Housing affordability, cost-of-living and NHS workforce retention in a high-cost region of England: A multiphase study

Rising living costs in high-cost areas of England are causing financial strain for NHS staff, particularly those in lower pay bands. Housing affordability has become a key issue for workforce retention and poses risks to the stability of healthcare services. This study examined financial pressures facing NHS staff in two Integrated Care Systems in South East England and identified policy options to support workforce sustainability. A mixed-methods design was used that combined a survey of healthcare staff with qualitative discussions with housing providers and local authorities to explore the impact of housing costs and financial stress on decisions about whether to remain in post. Findings show that lower-paid staff faced significant difficulties securing affordable housing near their workplaces, contributing to financial hardship and intentions to leave. Stakeholders highlighted barriers such as high land costs, funding constraints and limited collaboration between the NHS and housing sectors, and proposed practical approaches including partnerships with housing providers, repurposing vacant properties and targeted financial support for staff. Stakeholders tended to frame these solutions within existing welfare-based approaches, yet the findings also suggest that where staff can afford to live has direct implications for service continuity. Considering housing for NHS staff as part of the wider infrastructure that supports essential services therefore offers an important direction for future policy. • The lack of affordable housing threatens NHS workforce stability. • Over 60% of lower paid workers’ income is spent on housing costs. • Financial pressures lead 70% of staff to consider leaving their roles. • Prioritise affordable housing in NHS planning. • Stronger cross sector collaboration can stabilise the NHS workforce.