Nursing and midwifery crisis

#28 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 6. 1 The Government agrees with the Committee’s recommendations. Ta rget implementation date: Spring 2021 6.2 It is important that as a health and care system, the department and NHS continue to assess the potential …

Not Addressed

#27 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 6. 1 The Government agrees with the Committee’s recommendations. Ta rget implementation date: Spring 2021 6.2 It is important that as a health and care system, the department and NHS continue to assess the potential …

Not Addressed

#25 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 6. 1 The Government agrees with the Committee’s recommendations. Ta rget implementation date: Spring 2021 6.2 It is important that as a health and care system, the department and NHS continue to assess the potential …

Not Addressed

#24 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 5.1 The Government agrees with the Committee’s recommendation. Recommendation implemented 5.2 The department, NHSE&I and HEE wrote to the Committee on 11 November 2020 outlining implementation of the Committee’s recommendation. Some of the data requested …

Not Addressed

#23 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 5.1 The Government agrees with the Committee’s recommendation. Recommendation implemented 5.2 The department, NHSE&I and HEE wrote to the Committee on 11 November 2020 outlining implementation of the Committee’s recommendation. Some of the data requested …

Not Addressed

#22 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 5.1 The Government agrees with the Committee’s recommendation. Recommendation implemented 5.2 The department, NHSE&I and HEE wrote to the Committee on 11 November 2020 outlining implementation of the Committee’s recommendation. Some of the data requested …

Not Addressed

#21 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 5.1 The Government agrees with the Committee’s recommendation. Recommendation implemented 5.2 The department, NHSE&I and HEE wrote to the Committee on 11 November 2020 outlining implementation of the Committee’s recommendation. Some of the data requested …

Not Addressed

#9 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 2.1 The government disagrees with the Committee’s recommendation. 2.2 The government agrees that the modelling will need to be updated in light of the COVID-19 outbreak. However, it cannot currently commit to when any such …

Not Addressed

#8 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 2.1 The government disagrees with the Committee’s recommendation. 2.2 The government agrees that the modelling will need to be updated in light of the COVID-19 outbreak. However, it cannot currently commit to when any such …

Not Addressed

#7 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 2.1 The government disagrees with the Committee’s recommendation. 2.2 The government agrees that the modelling will need to be updated in light of the COVID-19 outbreak. However, it cannot currently commit to when any such …

Not Addressed

#6 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 6. 1 The Government agrees with the Committee’s recommendations. Ta rget implementation date: Spring 2021 6.2 It is important that as a health and care system, the department and NHS continue to assess the potential …

Not Addressed

#5 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 5.1 The Government agrees with the Committee’s recommendation. Recommendation implemented 5.2 The department, NHSE&I and HEE wrote to the Committee on 11 November 2020 outlining implementation of the Committee’s recommendation. Some of the data requested …

Not Addressed

#4 —

Public Accounts Committee

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 …

Gov response: 2021. The department will use the annual update to keep the Committee informed of the success of the Fund with evidence from the monitoring and evaluation process.

Under Consideration

#3 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 3. 1 The government agrees with the Committee’s recommendation. Ta rget implementation date: Autumn 2021 3.2 The commitment to 50,000 more nurses is underpinned by a robust costed delivery programme which will be achieved through …

Not Addressed

#2 —

Health and Social Care Committee

Recommendation: With 8 out of 10 midwives reporting that they did not have enough staff on their shift to provide a safe service, it is clear that urgent action is needed to address staffing shortfalls in maternity services. Evidence submitted to …

Gov response: 24. The Government is considering this recommendation. 25. The inquiry’s report welcomed the recent investment of £95.6m by NHSEI to target the three overarching themes identified in the first Ockenden Report: workforce numbers, training and …

Not Addressed

#11 — Require Government to commit to safe maternity staffing and continuity of carer target.

Health and Social Care Committee

Recommendation: The Government must give firm commitments in the refreshed Long Term Workforce Plan to deliver safe staffing levels for maternity services. Without this, safe and sustainable maternity care will remain out of reach. As part of the workforce plan the …

Gov response: Over the last 10 to 15 years, there have been significant increases in the midwifery workforce. In 2010 to 2011, there were around 34 deliveries for each full-time equivalent (FTE) midwife. The number of qualified …

Not Addressed

#10 — Maternity workforce shortages remain a significant barrier to safe care provision.

Health and Social Care Committee

Recommendation: Workforce shortages remain a major barrier to safe maternity care, despite recent recruitment progress. We are disappointed the Government suspended its continuity of carer target, which is especially important for marginalised women, including Black women, who face greater challenges in …

Gov response: Maternity services must continue to be a core priority for ICBs, which is why improving outcomes (including safety) in maternity and neonatal services remains a core priority as set out in the Medium Term Planning …

Under Consideration

#29 — Set out specific measures to reduce burnout and improve pay for CMHS staff.

