Recommendations & Conclusions
17 items
3
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 improving retention rates. However, it could not tell us how …
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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 improving retention rates. However, it could not tell us how many nurses each of these supply routes are expected to provide, as local areas are reviewing their plans in light of COVID-19. The NHS is relying on a substantial short-term increase in overseas recruitment for nurses, but the COVID-19 outbreak illustrates that this is a risky strategy as international recruitment has been delayed as a result of travel restrictions. NHSE&I acknowledges that pay remains an important issue for NHS nursing, which has impacted on retention in the past; in international recruitment, other countries often have more leeway to pay nurses more than in the 6 NHS nursing workforce UK. Apprenticeships and nursing associate roles are potentially a more accessible, if longer, route to becoming a registered nurse, but providers are finding it challenging to deliver apprenticeships at scale. Recommendation: As part of the published people plan, the Department, NHSE&I and HEE should include a set of costed and detailed action plans for each of the different supply routes for nursing, and how many nurses each route is expected to contribute to the overall nursing workforce. They should consider what national actions, for example on pay, they may need to take to increase recruitment and retention.
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Government response AI summary
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 …
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HM Treasury
5
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 bursary and payment of tuition fees for students and moved …
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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 bursary and payment of tuition fees for students and moved them onto student loan arrangements. The Department hoped to increase the number of places on these courses by 10,000 by 2020, but accepts that the new policy has failed to meet all its objectives. While the numbers of people accepting a place on a nursing degree course have increased since 2017, only 430 (2%) more people accepted a place in 2019 compared with 2016. The number of applicants is also still well below pre-2017 levels, although the latest data show a 15% increase in domestic applicants for nursing degrees from 2019 to 2020. The policy change also impacted some students and regions more than others: for example, there were large falls in student numbers on learning disability nursing degrees. In December 2019, the government announced the introduction of a new maintenance grant for nursing students from September 2020. Recommendation: The Department, NHSE&I and HEE should write to the Committee in October 2020 setting out how they expect the new maintenance loan to increase nursing student numbers overall and for different types of student, NHS nursing workforce 7 nursing specialisms and regions. This should also set out how the loan might affect drop-out during courses.
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Government response AI summary
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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HM Treasury
6
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 so much during the COVID-19 outbreak. NHSE&I told us it …
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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 so much during the COVID-19 outbreak. NHSE&I told us it had put measures in place to support staff, but there are worrying signs of increased levels of stress and burnout since the start of the outbreak, with 90% of nurses reporting higher levels of anxiety in a survey of staff. The NHS also acknowledges that it must do more to improve local leadership and make better use of flexible working arrangements if it is to retain nursing staff in the longer term. HEE also estimates that 20% of final-year students who stepped up to work for the NHS during the outbreak may have difficulty completing the clinical practice hours they need to graduate on time this year. We are also concerned in case the necessary safeguards being put in place to protect Black, Asian and minority ethnic staff, who are disproportionately affected by COVID-19, restrict their work experience and career progression. Recommendation: We welcome NHSE&I’s publication of early lessons from COVID-19. NHSE&I should ensure it also makes available a full and frank assessment of the new challenges to nursing recruitment and retention specifically and how health providers should address them, particularly where this could disadvantage certain groups for example students or minority ethnic staff. Recommendation: As part of this assessment, NHSE&I should take stock of the measures in place to support nursing staff’s mental health and wellbeing, to share good practice and identify what else staff may need. 8 NHS nursing workforce 1 Plans for addressing the need for more nurses
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Government response AI summary
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.
