reported the highest burnout of any group in 2025, at 39.84%, roughly eight percentage points above the national average, alongside the sharpest rise in reports of unwanted sexual behaviour from patients or the public, now affecting close to one in three ambulance staff. Admin and clerical staff, general management and other "wider healthcare team" roles, groups that rarely feature in public debate about NHS workforce pressure, saw some of the steepest declines in engagement of any staff category in 2025, each falling more than four percentage points on measures like willingness to recommend their organisation as a place to work. A workforce strategy that treats "NHS staff" as a single undifferentiated group, or that focuses attention only on the most visible clinical roles, will miss where a meaningful share of the strain is actually concentrated.

This unevenness extends to how burnout is distributed across a career, not just across occupations. Nuffield Trust analysis has found that burnout increased in 2025 specifically among staff with six or more years of service, while newer starters reported levels similar to the year before. That pattern is worth sitting with: it suggests the NHS is not simply struggling to induct new staff into a difficult job, it is gradually wearing down the experienced staff it has spent years training and retaining, the group most costly and slowest to replace.

The table below sets out how the picture has shifted since 2021

Indicator	2021	2025	Change
Felt burnt out because of their work	34.3%	31.5%	-2.8 points, but rising again since 2023-24 low
Unwell due to work-related stress (12 months)	46.8%	42.4%	-4.4 points, plateauing since 2023
Enough staff to do job properly	27%	33%	+6 points, still below half
Work frustrates them	40%	37%	-3 points

Read across the row, and the picture is one of partial, incomplete recovery rather than genuine improvement. Even on the most favourable indicator, staffing adequacy, only a third of NHS staff feel there are enough people to do their job properly. Two in three do not.

What this means for the workforce plan

England's forthcoming NHS workforce strategy is, on paper, an opportunity to address this directly, through recruitment, retention and better working conditions. But the 2025 survey is a useful reminder that recruitment numbers alone will not fix a burnout problem. Between 2022 and 2024, NHS England added roughly 140,000 staff across hospitals, general practice and community services, and the proportion of staff reporting adequate staffing did rise. Burnout, work-related stress and staff intent to leave, however, did not fall nearly as much as headcount rose, and in 2025 several of these measures reversed.

That gap between headcount and wellbeing is the part of this story that health economists, not just workforce planners, need to be paying attention to. Adding staff addresses one input into a stretched system. It does not, on its own, address the conditions that turn a stretched system into a burnt-out one. Rota design, management support, physical working conditions, and the balance between clinical and administrative burden all shape whether extra headcount translates into a genuinely less pressured working environment or is simply absorbed by rising demand.

The expansion of Additional Roles Reimbursement Scheme (ARRS) staff in primary care over the past few years is one example of headcount growth of exactly this kind, and it remains an open empirical question whether it has meaningfully reduced pressure on existing GPs and practice staff, or simply changed the composition of an already stretched workforce. That is precisely the sort of question a workforce plan needs to be able to answer with evidence, not assumption, before committing further billions to headcount expansion as the default policy lever.

Until burnout, presenteeism and staff-reported adequacy are tracked and evaluated with the same rigour as headcount and vacancy rates, the NHS is likely to keep publishing broadly the same survey results every March, recruitment gains and all, because the metric that most directly predicts whether care is safe, sustainable and affordable is not how many people are on the payroll. It is how many of them can still do the job without it costing them their health.

Sources

• NHS Staff Survey, NHS England (annual results, 2021-2025)

• NHS Employers, "NHS Staff Survey 2025: health and wellbeing overview"

• NHS Confederation, "NHS Staff Survey results 2025: what you need to know"

• Nuffield Trust, "Safety culture in the NHS."