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Third Report - Workforce: recruitment, training and retention in health and social care

Health and Social Care Committee HC 115 Published 25 July 2022
Report Status
Government responded
Conclusions & Recommendations
73 items (38 recs)
Government Response
AI assessment · 48 of 73 classified
Accepted 6
Accepted in Part 4
Acknowledged 13
Deferred 5
Not Addressed 9
Rejected 11
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Recommendations

38 results
2 Accepted

Publish comprehensive NHS workforce strategy report with gap analysis and future projections.

Recommendation
Without full and frank transparency on projected workforce gaps, the public and NHS staff can have little confidence that the Government has grasped the depth of the workforce crisis, and little confidence in Framework 15 or the NHS workforce strategy. … Read more
Government Response Summary
The government agrees with the recommendation for robust, long-term workforce planning and has commissioned the NHS England Long Term Workforce Plan, which will include independently-verified projections for 5, 10, and 15 years and is committed to publishing it shortly.
Department of Health and Social Care
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3 Rejected
Para 40

Introduce comprehensive bursary scheme for nursing and midwifery students, guaranteeing NHS work.

Recommendation
The Government’s current target of recruiting 50,000 NHS nurses is not having any meaningful impact on the true scale of nursing shortages. The Government must introduce a new bursary scheme comprising full coverage of tuition fees, a non-means- tested grant … Read more
Government Response Summary
The government rejects introducing a new bursary scheme and guaranteed NHS work, stating it is committed to delivering 50,000 more nurses through existing training investments, diversification, recruitment, and retention, noting a non-repayable training grant of £5,000 exists for eligible students.
Department of Health and Social Care
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5 Not Addressed
Para 44

Formal re-entry programmes needed for secondary care doctors returning after long breaks.

Recommendation
Formal re-entry programmes, akin to those which already exist for primary care, should be developed by the NHS, Health Education England, the General Medical Council, and other relevant bodies for secondary care doctors who wish to return to work after … Read more
Government Response Summary
Formal re-entry programmes, akin to those which already exist for primary care, should be developed by the NHS, Health Education England, the General Medical Council, and other relevant bodies for secondary care doctors who wish to return to work after a long break.
Department of Health and Social Care
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6 Not Addressed

Consult relevant bodies to mobilise more NHS volunteers and consider necessary legal changes.

Recommendation
Given the success of training to task during the pandemic, the Government must consult with relevant bodies to explore further opportunities to mobilise this willing group of volunteers. They must also consider whether further changes to the law are necessary … Read more
Government Response Summary
The government response is a copy of the recommendation.
Department of Health and Social Care
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7 Accepted
Para 56

Implement immediate recruitment and retention actions in maternity services for positive birthing experiences.

Recommendation
Maternity services in England and Wales are under unsustainable pressure. We welcome the commitments that the Government has made in response to the Ockenden report, whilst recognising that these changes will come too late for some mothers and babies. The … Read more
Government Response Summary
The NHS is allocating £127 million to trusts to boost staffing numbers and improve leadership, training and working culture, funding an e-rostering tool, and investing in training for staff. They have also increased midwifery training places by 26% since 2017, launched a recruitment campaign, and provided financial support for childcare costs.
Department of Health and Social Care
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8 Acknowledged
Para 57

Publish clear plan for recruiting additional midwives and obstetricians for safe maternity staffing.

Recommendation
In July 2021, we recommended that NHS England needed an additional 1,932 midwives and 496 obstetricians to operate at a level that Birthrate Plus considered safe. Rather than adding to their headcount, NHS England has lost 552 midwives between March … Read more
Government Response Summary
The government states that the NHS has faced significant challenges, including the COVID-19 pandemic, impacting staffing levels. They outline steps to improve recruitment and retention of midwives, including increasing training places, launching a recruitment campaign, providing financial support for childcare, investing in technology, and offering flexible working arrangements and wellbeing support.
Department of Health and Social Care
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9 Deferred
Para 58

Require Government to publish funded maternity workforce plan matching RCOG staffing levels within six months.

