We have repeatedly raised concerns about care workforce shortages. When we reported in 2018, vacancy rates for 2016–17 were 6.6%.38 The vacancy rate has increased since then and, as the NAO reported, in 2022–23 vacancies were 152,000, a rate of 9.9%, despite the recruitment of 70,000 staff from overseas. We observed that, although this was lower than the high point of 2021–22, when reported vacancies reached 164,000, this was still way off the 60,000 from 2012–13.39 The Department agreed that vacancies were too high but assured us that things were improving. We heard that monthly figures for November 2023 showed a vacancy rate of 8.4% but the Department acknowledged that these were not as robust as the annual figures.40 When we highlighted regional variation, the Department agreed that rural areas were undoubtedly worse affected and that addressing geographical disparities was a high priority for both its staff and local authorities. The Department noted the challenge that as more young people live in cities and more elderly people live in rural and coastal areas, demand was higher in rural areas but the people to deliver care were in the cities.41