NHS nursing workforce

Public Accounts Committee Closed Inquiry
Opened: 15 Jun 2020 Closed: 9 Nov 2020 Parliament page
Despite a range of actions to resolve the long term issue of workforce shortages in nursing, including tackling worsening retention rates, problems have persisted. The NHS Long Term Plan signalled the need for an increase in the number of nurses, and in December 2019 the government confirmed its pledge of … Read more
15 Recommendations
13 Conclusions
1 Report
1 Oral session
1 Letter
1 Event
Activity timeline 4 events
3 Feb
2021
Report published
1 Feb
2021
Correspondence
23 Sep
2020
Report published
20 Jul
2020
Oral evidence
Oral evidence sessions 1 session
20 Jul 2020
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NHS nursing workforce
Lee McDonough · Department for Energy Security and Net Zero Mark Radford · Health Education England Prerana Issar · NHS England and NHS Improvement Ruth May · NHS England and NHS Improvement Sir Chris Wormald · Department of Health and Social Care
Title HC No. Published Items Response
Eighteenth Report - NHS nursing workforce HC 408 23 Sep 2020 28 Responded
Recommendations & Conclusions
28 results
2 Recommendation Not Addressed
Eighteenth Report - NHS nursing wo…
The Department could not show that its commitment to 50,000 more nurses by 2025 matches...
The Department could not show that its commitment to 50,000 more nurses by 2025 matches the actual need for nurses in the NHS. It is essential that the NHS understands not just how many nurses it needs, but where and … Read more
Government Response
The government's response does not address the recommendation to update and publish modelling work on NHS nurse demand, instead discussing funding decisions for the Towns Fund and Levelling Up Fund.
HM Treasury
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3 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
We are not convinced that the Department has plans for how the NHS will secure...
We are not convinced that the Department has plans for how the NHS will secure 50,000 more nurses by 2025. The Department plans to meet the 50,000 commitment by increasing the domestic supply of registered nurses, recruiting from overseas and … Read more
Government Response
The government accepted the recommendation, agreeing to publish detailed, costed action plans for each nursing supply route and their expected contributions to the 50,000 nurse target as part of the People Plan by Autumn 2021. They noted a three-year pay deal and continued reliance on the independent NHS Pay Review Body.
HM Treasury
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4 Recommendation Not Addressed
Eighteenth Report - NHS nursing wo…
The nursing needs of social care remain an unaddressed afterthought for the Department of Health...
The nursing needs of social care remain an unaddressed afterthought for the Department of Health & Social Care. Vacancies for nurses in social care have increased from a rate of 4.1% in 2012–13 to 9.9% in 2018–19, while the number … Read more
Government Response
The government response is incomplete and does not address the recommendation to set out its understanding of nursing requirements across health and social care and how it supports recruitment and retention in social care.
HM Treasury
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5 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The removal of the NHS bursary in 2017 signally failed to achieve the Department’s ambition...
The removal of the NHS bursary in 2017 signally failed to achieve the Department’s ambition to increase nursing student numbers. From 2017, the Department changed the funding arrangements for nursing, midwifery and allied health professional students. It removed the NHS … Read more
Government Response
The government agrees with the recommendation, confirming that the Department, NHSE&I, and HEE wrote to the Committee on 11 November 2020 as requested and will share further UCAS data when it becomes available in January 2021.
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6 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The COVID-19 outbreak presents new challenges, as well as opportunities, for improving the recruitment and...
The COVID-19 outbreak presents new challenges, as well as opportunities, for improving the recruitment and retention of nurses in the NHS. In particular, it is vital that the NHS protects the mental health and well-being of nurses who have contributed … Read more
Government Response
The government agrees with the recommendations, committing to continue assessing COVID-19 challenges on nursing recruitment and retention, and detailing existing comprehensive health and wellbeing support for staff, including developing mental health wellbeing hubs in seven regions.
HM Treasury
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1 Conclusion Not Addressed
Eighteenth Report - NHS nursing wo…
On the basis of a Report by the Comptroller and Auditor General, we took evidence...
On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department), NHS England and NHS Improvement (NHSE&I) and Health Education England (HEE) on the NHS nursing workforce.1
Government Response
The government provided a factual overview of the NHS nursing workforce, the roles of various bodies, and the context of the committee's report, without addressing any specific points from this introductory conclusion.
