New Acacium Group and Cavell report highlights financial stress affecting over half of flexible healthcare workers

By Karen Matthews-Shard, Global Clinical Director, Acacium Group.

As a nurse with over 40 years of experience across the NHS, armed forces, private sector and commissioning, I’ve seen the healthcare landscape evolve dramatically. But one constant remains: the importance of listening to those delivering care on the frontline. That’s why I’m proud to share insights from Acacium Group’s latest white paper published in partnership with Cavell, which captures the voices of over 26,000 flexible healthcare professionals, agency and bank workers, across more than 1,000 client sites across the UK.

Shaping safer health systems through the experience of the flexible workforce is more than data. It’s a reflection of the lived experiences of professionals who are vital to our health and social care systems. It highlights the challenges they face, the risks they navigate and opportunities to better support them.

Patient safety

One of the most concerning findings is that 21% of flexible workers raised patient safety concerns, with staffing shortages cited by 65% as the primary risk. As clinicians, we know that safe staffing isn’t just a metric, it’s a matter of life and death. Alarmingly, only 47% of NHS respondents felt staffing levels were sufficient, compared to 73% in the private sector. This disparity must be addressed if we’re serious about equitable care.

Mental health and financial stress

Over a quarter (27%) of respondents took illness-related time off, with 19% citing mental health factors. More than half (56%) said financial stress affects their mental wellbeing. These figures are deeply personal to me. I’ve seen colleagues struggle under the weight of burnout and financial insecurity. We must recognise that flexibility in work isn’t just a preference, it’s often a lifeline. Whether it’s juggling caring responsibility for children or elderly parents, or wanting to keep a hand in whilst you move toward retirement, flexible working makes that possible.

Retention and Inclusion

Retention is another red flag. The proportion of flexible workers expecting to stay long-term has dropped from 55% to 41%, and 29% have considered leaving due to financial stress. Satisfaction with induction and support is also declining. These are warning signs that we cannot ignore.

Discrimination remains a persistent issue. 19% of respondents experienced or witnessed harassment, with disabled staff twice as likely to be affected. Women were 25% more likely than men to report discrimination. Only 39% were satisfied with how these reports were handled. As a clinical leader, I find this unacceptable. Every worker, flexible or substantive, whether in acute or community settings, deserves to feel safe, respected and valued.

Moving forward

To my fellow nurses and midwives: your voice matters. This report is proof of that. And to our partners across health and social care: flexible workers are not just part of the solution, they are central to it. As our CEO Mike Barnard outlined in his open letter to healthcare leaders, we must listen to those on the frontline if we want meaningful reform.

That’s why our partnership with Cavell is so important, together, we’re amplifying the voices of nursing and midwifery professionals and driving forward the changes you need and deserve. Let’s ensure flexible professionals are not only recognised for the value they bring but actively included in shaping the future of our workforce.