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HM Treasury
11
Conclusion
Eighteenth Report - NHS nursing workfor…
Accepted
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 noted that approximately 80% of nursing graduates join the NHS …
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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 noted that approximately 80% of nursing graduates join the NHS and the other 20% start work in social care, primary care or the independent sector, or do not practise as nurses. It acknowledged that there are currently around 4,000 vacancies for social care nurses.19 As Skills for Care has reported, the vacancy rate for nurses in social care has increased from 4.1% in 2012–13 to 9.9% in 2018–19.20 The Royal College of Nursing also noted that the number of registered nursing posts in social care has fallen by 1,000 in the last year and by 10,400 (20%) since 2012–13.21
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Government response AI summary
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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HM Treasury
12
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 [the pandemic], that will be the focus on social care” …
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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 [the pandemic], that will be the focus on social care” and “if there is anything to learn from the pandemic, it is about how we have closer integration between health and social care … which therefore includes the workforce.”22 However, the Department told us that social care will not be included in the NHS People Plan as the focus of the plan is on developing the workforce to deliver the Long Term Plan for the NHS.23 Social care nurses are also not included in the NHSE&I and HEE model of the supply and demand of nurses to the NHS, which supports the People Plan .24 The Department argued that it would be too challenging to develop an integrated workforce plan for health and social care as the sectors have different statutory bases and its powers and influences over them are not the same.25
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Government response AI summary
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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HM Treasury
14
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 such as nurses who move from the NHS into social …
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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 such as nurses who move from the NHS into social care dropping out of their NHS pension.30 Locally, health and social care providers can also be in competition with one another for nursing staff.31 The Department argued that the fact it has separate plans for health and social care does not signify one being dominant over the other, and said it takes “a whole series of actions” for the social care sector.32 However, our Committee has warned before that the Department gives relatively little consideration to adult social care compared with health, including in reports on The adult social care workforce33and Readying the NHS and social care for the COVID-19 peak.34 For example, the latter report illustrated the stark contrast in the approach taken towards protecting the NHS from the pandemic compared with the care sector, with an action plan for adult social care published four weeks after the initial NHS letter on plans to respond to the COVID-19 outbreak.35 The Department acknowledged that the social care system is highly fragmented, for example, in the way it is run by a number of different providers, and told us there are some “yet-to- be-answered questions” about whether the Department will retain some of the national oversight and interventions in social care that it has used during the COVID-19 pandemic. The Permanent Secretary of the Department said that “we will certainly be wanting to look at what we have learned about social care during COVID and baking that into future policy.”36 28 C&AG’s Report, para 1.12 29 Q 37 30 Qq 29, 65 31 C&AG’s Report, para 1.6 32 Qq 17, 30 33 C&AG’s Report, The adult social care workforce in England, Session 2017–19, HC 714, 8 February 2018 34 C&AG’s Report, Readying the NHS and ad
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Government response AI summary
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.
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HM Treasury
15
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 bodies with responsibilities for nursing.38 The Department clarified that it …
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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 bodies with responsibilities for nursing.38 The Department clarified that it took overall responsibility for delivery of this commitment, with NHSE&I and HEE leading on delivery for individual routes.39
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Government response AI summary
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.
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HM Treasury
16
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 overseas. However, the Department and HEE were unable to quantify …
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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 overseas. However, the Department and HEE were unable to quantify how many nurses they expect from each of these different routes. HEE told us that its plans are dynamic and changing in the light of the COVID-19 outbreak, for example, to reflect an increase in the number of people applying for nursing degrees.40 NHSE&I expects to publish details of the numbers of nurses it needs with the second part of the People Plan, after the publication of the Spending Review.41
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Government response AI summary
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.
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HM Treasury
17
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 20% to 25% of new joiners since 2012.42 HEE confirmed …
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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 20% to 25% of new joiners since 2012.42 HEE confirmed that its global learners programme that supports trusts to bring overseas nurses to work in England had missed previous recruitment targets; over the two years 2018 and 2019, it attracted around 1,600 nurses compared with a target of 2,500.43 NHSE&I told us that COVID-19 and the resulting travel restrictions had delayed international recruitment. It said that providers report that there are over 6,000 overseas nurses in the pipeline who are willing to work in England and it anticipated that overseas recruitment will “open-up very rapidly”.44 However, it recognised that expanding the domestic supply of nurses is a more sustainable route to securing the nursing workforce. In response to our questions about the ethical implications of recruiting from overseas, NHSE&I told us that it follows the World Health Organisation’s code of practice which includes a list of 43 counties that it does not recruit from. It considered that its “earn, learn and return” programme offers an opportunity for overseas nurses to develop skills which can be taken back to the countries that nurses are recruited from.45
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Government response AI summary
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.
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HM Treasury
18
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 Prime Minister’s Office, Press Release – Prime Minister backs NHS …
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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 Prime Minister’s Office, Press Release – Prime Minister backs NHS staff with £5,000 annual payment for nursing students, December 2019; C&AG’s Report, para 11 38 Q 33; C&AG’s Report para 3.10 39 Q 39 40 Q 43 41 Q 20 42 C&AG’s Report paras 8, 2.20 43 Q 59; C&AG’s Report para 7 44 Q 55 45 Q 53 NHS nursing workforce 13 issue with regard to nurses”, and that the lack of pay rises in previous years had impacted on the retention of NHS nurses.46 In a Royal College of Nursing survey of their members, in July 2020, pay was the most common reason given for nurses to consider leaving the profession, while around three-quarters of nurses said that improved pay would make them feel more valued.47
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Government response AI summary
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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HM Treasury
20
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 lack of continuous learning and development. It told us that …
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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 lack of continuous learning and development. It told us that its retention programme is focused on these factors, as well as creating an environment that is free from discrimination, bullying and harassment. NHSE&I acknowledged that staff are under increased pressure as a result of the COVID-19 outbreak, which had also made the job of retaining staff more difficult.53 Nursing students
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Government response AI summary
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.