HM Treasury
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7 Conclusion Rejected
Eighteenth Report - NHS nursing wo…
NHSE&I told us that the advent of COVID-19 meant that workforce planning over a horizon...
NHSE&I told us that the advent of COVID-19 meant that workforce planning over a horizon of three to four years was not currently possible, and at the moment the main focus of the system was on winter planning. It thought … Read more
Government Response
The government disagreed with the committee's implication that long-term workforce planning was not possible, reiterating its commitment to delivering 50,000 more nurses. However, it acknowledged that updated modelling timelines remain uncertain due to the evolving COVID-19 outbreak.
HM Treasury
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8 Conclusion Rejected
Eighteenth Report - NHS nursing wo…
It is essential that the NHS understands not just how many nurses it needs, but...
It is essential that the NHS understands not just how many nurses it needs, but where and in what specialisms. However, the NAO and other stakeholders have noted that the NHS Long Term Plan contained service commitments that did not … Read more
Government Response
The government explicitly rejects the implied recommendation for a complete assessment, stating it cannot commit to when updated modelling will be complete or publishable due to ongoing changes from the COVID-19 outbreak.
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9 Conclusion Not Addressed
Eighteenth Report - NHS nursing wo…
The Department acknowledged that the demand for nurses and the extent of nurse shortages vary...
The Department acknowledged that the demand for nurses and the extent of nurse shortages vary between specialisms and regions.14 For example, in the period July– September 2019, NHS trusts in England reported an overall nursing vacancy rate of 12%, but … Read more
Government Response
The government stated its disagreement with the committee's (non-existent) recommendation, but then reiterated its commitment to delivering 50,000 more nurses overall through the NHS Long Term Plan and People Plan. The response did not specifically address the acknowledged variability of nurse shortages across different specialisms and regions.
HM Treasury
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10 Recommendation Rejected
Eighteenth Report - NHS nursing wo…
The Department explained that estimates of the number of nurses the NHS needs and where...
The Department explained that estimates of the number of nurses the NHS needs and where are not determined centrally but are produced locally through a bottom-up approach. NHSE&I said that local areas are currently revising their workforce plans in light … Read more
Government Response
The government rejects the recommendation to publish its overall estimate of nurse numbers, stating it cannot commit to a publication timeline due to the ongoing impact of COVID-19 on modelling, while highlighting its commitment to 50,000 more nurses.
HM Treasury
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11 Conclusion Accepted
Eighteenth Report - NHS nursing wo…
Nursing students cover both health and social care in their training and decide which sector...
Nursing students cover both health and social care in their training and decide which sector to work in after they graduate. This means that social care providers recruit from the same overall pool of nurses as the NHS. The Department … Read more
Government Response
The government agrees with the Committee's observation but disputes the characterization of social care nursing as an 'unaddressed afterthought,' outlining significant funding to Skills for Care, commitment to increasing Nursing Associates, and the appointment of a Chief Nurse for Social Care.
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12 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The Chief Nursing Officer of NHSE&I emphasised how the COVID-19 pandemic has illustrated the importance...
The Chief Nursing Officer of NHSE&I emphasised how the COVID-19 pandemic has illustrated the importance of social care and the value of better integration between health and social care. She commented that “if anything good can come out of it … Read more
Government Response
The government accepts the recommendation for better integration of health and social care workforce planning, citing £26.3 million funding for Skills for Care, support for Nursing Associate Apprenticeships, and the appointment of a Chief Nurse for Social Care by Spring 2021.
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13 Conclusion
Eighteenth Report - NHS nursing wo…
The Interim People Plan envisages a more pivotal role for integrated care systems, which are...
The Interim People Plan envisages a more pivotal role for integrated care systems, which are local partnerships of health and social care bodies that are jointly involved in local workforce planning and strategy. However, the NAO reported that partnerships are … Read more
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14 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The Department told us that its initiatives to increase the supply of nurses into the...
The Department told us that its initiatives to increase the supply of nurses into the NHS should benefit social care as both sectors have the same entry route. However, our Committee remains concerned about potential barriers to moving between sectors … Read more
Government Response
The government accepts the recommendation to improve integration and support for the social care nursing workforce, detailing £26.3 million funding for Skills for Care, promotion of apprenticeships, and the appointment of a Chief Nurse for Social Care by Spring 2021.
