Source · Select Committees · Public Accounts Committee
Eighteenth Report - NHS nursing workforce
Public Accounts Committee
HC 408
Published 23 September 2020
Recommendations
4
The nursing needs of social care remain an unaddressed afterthought for the Department of Health...
Recommendation
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 …
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HM Treasury
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Conclusions (27)
2
Conclusion
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 in what specialism. The NHS Long Term Plan, published in …
3
Conclusion
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 …
5
Conclusion
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 …
6
Conclusion
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 …
1
Conclusion
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
7
Conclusion
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 it would be possible to make a longer-term plan after …
8
Conclusion
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 have a complete assessment of the type and number of …
9
Conclusion
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 these ranged as high as 16% for mental health trusts …
10
Conclusion
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 of COVID-19. These will take account of the staff needed …
11
Conclusion
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 …
12
Conclusion
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” …
13
Conclusion
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 not statutory and therefore have no organisational accountabilities, and rely …
14
Conclusion
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 …
15
Conclusion
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 …
16
Conclusion
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 …
17
Conclusion
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 …
18
Conclusion
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 …
19
Conclusion
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 role, people can also gain experience as an associate before …
20
Conclusion
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 …
21
Conclusion
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 …
22
Conclusion
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 …
23
Conclusion
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 …
24
Conclusion
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 …
25
Conclusion
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 …
26
Conclusion
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 …
27
Conclusion
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 to establish how many wish to return to the NHS …
28
Conclusion
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 Q 40 65 NWF0006 - Royal College of Nursing submission, …