New research shows that the NHS has significantly expanded routes for clinical support staff to progress into registered professions, boosting workforce development and positioning the health service as a powerful driver of social mobility.
Over the last decade, healthcare assistants, nursing auxiliaries and other clinical support workers have gained far greater access to pathways into roles such as nursing, physiotherapy and other registered professions. In 2024, 16% of new nurses were recruited from NHS support roles – up from around 4% in 2014.
The expansion reflects NHS efforts to tackle workforce shortages, improve retention and open new opportunities for people from diverse backgrounds, including those in deprived areas. The government’s recent 10‑Year Plan for the NHS reinforced this commitment, focusing on training pathways to support “local prosperity” and drive opportunity for individuals in the most disadvantaged communities.
However, the research, published by the Institute for Fiscal Studies as part of the NIHR Policy Research Unit in Health and Social Care Workforce, reveals that access to progression opportunities is uneven.
Career transitions from support roles into registered professions are currently much more common in regions with stronger local labour markets, as well as in mental health trusts. In 2023, support staff in the South East were twice as likely to progress into registered NHS roles compared with those in the North East.
One likely reason, according to the report, is that some trusts face greater recruitment challenges and therefore have stronger incentives to “grow their own” workforce through in‑house training and apprenticeships.
The research highlights several other key findings:
- The share of clinical support staff moving into registered roles has doubled since 2010, with particularly sharp increases in transitions to nursing.
- Early cohorts of support‑staff‑turned‑nurses show higher retention rates than those recruited directly — suggesting they are more likely to remain in the NHS long‑term.
- However, early evidence indicates that this retention advantage may not hold at larger scale as training routes expand rapidly.
- The trend is set to continue: in 2024, more than 1,000 NHS staff began a nursing degree apprenticeship, compared with just over 300 in 2019.
The IFS warns that if the government intends to use apprenticeships and training pathways as a driver of social mobility, it must ensure all NHS trusts have the resources and incentives required to offer these opportunities – not only those in higher‑wage regions or areas with recruitment pressures.
Olly Harvey-Rich, author of the report and Research Economist at the IFS, 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.”
Ensuring equitable access could help deliver:
- A more diverse future NHS workforce
- Better retention across the system
- Stronger career pathways for staff in deprived areas
- More consistent progress in filling national workforce gaps
The findings underscore the importance of investing in long‑term development routes for support staff, a strategy that is already reshaping the NHS workforce and is set to accelerate in the years ahead.
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