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HM Treasury
21
Conclusion
Eighteenth Report - NHS nursing workfor…
Accepted
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 the existing student finance arrangements, with most eligible for full …
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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 the existing student finance arrangements, with most eligible for full loans for tuition fees and maintenance costs. The Department hoped to increase the number of places on these courses by 10,000 by 2020.54 However, it acknowledged that the policy had failed to meet all its objectives.55 In 2017, the first year of the new arrangements, the number of applicants for nursing and midwifery courses fell by 11,000 (21%). Universities accepted a higher proportion of applicants than previously, so there was a 3% fall in the number of 46 Qq 60, 62, 63. 47 NWF0006 - Royal College of Nursing submission, para 4.3, 4.5 & 4.8. 48 Qq 43, 44, 69 49 Q 48; C&AG’s Report, paras 2.24, 2.25 50 Qq 45, 47 51 Q 27 52 Qq 48, 69, 70 53 Qq 40, 52 54 C&AG’s Report, para 2.5 - 2.6 55 Q 71 14 NHS nursing workforce new students.56
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Government response AI summary
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.
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HM Treasury
22
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 the North East. This is in contrast to large reductions …
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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 the North East. This is in contrast to large reductions in students accepted onto learning disability courses (-41%) and for applicants from the South East (-24%).57 The Department acknowledged there was a particular drop-off in the number of mature students (aged 21 and over) who represent a big source of nurses.58
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Government response AI summary
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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HM Treasury
23
Conclusion
Eighteenth Report - NHS nursing workfor…
Accepted
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 degree course compared with 2016 when the NHS bursary was …
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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 degree course compared with 2016 when the NHS bursary was still available. Between 2017 and 2019, the number of people applying for courses even dropped a little further, from 41,715 in 2017 to 39,665 in 2019.59 HEE told us that the latest UCAS data from June 2020 showed a 15% increase in domestic applicants for nursing degrees from 2019 to 2020.60 However, it is not yet certain whether this will translate into an increase in the number of people accepted onto courses: the number of applicants as at June 2020 (42,740) is still below the number as at June 2016 (51,730) and trends in applicants and acceptances have not mirrored each other since 2017.61
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Government response AI summary
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.
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HM Treasury
24
Conclusion
Eighteenth Report - NHS nursing workfor…
Accepted
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 tuition fees and the higher education market will therefore still …
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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 tuition fees and the higher education market will therefore still determine the number of places.62 The Department said it was not aiming to recreate the position prior to 2017 and had sought to learn lessons in particular by its targeting of the new training grant to specific groups of people and specialisms where there are particular concerns. For example, an additional £1,000 will be made available to nurses specialising in learning disabilities and mental health, and there will be an extra £1,000 of childcare support to those who are eligible.63 Opportunities and challenges created by COVID-19
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Government response AI summary
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.
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HM Treasury
25
Recommendation
Eighteenth Report - NHS nursing workfor…
Accepted
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 degrees. The withdrawal of the NHS bursary applied to students …
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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 degrees. The withdrawal of the NHS bursary applied to students on courses in England. NHS bursary schemes continued in the other home nations after 2017, but eligibility was limited either to those already resident, or committing to work, in that country. Where possible, we examine English-domiciled applicants applying to English universities, as the group potentially most affected by the bursary withdrawal, but available data do not always separate out this group. 57 C&AG’s Report, para 2.9, figure 12. Based on UK-domiciled students, English universities, and excludes midwifery degrees. 58 Q 81 59 C&AG’s Report, figure 11. Based on England-domiciled applicants, UK universities, and includes midwifery degrees. 60 Q 43 61 University Colleges and Admissions Service (UCAS), 2020 cycle applicant figures – 30 June deadline, analysis of applicants for nursing and midwifery degrees domiciled in England and applying to English universities; C&AG’s Report, figure 11. 62 C&AG’s Report, para 2.6, 2.16 63 Qq 33, 42, 71–72 NHS nursing workforce 15 which reported 90% of nurses as experiencing higher rates of anxiety than before the COVID-19 pandemic.64 In a Royal College of Nursing survey, some 36% of respondents indicated that they are considering leaving nursing in the next year, compared with 28% from before the pandemic. When asked about why they are considering leaving, nurses reported that it was pay (64%), low staffing levels (45%), the way nursing staff had been treated during the pandemic (45%) and lack of management support (44%).65
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Government response AI summary
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.
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HM Treasury
26
Conclusion
Eighteenth Report - NHS nursing workfor…
Accepted
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 rest breaks and annual leave.66 NHSE&I told us that it …
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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 rest breaks and annual leave.66 NHSE&I told us that it has made a free mental health helpline available to all NHS and social care staff and is providing practical support, such as free tea and coffee.67 It highlighted that flexible working and better local leadership and line management are also key to retaining staff in the longer term. However, it recognised that there is currently variability in the quality of leadership and so it is expanding the number of places on its leadership academy and providing access to line management training for every line manager in the NHS. It said that it would be looking to retain some of the innovations that have helped improve the work-life-balance of staff during the COVID-19 outbreak, such as better use of technology and more flexible or remote working.68 The first part of the People Plan, published in July, covers improvements to staff support and leadership culture, as well as highlighting service innovations that have taken place over the last few months.69
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Government response AI summary
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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HM Treasury