Recommendation
There is an urgent need for a robust and funded maternity-wide workforce plan, which must be delivered without further delay. The Government must commit to funding, recruiting, and retaining the workforce at the level set out by the forthcoming report … Read more
Government Response Summary
The government agreed with the need for robust workforce planning and committed to publishing an NHS England Long Term Workforce Plan shortly, which will include projections, but did not commit to specific funding and recruitment levels or the six-month plan based on the Royal College of Obstetricians and Gynaecologists' forthcoming report.
Department of Health and Social Care
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10 Deferred
Para 59

Require Government to publish detailed plan for £200-350 million additional maternity funding within six months.

Recommendation
The Government has accepted the recommendation, first made by this committee and then by the Ockenden report, that maternity services should be funded by an additional £200–350 million per annum. The Government must lay before Parliament, within six months, a … Read more
Government Response Summary
The government did not provide the requested spending plan or commitment to lay one before Parliament within six months, instead redirecting the committee to previously published responses to expert panel evaluations on maternity workforce.
Department of Health and Social Care
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14
Para 71

Require Government to invest in and expand the Medical Training Initiative ethically for recruitment.

Recommendation
International recruitment from the developing world must be done in an ethical way, and the Academy of Medical Royal Colleges’ Medical Training Initiative, which recruits international medical graduates to work in the NHS for a fixed-term period with a specific … Read more
Department of Health and Social Care
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15
Para 72

Require Government to revise proof for adult dependant visas for health and social care workers.

Recommendation
Many health and social care workers have caring responsibilities, including for adult relatives. The Government must commit to revising the amount of proof that must be provided to bring an adult dependant into the UK through the Sole Responsibility and … Read more
Department of Health and Social Care
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20 Not Addressed
Para 81

Review provision of affordable, flexible childcare for health and social care staff.

Recommendation
The Government should review the provision of affordable and flexible childcare for people working in the health and social care sector, and assess whether it is possible to improve it.
Government Response Summary
The government agrees with the statement but responds by detailing broader cost of living support, affordable housing initiatives, and innovative transport options for care workers, rather than committing to a specific review of affordable and flexible childcare for the health and social care sector.
Department of Health and Social Care
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21 Accepted
Para 88

Insufficient NHS workforce modelling fails to account for impact of flexible working.

Recommendation
Managed well, the trend towards less-than-full-time and flexible working will be a powerful force in making the NHS a more attractive employer. However, in order to maintain standards of care for patients and offer truly flexible working to staff, the … Read more
Government Response Summary
The government accepted the recommendation, stating they have commissioned the NHS England Long Term Workforce Plan and the HEE Framework 15 to provide independently-verified projections for 5, 10, and 15 years, committing to publishing it shortly.
Department of Health and Social Care
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23
Para 92

Award all Agenda for Change NHS staff a pay rise accounting for cost-of-living.

Recommendation
It is unacceptable that some NHS nurses are struggling to feed their families, pay their rent, and travel to work. To reflect the crucial work that they do to keep the NHS running, and to improve recruitment and retention, the … Read more
Department of Health and Social Care
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25 Acknowledged
Para 103

Reform NHS pension scheme to prevent senior staff early retirement and reduced hours.

Recommendation
It is a national scandal that senior medical staff are being forced to reduce their working contribution to the NHS or to leave it entirely because of NHS pension arrangements. Clearly, the Government’s changes to tax regulations have not gone … Read more
Government Response Summary
The government's response acknowledged the issue by referring to "Our Plan for Patients," which mentions increasing pension flexibilities to retain senior clinicians but provides no specific details or commitments regarding the reform of the NHS pension scheme itself.
Department of Health and Social Care
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26 Acknowledged

Explore methods to replicate temporary suspension of NHS pension regulations post-pandemic.

