Admin, estates and support staff: the retention gap behind the clinical headlines.

Report 3 of our NHS series split a year of exit questionnaires, December 2024 – December 2025, by staff group. For the non-clinical and support groups the reasons are specific, and in our experience these groups are often an afterthought in retention plans.

Admin and clerical: nowhere to go, and the ground keeps moving

Admin and clerical staff work across clinical and corporate services, from ward and clinic administration to HR, finance and management posts. Their dissatisfaction is slightly lower than the frontline clinical groups but still substantial, and the reasons are consistent:

• Band ceilings: getting stuck in banded roles with limited routes upward
• Recognition: feeling that administrative skill is valued less than clinical skill
• Instability: restructures, centralisation and worries about job security
• Patient-facing load: a heavy volume of work and emotional labour

The comments in the report capture it: people who enjoyed supporting patients and staff but felt nobody recognised how complex the job was, and people who reached a point where there was nowhere to progress while repeated restructures made the role feel unstable.

Estates, facilities and ancillary: dignity and voice

Porters, catering, housekeeping and maintenance staff describe physical demands and shift patterns, pay and a sense of being invisible in organisational priorities, and fairness and voice in local management. Report 3 concludes that this is a group where small improvements in dignity, respect and communication can have a disproportionate effect on retention.

Clinical support staff: the bottom of the ladder

Health care support workers and additional clinical services staff carry much of the frontline workload and physical strain. They frame leaving around pay against responsibility, banding and limited routes upward, and describe limited say over shift patterns and limited access to development. Some leave to start nurse training they could not reach in their own organisation. Our new-starter data shows additional clinical services starters arriving with a strongly anchored intention to stay – a majority expect three years or more – which makes losing them to a blocked route all the more avoidable.

The common thread: a two-tier experience

Some admin, estates and corporate leavers describe their contribution as less visible or less valued than that of clinical colleagues, even where services would fail without them. Nobody sets out to create that. In our experience it happens when recognition schemes, communications, development budgets and leadership attention are built around clinical work by default. Progression is a shared frustration with clinical staff, but it looks different here: band ceilings and restructures rather than a shortage of advanced practice posts.

What the data points to

The report’s recommendations for each group, with a practical suggestion of ours for the first two:

• Admin and clerical: make progression pathways explicit and accessible; visibly value administrative expertise as part of the clinical system; minimise churn from restructures, or communicate change in ways that protect trust. We suggest a published map of admin roles by band with the skills and development that lead from one to the next.
• Estates and ancillary: attention to dignity, respect and recognition; safe, properly resourced working conditions; involvement in wider organisational conversations, not just operational tasks. We suggest making sure these teams hear about trust news and “you said, we did” updates at the same time as everyone else, in a format that reaches people who do not sit at a computer.
• Nursing support and additional clinical services: recognise and reward the complexity of support roles; provide structured routes into registered training; involve these staff in team decisions and local service improvement.

Report 1 adds one more that applies with particular force here: improve communication and involvement during change – a transparent rationale, real involvement in shaping the change, and regular two-way feedback. For the full staff-group comparison, see Who is leaving the NHS, and from which roles?; for communicating change, see Sending isn’t communicating.