Intended for healthcare professionals


Who retires early from the NHS because of ill health and what does it cost? A national cross sectional study

BMJ 2001; 322 doi: (Published 27 January 2001) Cite this as: BMJ 2001;322:208
  1. Shriti Pattani, specialist registrara,
  2. Nick Constantinovici, clinical lecturerb,
  3. Siân Williams (Sian.Williams{at}, consultanta
  1. a Occupational Health and Safety Unit, Royal Free Hampstead NHS Trust, London NW3 2QG
  2. b Department of Primary Care and Population Sciences, Royal Free and University College Medical School of the University of London, London NW3 2PF
  1. Correspondence to: Siân Williams
  • Accepted 11 September 2000

About one million people are employed by the NHS in England and Wales, 96% of whom belong to the NHS occupational pension scheme.1 The scheme allows early retirement because of ill health for employees “incapable of discharging efficiently the duties of their employment by reasons of permanent ill-health or infirmity of mind or body.” There is no requirement for the employer to attempt to offer a more suitable job. This study estimates the magnitude of the problem in terms of annual rates of retirement because of ill health, the direct cost to the NHS Pensions Agency, and whether this ill health is caused by work.

Participants, method, and results

We examined retirement forms for the first 2000 of 5469 applicants from England and Wales who were granted retirement during 1998-9 because of ill health.1 Complete data were obtained on 1994 of them. Their mean age was 51.6 years (SD 7.4 years) and 72% were female. The commonest reasons for retirement because of ill health were musculoskeletal (49%), psychiatric (20%), and cardiovascular conditions (11%). The table shows inverse linear trends (P<0.001) in the frequency of musculoskeletal and psychiatric diagnoses across occupational groups, musculoskeletal disorders being relatively more common in jobs likely to have a higher manual element (table).

Type of medical condition and rates of retirement because of ill health for 1998-9 in England and Wales, by occupation. Values are numbers (percentages) unless stated otherwise

View this table:

We asked our sample about their length of NHS service and whether they believed their ill health was caused by work. Their views were compared with the answers given by their managers to a similar question on the form for retirement from ill health. Of the 1317 retired workers who replied, 87% had worked in the NHS for at least 10 years (mean 21.2 (9.1) years). Almost half of those who retired because of musculoskeletal or psychiatric conditions (43% in both cases) thought their ill health was caused through work. This belief was shared by their managers in 24% of cases of retirement on musculoskeletal grounds (57% agreement), but in only 4% of retirements for psychiatric reasons (8% agreement).

The 1998-9 rate of retirement because of ill health in England and Wales was 5.5 per 1000 NHS employees. The table shows a wide variation across occupational groups. Ambulance workers were seven times more likely to retire on grounds of ill health than technical or professional staff.24 We estimate that the cohort of 5469 NHS employees who retired early in 1998-9 will cost the Pensions Agency an additional £416m more up to age 70 than would have been expected if they had retired normally (see BMJ website). Two thirds of the total sum will be received by nurses (£180m) and doctors (£104m).


Rates of early retirement were higher in jobs likely to involve more manual work (mostly because of musculoskeletal problems). This may reflect a higher incidence of work related injuries in these jobs. Alternatively, musculoskeletal conditions leading to incapacity may preclude return to manual work. The greater acceptance by managers that work was responsible for musculoskeletal disabilities may reflect specific, witnessed musculoskeletal injuries at work. The work related component of psychiatric illness may be less tangible and thus less apparent to managers.

This is the first major study of retirement because of ill health in the NHS. Our rate of retirement because of ill health of 5.5/1000 NHS employees compares with rates of 2/1000 to 25/1000 employees reported in a recent study of six UK industries (four public and two private).5

The huge cost to the NHS Pensions Agency of retirement because of ill health could be reduced if the NHS were able to prevent some work related ill health and to encourage redeployment where ill health prevents staff from continuing in their normal job. There is a need for high quality research to identify effective interventions in these areas. This is particularly pertinent in the current employment climate and could help the NHS retain experienced staff at a time of crisis in recruitment and retention. We will contact our cohort again to find out whether they have found alternative work and, if so, to identify predictors of re-employment.


We thank Richard Rance for assisting with questionnaire design and data collection and input, the NHS Pensions Agency for financial support and for allowing us access to its records, Medical and Industrial Services for its help in mailing the questionnaires and retrieving data from the application forms for retirement on grounds of ill health, and Professor Charles Normand and Mr Gary Cole for advice on cost calculations.

Contributors: SP, NC, and SW designed the study, devised the data collection instruments, and wrote the paper. SP and SW obtained the funding. SP oversaw data collection and obtained ethical approval. NC analysed the data. SW conceived the idea and oversaw the study. SP is guarantor of the study.


  • Funding Part-funded by the NHS Pensions Agency.

  • Competing interests None declared.

  • Embedded Image Details of how NHS pensions are calculated are given on the BMJ's website. This article is part of the BMJ's trial of open peer review, and documentation relating to this also appears on the website


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