Recommendation
The temporary suspension of regulations governing the administration of NHS pensions, made under the Coronavirus Act 2020, helped to ameliorate this issue during the pandemic. The Government should consider ways to achieve the same outcome now the pandemic is behind … Read more
Government Response Summary
The government's response acknowledged the issue by referring to "Our Plan for Patients," which includes commitments to increasing pension flexibilities to retain senior clinicians, but provided no specific details or commitment to considering ways to achieve the outcome of suspended pension regulations.
Department of Health and Social Care
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27 Acknowledged
Para 105

Develop a national NHS 'retire and return' policy replacing ad hoc local schemes.

Recommendation
NHSE should develop a national NHS “retire and return” policy to replace ad hoc local schemes. In the short term, the Government should instruct NHS England to require NHS Trusts to follow pension recycling guidance it has already issued to … Read more
Government Response Summary
The government states its 'Our Plan for Patients' includes commitments to expand the health and care workforce by supporting senior staff retention, increasing pension flexibilities, and using staff to the full extent of their qualifications, but does not specifically address a national 'retire and return' policy or pension recycling guidance.
Department of Health and Social Care
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30 Accepted in Part
Para 118

UK medical school places require significant increase of 5,000 annually.

Recommendation
In the absence of an independent mechanism to assess the increase necessary, we agree with the recommendation of the Medical Schools Council and the Academy of Medical Royal Colleges that the number of medical school places in the UK should … Read more
Government Response Summary
The government partially accepted the recommendation, noting it had already funded an additional 1,500 medical school places and temporarily lifted caps, and stated that a forthcoming Long Term Workforce Plan will set out actions to ensure sufficient staff, but it did not commit to the recommended increase of 5,000 places.
Department of Health and Social Care
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33 Acknowledged

Expand places at 2018 cohort medical schools starting academic year 2023–24.

Recommendation
The 2018 cohort of medical schools are proving a success story in terms of widening participation, and in producing cohorts of local doctors who are more likely to stay local to their training centre once they have graduated. The Government … Read more
Government Response Summary
The government agrees with the need for robust, long term, workforce planning and have commissioned two pieces of work to support this: the HEE led long term strategic framework (Framework 15) and the NHS England Long Term Workforce Plan, and committed to publishing the Long Term Workforce Plan shortly.
Department of Health and Social Care
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34 Acknowledged
Para 128

Ensure appropriate funding for all medical schools to train UK students.

Recommendation
If the 2018 cohort are dependent on international recruitment, the benefit of their placement in under-doctored areas is likely to be eroded. The Government must ensure that the 2018 cohort, and all medical schools, are appropriately funded to train UK … Read more
Government Response Summary
The government agrees with the need for robust, long term, workforce planning and have commissioned two pieces of work to support this: the HEE led long term strategic framework (Framework 15) and the NHS England Long Term Workforce Plan, and committed to publishing the Long Term Workforce Plan shortly.
Department of Health and Social Care
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35 Rejected
Para 132

Review student clinical placement tariff setting for transparency and equitable rates.

Recommendation
The Department of Health and Social Care must commit to reviewing the process by which student clinical placement tariffs are set to establish why there is such a large difference between medical and non-medical clinical student tariffs. This review should … Read more
Government Response Summary
The government does not agree to review the process by which student clinical placement tariffs are set, and instead focuses on its efforts to deliver 50,000 more nurses through investment and diversification of the training pipeline.
Department of Health and Social Care
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36 Not Addressed
Para 137

Commission independent review of postgraduate medical training duration, flexibility, and specialty places.

Recommendation
We believe that the General Medical Council’s emphasis on acquiring competency in postgraduate training, rather than focusing on “time-served” is the right way to go. The Government must commission an independent review of all postgraduate training to consider whether it … Read more
Government Response Summary
The Government must commission an independent review of all postgraduate training to consider whether it is possible to i) reduce the time it takes to obtain a postgraduate qualification, whilst maintaining rigorous patient safety and professional standards; ii) ensure that those who train less-than-full time are not penalised for
Department of Health and Social Care
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37 Accepted in Part

Temporary, bank, and agency staff require full access to NHS training.