HM Treasury
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15 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
In December 2019, the government confirmed its manifesto commitment to increase nurse numbers by 50,000...
In December 2019, the government confirmed its manifesto commitment to increase nurse numbers by 50,000 by 2025.37 To deliver this, the Department has set up a programme board, chaired by the Minister of State, which brings together all the relevant … Read more
Government Response
The government accepts the implied recommendation to deliver on its 50,000 more nurses commitment, outlining its robust delivery programme encompassing various recruitment and retention strategies and promising to publish plans by Autumn 2021.
HM Treasury
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16 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The Department told us that it planned to meet the commitment to deliver 50,000 more...
The Department told us that it planned to meet the commitment to deliver 50,000 more nurses by increasing the domestic supply of graduate nurses, widening access to nursing through, for example, apprenticeships, improving retention rates and continuing to recruit from … Read more
Government Response
The government accepts the recommendation to quantify the numbers of nurses expected from different supply routes for the 50,000 target, stating it has adapted its programme and will publish detailed plans as soon as practicable by Autumn 2021.
HM Treasury
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17 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The Long Term Plan signalled the need for a “step change in the recruitment of...
The Long Term Plan signalled the need for a “step change in the recruitment of international nurses”. In 2019, there were 51,000 overseas nurses working in the NHS (17% of the nursing workforce), with overseas nurses already making up between … Read more
Government Response
The government accepts the implied recommendation regarding international nurse recruitment, confirming it is part of the 50,000 more nurses target and that detailed plans will be published as soon as practicable by Autumn 2021.
HM Treasury
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18 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
HEE acknowledged that there were global differences in nursing salaries, alongside other structural and market...
HEE acknowledged that there were global differences in nursing salaries, alongside other structural and market differences, with other countries having more leeway in what they can pay than the UK. More generally, NHSE&I accept that pay remains “an important 37 … Read more
Government Response
The government accepts the implied recommendation on nursing pay by referring to a 2018 three-year pay deal that increased starting salaries and stating it will rely on the independent NHS Pay Review Body for future pay considerations.
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19 Conclusion Acknowledged
Eighteenth Report - NHS nursing wo…
The Department and HEE highlighted the important role that apprenticeships and nursing associates play in...
The Department and HEE highlighted the important role that apprenticeships and nursing associates play in widening access to the nursing profession, by enabling people to earn money as they train. In the case of nursing associates, which is a separate … Read more
Government Response
The government stated its agreement with the committee's (non-existent) recommendation and reiterated that apprenticeships and nursing associate conversions are key components of its robust, costed programme to deliver 50,000 more nurses. The response did not explicitly address the committee's observations about the challenges in scaling these routes or targets being off-track.
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20 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
NHSE&I emphasised that retaining staff is a “valid and important” supply route, which represents the...
NHSE&I emphasised that retaining staff is a “valid and important” supply route, which represents the “best investment” for increasing numbers. It told us the main factors affecting retention include staff feeling stressed by the work, lack of flexibility and a … Read more
Government Response
The government accepts the implied recommendation to focus on staff retention, confirming it is a key part of the 50,000 nurse delivery programme and that detailed plans will be published as soon as practicable by Autumn 2021.
HM Treasury
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21 Conclusion Accepted
Eighteenth Report - NHS nursing wo…
From 2017, the Department changed the funding arrangements for nursing, midwifery and allied health professional...
From 2017, the Department changed the funding arrangements for nursing, midwifery and allied health professional students. Prior to 2017, HEE paid tuition fees to universities and NHS bursaries to students to cover their living costs. Instead, these students moved onto … Read more
Government Response
The government states the underlying recommendation has been implemented, confirming that the department, NHSE&I, and HEE wrote to the Committee on 11 November 2020 and will share further UCAS acceptance data when it becomes available in January 2021.
HM Treasury
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22 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
The policy change impacted on some students and regions more than others.
The policy change impacted on some students and regions more than others. For example, from 2016 to 2018, there was a 10% increase in the number of students accepted onto nursing degree courses for children’s nursing and for applicants from … Read more
Government Response
The government accepts the recommendation to address disparities in nursing student intake, stating it has already implemented the recommendation and provided an outline to the Committee, with further UCAS data to be shared in January 2021.
