This is our third annual report analysing the staff profile and trends in the NHS workforce in England. It is intended to be read as an annual update, examining changes in the overall profile of NHS staffing in 2018.

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As well as assessing the implications of trends in NHS staffing, this report also focuses in more detail on two critical ‘pressure points’ – the retention and attrition of NHS staff in general, and then student nurse attrition.

It is being published at a critical moment. The NHS Long Term Plan, published in January 2019, sets out an ambitious programme of service-delivery expansion and change. It recognises that the NHS workforce can be the enabler of its objectives. However, if the existing workforce shortages continue, they will severely hinder progress.

This report sets out recommendations for improving these worrying trends. It then concludes with a brief assessment of ‘where next’ in terms of health workforce policy and planning in England, in the context of ongoing reforms of the NHS.