Recommendation
NHS England must ensure that temporary, bank, and agency staff are given full access to NHS training to allow them to level up their skills, to ensure that they are able to sign up for additional shifts. (Paragraph 141) Working … Read more
Government Response Summary
The government agrees in part to provide better training and career development pathways in social care to drive recruitment and retention and commits to improving knowledge, skills, health and wellbeing and recruitment policies, providing resources through Skills for Care, and removing barriers to collaborative planning and working.
Department of Health and Social Care
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40
Para 151

Commission a What Works Centre for discrimination issues in public sector workforces

Recommendation
The NHS is not the only public sector organisation which finds itself facing the challenge of tackling racism. Given that addressing inequalities is a cross-government priority, the Government must commission a What Works Centre to research issues of discrimination in … Read more
Department of Health and Social Care
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41
Para 152

Fund Skills for Care to pilot Workplace Racial Equality Standard in independent social care

Recommendation
We welcome the roll-out of a pilot Social Care Workplace Racial Equality Standard to some local authorities and encourage the Government to extend the Social Care Workforce: recruitment, training and retention in health and social care 63 Workplace Racial Equality … Read more
Department of Health and Social Care
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45
Para 162

Report progress on closing gender pay gaps in medicine against review recommendations

Recommendation
It is unacceptable that the gender pay gap persists in medicine. The Government should make a report on progress made against recommendations on how to close this gap made in ‘Mend the Gap: The Independent Review into Gender Pay Gaps … Read more
Department of Health and Social Care
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46 Not Addressed
Para 165

NHS England needs national menopause strategy to retain senior staff

Recommendation
NHS England should develop and implement a national menopause strategy focused on the retention of senior staff who may be reducing their hours, leaving management or supervisory roles, or retiring earlier than intended, because of a lack of support around … Read more
Government Response Summary
The response discusses the UK Ethical Code of Practice for employing international health and care staff and ensuring they don't pay fees, which does not address the recommendation about a national menopause strategy for retaining senior staff.
Department of Health and Social Care
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48
Para 169

Consider reforms to Medical Act 1983 for simplifying GMC regulatory processes

Recommendation
The Government should consider whether reforms can be made to the Medical Act 1983 to ensure that General Medical Council regulatory processes can be simplified to reassure both the public and clinicians, without the loss of accountability.
Department of Health and Social Care
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50 Acknowledged

Reducing bureaucracy and administrative tasks improves frontline workers' mental health and headspace.

Recommendation
In this context, it is important that the Government looks at ways of improving short term efficiency to promote positive mental health and headspace for all frontline workers. It could do this through looking at ways to reduce bureaucracy—perhaps through … Read more
Government Response Summary
The government is keen to explore all avenues to improve frontline efficiency, referring to the NHS Long Term Plan's commitment to technology and the 'What Good Looks Like' framework and 'digital playbooks', as well as the Framework for Action to support NHS staff wellbeing.
Department of Health and Social Care
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53 Rejected
Para 185

Increase annual funding for social care by £7 billion by 2023–24.

Recommendation
We reiterate the recommendation made in our ‘Social care: funding and workforce’ report that annual funding for social care should be increased by £7 billion by 2023–24. This will account for demographic changes, uplift staff pay in line with National … Read more
Government Response Summary
The government rejects the recommendation for a £7 billion annual increase in social care funding by 2023-24, instead committing up to £2.8 billion in 23-24 and £4.7 billion in 24-25, which it states is the largest increase in history.
Department of Health and Social Care
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54 Rejected

Ensure Fair Cost of Care calculations pay social care workers Band 3 NHS rates.

Recommendation
We welcome the Fair Cost of Care exercises as an opportunity to address the underfunding of the social care sector. However, these exercises must not be used as an excuse to reinforce the low pay which is endemic in the … Read more
Government Response Summary
The government disagrees with calculating the cost of care based on paying care workers the same rate as equivalent NHS roles (Band 3 Agenda for Change), stating that care worker pay is the responsibility of independent care employers who consider local market conditions.
Department of Health and Social Care
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56 Not Addressed

Ensure Fair Cost of Care calculations pay social care workers Band 3 NHS rates.

