The research, published by the Institute for Fiscal Studies (IFS) as part of the NIHR Policy Research Unit in Health and Social Care Workforce, shows 16% of the new nursing cohort in 2024 were recruited from a clinical support role in the NHS, compared with around 4% in 2014.

However, the data reveals that occupational transitions have been much more common in regions with higher wages elsewhere in the local labour market, as well as in mental health trusts. For example, in 2023, clinical support staff working in the South East were twice as likely to move into registered roles in the NHS as those working in the North East. One likely explanation is that some of these trusts find it more difficult to recruit, and so have a stronger incentive to train staff in-house.

Other findings in the report include:

• The share of clinical support workers who move into a registered profession has doubled since 2010, with particularly sharp rises in transitions to nursing
• There is evidence that earlier cohorts of occupational movers have higher retention in their new roles than comparable staff recruited directly. However, early evidence on more recent cohorts suggests that this pattern may not replicate when these roles are expanded at scale
• Increasing rates of transition are set to continue for at least the next few years, as many staff are still in training. Over 1,000 existing NHS staff members started a nursing degree apprenticeship in 2024, up from just over 300 in 2019.

Olly Harvey-Rich, research economist at IFS and an author of the report, said: ‘New pathways into registered roles are a valuable way for NHS trusts to attract and retain staff, and often result in training opportunities that would not have otherwise been available. But the trusts that are keenest to offer internal staff training are often in areas of the country that already have higher wages and better training opportunities; trusts in more deprived areas may find it cheaper to hire through other routes.

‘As the NHS drafts its new 10-year Workforce Plan, it should therefore be clear about what it wants these pathways to achieve. There will likely be a trade-off between designing incentives that target areas with workforce shortages and achieving broader social objectives such as reducing regional inequalities.'

In response, Caroline Waterfield, director of development and employment at NHS Employers, said: ‘We welcome this independent review from the Institute for Fiscal Studies. Before the 10-Year Workforce Plan is finalised, it will be important to consider the findings of this report and understand what has worked well and why.

‘This will help ensure that the right policy, strategy and funding levers are in place within the NHS and across government in skills and employment, enabling the NHS to continue offering more people opportunities for career progression and to have a positive impact on social mobility.'