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23 Conclusion Accepted
Eighteenth Report - NHS nursing wo…
Since 2017, the number of people accepted onto nursing and midwifery degree courses has increased...
Since 2017, the number of people accepted onto nursing and midwifery degree courses has increased from 22,045 in 2017 to 23,060 in 2019. This still means that, in 2019, only 430 (2%) more people accepted a place on a nursing … Read more
Government Response
The government states the underlying recommendation has been implemented, confirming that the department, NHSE&I, and HEE wrote to the Committee on 11 November 2020 and will share further UCAS acceptance data when it becomes available in January 2021.
HM Treasury
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24 Conclusion Accepted
Eighteenth Report - NHS nursing wo…
In December 2019, the government announced the introduction of a new maintenance grant for nursing...
In December 2019, the government announced the introduction of a new maintenance grant for nursing students from September 2020, which consists of a non-repayable grant of £5,000 to £8,000 to help with living costs. Students will still pay their own … Read more
Government Response
The government states the underlying recommendation has been implemented, confirming that the department, NHSE&I, and HEE wrote to the Committee on 11 November 2020 and will share further UCAS acceptance data when it becomes available in January 2021.
HM Treasury
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25 Recommendation Accepted
Eighteenth Report - NHS nursing wo…
NHSE&I acknowledged that there are worrying signs of stress and burnout amongst NHS staff since...
NHSE&I acknowledged that there are worrying signs of stress and burnout amongst NHS staff since the COVID-19 outbreak. It cited figures from a Nursing Times survey, 56 C&AG’s Report, para 2.6. Based on England-domiciled applicants, UK universities, and includes midwifery … Read more
Government Response
The government accepts the implied recommendation to address staff stress and burnout, detailing an existing health and wellbeing support package and committing to review and refine this offer, including developing mental health wellbeing hubs in seven regions by Spring 2021.
HM Treasury
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26 Conclusion Accepted
Eighteenth Report - NHS nursing wo…
The Royal College of Nursing noted that, to retain nurses who worked during the pandemic,...
The Royal College of Nursing noted that, to retain nurses who worked during the pandemic, it will be essential to provide access to specialised mental health support, carry out risk assessments for staff and ensure people are able to take … Read more
Government Response
The government agrees with the observation, outlining its ongoing comprehensive health and wellbeing support for staff, including a commitment to review and refine national offerings and develop mental health wellbeing hubs in seven regions.
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27 Conclusion Acknowledged
Eighteenth Report - NHS nursing wo…
NHSE&I noted that over 32,000 nurses stepped up to support the NHS during the COVID-19...
NHSE&I noted that over 32,000 nurses stepped up to support the NHS during the COVID-19 outbreak, including former nurses and over 20,000 students. However, it acknowledged that there needs to be better local systems for retaining these returners, such as … Read more
Government Response
The government agrees with the observation, outlining its ongoing assessment of COVID-19's impact on nurse recruitment and retention, and its existing health and wellbeing support for staff, including the development of mental health hubs, but does not specifically detail actions for retaining returners or addressing lost student placement hours.
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28 Conclusion Acknowledged
Eighteenth Report - NHS nursing wo…
NHSE&I acknowledged that COVID-19 has had a disproportionate impact on Black, Asian and minority ethnic...
NHSE&I acknowledged that COVID-19 has had a disproportionate impact on Black, Asian and minority ethnic (BAME) staff and admitted that there is variability in how well these staff have been supported during the pandemic. In response to our questions 64 … Read more
Government Response
The government acknowledged the disproportionate impact of COVID-19 on BAME staff and stated that work is already underway to assess these challenges as part of the 50,000 nursing target and the People Plan. It also described the comprehensive health and wellbeing support package offered to all NHS staff.
HM Treasury
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Government Response AI assessment · 27 of 15 classified
Accepted 17
Acknowledged 3
Not Addressed 4
Rejected 3
Total 15 recs + 13 conclusions
Correspondence 1 letter
1 Feb 2021 Correspondence from Sir Chris Wormald, Permanent Secretary, Department of Health and Social Care, re House of Commons Committee of Public Accounts Eighth Report of Session 2019-21, NHS Capital Expenditure and Financial Management, dated 29 January 2021.
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