Recommendation
We welcome the Fair Cost of Care exercises as an opportunity to address the underfunding of the social care sector. However, these exercises must not be used as an excuse to reinforce the low pay which is endemic in the … Read more
Government Response Summary
The government states it has excluded this recommendation from its response because it is a duplication of recommendation 54.
Department of Health and Social Care
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59 Acknowledged
Para 196

Restore social care staff free access to NHS training by July 2023.

Recommendation
Better training and career development pathways in social care will be an essential part of driving recruitment and retention in the sector. The Government must commit to restoring social care staff free access to the same NHS training as community … Read more
Government Response Summary
The government agrees on the importance of training and development for social care staff, outlining existing funding through Skills for Care and the Workforce Development Fund, and committing to work with partners to identify joint training opportunities.
Department of Health and Social Care
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60 Deferred
Para 197

Publish a fully costed plan for funding Level 5 diplomas for care home managers.

Recommendation
It is clear that some care home managers lack the training and support they need to stay in post. We welcome the Government’s commitment to fund Level 5 diplomas for those who need them, and we urge the Government to … Read more
Government Response Summary
The government broadly agrees, stating it has published plans for workforce reform in the ‘People at the Heart of Care’ white paper and will set out more detailed plans, including for training, in due course.
Department of Health and Social Care
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61 Deferred
Para 201

Introduce a new mandatory Care Certificate by 2023, formally assessed and portable.

Recommendation
By 2023, the Government must introduce a new, mandatory Care Certificate which is i) subject to a formal assessment process, ii) externally offered and accredited, iii) offered at no cost to providers, and iv) portable between social care providers and … Read more
Government Response Summary
The government broadly agrees, referencing its workforce reform plans in the ‘People at the Heart of Care’ white paper, which include reforming the Care Certificate for portability, and will set out more detailed plans in due course.
Department of Health and Social Care
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63 Rejected
Para 211

Provide sufficient funding to end “by-the-minute” homecare commissioning and improve care worker terms.

Recommendation
The Government must commit to providing sufficient funding for the social care sector so that Local Authorities and private providers are able to end the practice of “by- the-minute” commissioning of homecare. Local Authorities and private providers in turn must … Read more
Government Response Summary
The government disagrees with the recommendation, stating it has already provided sufficient funding for local authorities to meet their duties in the social care sector.
Department of Health and Social Care
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68 Rejected
Para 220

Pass recruitment and retention funds directly to local providers for targeted campaigns.

Recommendation
Local providers are best suited to understand the recruitment challenges in their local areas. The Government must pass recruitment and retention funds directly to providers to be invested in local recruitment campaigns.
Government Response Summary
The government disagrees with the recommendation to pass funds directly to providers, stating that local health and care systems are better placed to determine how to use workforce funds, which are already provided to local systems.
Department of Health and Social Care
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69 Accepted in Part
Para 226

Decrease Health and Care Worker visa salary requirements and add care workers to shortage list.

Recommendation
The Government should report on how many care workers have been issued with Health and Care Worker visas since the scheme was launched. The salary requirement for the visa should be decreased to the average salary for a social care … Read more
Government Response Summary
The government reported that 56,900 care worker visas were granted in 2022, noting that care workers were added to the Health and Care Visa and Shortage Occupation List in February 2022. However, they rejected the recommendation to reduce the minimum salary requirement, citing it as a cornerstone of the Points Based System.
Department of Health and Social Care
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70 Rejected
Para 227

Waive international recruitment costs, including skills charge, for care workers and sponsors.

Recommendation
International recruitment is too expensive for some social care providers. The Government should consider helping by waiving the cost of sponsorship certificates and licenses, including the immigration skills charge, for care workers and their sponsors, for two years, and other … Read more
Government Response Summary
The government rejected the recommendation to waive the cost of sponsorship certificates and licenses for care workers, deeming it unreasonable. They noted positive responses to current inclusion on the Shortage Occupation List and announced a £15 million support fund to help reduce recruitment costs and complexity for providers.
Department of Health and Social Care
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Conclusions (35)

Observations and findings
1 Conclusion Accepted
Para 27
We welcome the previous Secretary of State’s determination to meet his duties under section 41 of the Health and Care Act. To meet these duties, the new Secretary of State must lay before Parliament objective, transparent and independently audited reports on workforce projections for health, public health, and social care …
Government Response Summary
The government committed to publishing a Long Term Workforce Plan shortly, which will include independently-verified projections for doctors, nurses, and other professionals needed in 5, 10, and 15 years, building on the HEE strategic framework.
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4 Conclusion
Para 42
It will not be possible to re-recruit those who have voluntarily surrendered their medical licences without addressing the factors which caused them to do so. For many retirees, this means addressing pensions and the development of “retire and return” policies, for others, this means addressing poor workplace cultures. We will …
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11 Conclusion
Para 60
Improving diversity in the recruitment of midwives will improve the standard of care that black, Asian, mixed-race, and minority ethnic women receive throughout pregnancy, birth, and the post-natal period. Health Education England should set forth a recruitment plan with clear targets to increase the ethnic diversity of people going into …
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12 Conclusion
NHS England must publish interim figures reporting on how close it is to achieving its target of 75% of women from black and minority communities and a similar percentage of women from the most deprived groups receiving continuity of care from their midwife throughout pregnancy, labour, and the postnatal period …
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13 Conclusion
Para 70
Administrative barriers are often placed in the way of talented international medical graduates who wish to work in the NHS. In particular, it can be difficult for them to join the specialist register. To streamline this process, and boost recruitment into the NHS, the General Medical Council should introduce a …
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16 Conclusion
Para 73
The practice of requiring medical staff entering the country on Tier 5 visas to pay and reclaim the NHS surcharge should be scrapped.
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17 Conclusion
Para 74
All international medical graduate GP trainees should be offered leave to remain in the UK upon successful completion of GP speciality training. This would encourage them to live and work in the UK, protecting the NHS’s investment and boosting the GP headcount.
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18 Conclusion
There should be more support both for newly qualified international GPs and their would-be employers. There should be a default visa extension for six months after the international medical graduate’s expected GP training completion date, to give them time to find an appropriate employer. The Home Office and UK Visas …
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19 Conclusion
The NHS must ensure that all staff have access to adequate facilities. At the minimum, all staff should have access to 24/7 hot food and drinks, free parking, and places to rest, store their belongings, shower and change, and take breaks with colleagues. The NHS should conduct a welfare provision …
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22 Conclusion
Para 89
Whilst we welcome changes made to the NHS contract that give every NHS worker a “day one” right to request flexible working, it is clear that this has been insufficient to make flexible working a daily reality in the NHS. No NHS employee should be choosing to locum or work …
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24 Conclusion
Para 93
The NHS must review the job descriptions used for nursing and midwifery roles under Agenda for Change to ensure that nurses and midwives are being paid fairly for the safety critical roles that they deliver.
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28 Conclusion
Para 108
The current UDA-contract system is not fit for purpose, and urgent reform is needed to boost recruitment and retention in NHS dental services. We will return to this issue in a forthcoming inquiry into dental services.
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29 Conclusion
There is an opportunity to better utilise the pharmacy workforce, and in doing so, to optimise workloads across primary care, reduce pressure on general practice and hospitals, and support integrated care systems. This optimisation will not be possible without an integrated and funded workforce plan for pharmacy which must be …
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31 Conclusion
Para 119
As part of the expansion of medical schools, the cap on the number of medical school places offered to international students should be lifted by allowing full registration at the end of the Primary Medical Qualification and asking international students to fund the cost of their foundation year placements.
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32 Conclusion Acknowledged
Para 120
Should the Government increase the number of medical school places, they must consider an appropriate increase in the size and resourcing of medical schools, including in their facilities and faculty, as well as increased numbers of clinical placements spread throughout the country, and more speciality training positions for the increased …
Government Response Summary
The government agrees with the need for robust, long term, workforce planning and have commissioned two pieces of work to support this: the HEE led long term strategic framework (Framework 15) and the NHS England Long Term Workforce Plan, and committed to publishing the Long Term Workforce Plan shortly.
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38 Conclusion Not Addressed
Para 149
We were horrified to hear clear evidence of racism within the NHS, with some staff subjected to racist bullying, harassment, and abuse from colleagues and patients. This behaviour is unacceptable anywhere, and we condemn it expressly here. Tackling racism is a recruitment and retention issue, and the NHS and Government …
Government Response Summary
The government agrees with these recommendations, and encourages Local Authorities to evaluate the risk of modern slavery in their adult social care supply chains.
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39 Conclusion Not Addressed
Para 150
There should be greater accountability from NHS senior and middle management for the reduction of incidents of racist discrimination amongst staff. This should include explicit equality, diversity, and inclusion responsibilities in senior leadership job role descriptions, against which the performance of senior leaders is reviewed, and to which their pay …
Government Response Summary
The government agrees with these recommendations, and encourages Local Authorities to evaluate the risk of modern slavery in their adult social care supply chains.
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42 Conclusion
Para 157
The NHS has shown through the pilot scheme in the East of England that setting up independent review panels to review anonymised case information before cases are formally referred to the General Medical Council results in parity of referral between white and ethnic minority doctors. This practice must be rolled …
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43 Conclusion
Para 158
We welcome the General Medical Council’s new targets to eliminate disproportionate complaints from employers about ethnic minority doctors (by 2026) and eradicate disadvantage and discrimination in medical education and training (by 2031). The Nursing and Midwifery Council must introduce parallel targets to eliminate disproportionate complaints from employers about ethnic minority …
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44 Conclusion
Para 161
Talented women are missing out on the opportunity to become surgeons because of a lack of support and role models. The NHS should develop a strategy to attract and retain more women into surgery.
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47 Conclusion
Para 168
The NHS should look to improve its complaints procedure to ensure that doctors are supported throughout any investigation or inquiry, including to the General Medical Council, and are protected in particular from spurious, vexatious, or discriminatory complaints.
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49 Conclusion
The NHS must commit to the creation of positive working cultures and inclusive work environments. They should do this through creating and enforcing zero tolerance policies for harassment, discrimination, and bullying towards all staff, with targeted policies for staff who may be particularly vulnerable to these behaviours, and online behaviours. …
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51 Conclusion Acknowledged
Para 181
Witnesses to this inquiry left us in no doubt that pay is a crucial factor in recruitment and retention in social care. Social care providers are consistently being outbid by the retail and hospitality sectors. However, whilst pay increases are sorely needed, merely raising wages is not enough. A long-term, …
Government Response Summary
The government acknowledges the importance of pay and a long-term strategy for social care, noting additional funding of up to £2.8 billion in 23-24 and £4.7 billion in 24-25, and an increase in the National Living Wage. It will publish a plan for adult social care system reform that will support the workforce.
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52 Conclusion Rejected
Para 182
NHS England employs 104,000 people in adult social care jobs. NHS England must undertake a review of pay in their social care jobs. In the review, NHS health and social care roles must be compared based on the skills, competencies, and levels of responsibility shown in various roles in each …
Government Response Summary
The government rejects the recommendation for NHS England to review pay in social care jobs, stating that NHS England does not directly employ an adult social care workforce and that care worker pay is the responsibility of independent care employers.
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55 Conclusion Not Addressed
Para 185
We have heard evidence that staff shortages are having an impact on the ability of social care staff to provide good-quality care to the people they support. Lara Bywater told us that in the 20 years she has been running her organisation, she has “never seen a staff shortage impact …
Government Response Summary
The government notes that this is not a recommendation and states that the issues raised are covered in other responses.
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57 Conclusion Acknowledged
Para 190
The work that social carers do is essential to the lives of those who are cared for, and to their families. It is vital that they are treated by the Government and by wider society with the same respect as their NHS colleagues. It is not until parity of esteem …
Government Response Summary
The government agrees on the importance of treating social carers with respect, recognising their commitment, and states its vision for a supported and recognised ASC workforce outlined in the People at the Heart of Care White Paper.
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58 Conclusion Acknowledged
Para 191
The value of continuity of care in social care settings, particularly for people who rely on non-verbal communication, is undeniable. It is essential that the Government acts swiftly to implement the findings of this report to improve retention in the sector.
Government Response Summary
The government agrees on the vital importance of continuity of care and is committed to working with local authorities and independent providers to address recruitment and retention challenges, with its strategy outlined in the People at the Heart of Care White Paper.
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62 Conclusion Rejected
Para 210
The practice of “by-the-minute” commissioning is having a devastating impact on the continuity of care offered to service users and the terms and conditions under which workers must provide care. The reality is that some care is commissioned in this way because social care is chronically underfunded by central Government. …
Government Response Summary
The government explicitly disagrees with the conclusion that social care is chronically underfunded, citing sustained government investment and increased spending by local authorities.
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64 Conclusion Rejected
It is completely unacceptable that the practice of not paying for travel time means that some domiciliary care workers are effectively working for less than the minimum or living wage. The Department for Business, Energy, and Industrial Strategy, with the support of HMRC must re-examine sector-specific guidance to address complexities …
Government Response Summary
The government disagrees that new guidance is required on travel time, stating that current legislation already entitles social care workers to be paid for time spent travelling between appointments and that HMRC proactively enforces minimum wage compliance.
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65 Conclusion Rejected
New regulations should be introduced by 2023 in which care workers initially employed on zero-hours contracts must be offered a choice of contract after three months of employment. The new regulations should state that domiciliary care workers must be paid for their time spent travelling between appointments, and that time …
Government Response Summary
The government disagrees with the recommendation for new regulations on zero-hours contracts, supporting a range of contract types and noting a commitment to introduce a right to request a more predictable contract, while also stating existing minimum wage legislation covers travel time.
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66 Conclusion Accepted
Para 218
Wider market forces, including the rising cost of living, a lack of affordable housing, and a lack of public transport in remote locations are having an impact on the recruitment and retention of health and social care workers. These issues manifest differently across the country, and it is clear that …
Government Response Summary
The government agrees with the statement, detailing existing and announced support for the cost of living, including energy bill relief and wider support, and referencing the £11.5 billion Affordable Homes Programme to address housing issues.
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67 Conclusion Deferred
Para 219
Social care workers should be designated as key workers on the same basis as public sector employees so they can access affordable rented housing from local authorities and registered providers.
Government Response Summary
The government is committed to supporting access to affordable housing but states there is no single national definition of key workers for this purpose, empowering local authorities to make these decisions for their areas.
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71 Conclusion Accepted in Part
Para 233
The NHS must undertake a review of its recruitment processes to ensure that no international health and care staff are being subject to punitive repayment clauses in their contracts. Those who are subject to repayment clauses must be released from them, and future NHS contracts must not contain repayment clauses.
Government Response Summary
NHS England (NHSE) requires all trusts to follow the UK Ethical Code of Practice, which has been updated to ensure repayment clauses are transparent, proportionate, flexible, and taper down over time. NHSE will continue to explore further guidance with partners.
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72 Conclusion Accepted
Para 234
Labour Market Enforcement bodies must work closely with external partners in social care to find ways to disseminate information and raise awareness about employment rights and the enforcement powers of Labour Market Enforcement bodies among employers (including those receiving direct payments), workers, and Local Authorities.
Government Response Summary
The government agrees with the recommendation, stating that Labour Market Enforcement bodies already have an active, ongoing programme of engagement with external partners in the social care sector to disseminate information about employment rights and enforcement powers.
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73 Conclusion Acknowledged
Local Authorities must evaluate the risk of modern slavery in their adult social care supply chains and ensure that the risk of modern slavery is assessed as part of the due diligence processes at the commissioning and contracting stage and in performance monitoring. They should ensure that there is effective …
Government Response Summary
The government agrees with the recommendation and encourages Local Authorities to evaluate the risk of modern slavery in their adult social care supply chains and during due diligence processes. They also highlighted the ongoing engagement of Labour Market Enforcement bodies with external partners, including LAs.
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