Health and Social Care Committee

Recommendation: Staff retention is important for continuity of care for people with SMI. As part of the forthcoming 10 Year Workforce Plan, the Government should set out specific measures to reduce burnout, including action on caseload management and access to supervision; …

Gov response: The government partially accepts this recommendation. Staff retention is critical to ensuring continuity of care for people with SMI. Workforce pressures, including burnout and limited progression opportunities, are recognised challenges across mental health services. NHS …

No Published Response

#26 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 6. 1 The Government agrees with the Committee’s recommendations. Ta rget implementation date: Spring 2021 6.2 It is important that as a health and care system, the department and NHS continue to assess the potential …

Not Addressed

#32 —

Health and Social Care Committee

Recommendation: We recommend again, that Health Education England publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained. We further recommend that …

Gov response: The Committee recommended HEE publish independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years, and that these projections should also cover social care as well. …

Under Consideration

#31 —

Health and Social Care Committee

Recommendation: It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what …

Gov response: 5.9 The Committee recommended HEE publish independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years, and that these projections should also cover social care as …

Under Consideration

#16 —

Health and Social Care Committee

Recommendation: We repeat our recommendation that HEE must be required (whether in its own right or as part of NHS England) to publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years, …

Gov response: Accept in principle. As set out in the response to recommendation 15, the Government recognises the importance of supporting frontline staff and the need for independently verified assessment of health, social care and public health …

Under Consideration

#13 —

Public Accounts Committee

Recommendation: This Committee’s September 2020 report, NHS nursing workforce, concluded that there was a risk that the NHS was focusing on short-term pressures at the expense of the 23 C&AG’s Report, page 30 24 Qq 69, 75 25 NHS0043 NHS Providers …

Gov response: 3.1 The government agrees with the Committee’s recommendation. Target implementation date: Spring 2023 3.2 Ensuring that the NHS has a workforce in the right numbers and with the right skills to deliver service commitments to …

Not Addressed

#16 —

Public Accounts Committee

Recommendation: We have been raising concerns about the lack of long-term planning for the NHS workforce since well before the COVID-19 pandemic52. We have noted that among comparable OECD countries the UK has relatively low numbers of nurses and doctors per …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Target implementation date: 2023 2.2 At the Autumn statement 2022, the government set out its commitment to publish a long-term workforce plan for the NHS in 2023 …

Accepted

#2 —

Public Accounts Committee

Recommendation: We remain very concerned about the critical shortages across the NHS workforce and the Department’s repeated delays in publishing a strategy to address them. Workforce shortages are widespread across the NHS, and particularly acute in some specialisms, for example midwifery. …

Gov response: The government agrees with the Committee’s recommendation. long-term workforce plan for the NHS in 2023 and it will do so.

Accepted

#2 —

Women and Equalities Committee

Recommendation: Continuity of carer is a cornerstone of the Government and NHS commitment to deliver safer maternity services for all women. It is simply not possible to implement it safely, however, due to the considerable staffing shortages across maternity services. A …

Gov response: 15. The Delivery Plan sets out that NHS services will ensure the right numbers of the right staff are available to provide the best care for women and babies through regular local workforce planning, including …

Under Consideration

#24 — NHS Long Term Workforce Plan addresses projected shortfall of up to 360,000 staff.

Public Accounts Committee

Recommendation: In the workforce plan, NHS England estimates that over a 15-year period, without action, there would be a shortfall of 260,000 to 360,000 staff by 2036–37. NHS England explained that, because it takes time to train people and that they …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Target implementation date: April 2024 2.2 NHS England has revised the scope of the retention programme, in response to the cost of living impacts and the need …

Not Addressed

#30 — Significant workforce shortfall of medical microbiologists and virologists undermines NHS infection control.

Public Accounts Committee

Recommendation: Another challenge relates to the NHS workforce. There is a shortfall of professionals in this area, including of medical microbiologists and virologists.77 According to the Royal College of Pathologists, there is a 20% shortfall in consultant medical microbiologists and a …

Gov response: 5.1 The government agrees with the Committee’s recommendation Target implementation date: Summer 2026 5.2 The government is prioritising AMR and infection control across the healthcare system. This includes embedding AMR into national and regional strategies, …

Accepted

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

Health and Social Care Committee

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 …

Gov response: We do not agree with this recommendation. We have committed to deliver 50,000 more nurses in our NHS by the end of this Parliament. We will achieve this through a combination of investing in and …

Not Accepted

#13 — Require the Department to update and publish the RCOG maternity staffing tool.

Health and Social Care Committee

Recommendation: We urge the Department to update and publish the tool produced by RCOG in time for the rollout of the upcoming refreshed Workforce Plan, so that every maternity unit can use it to plan effectively, ensure appropriate staffing and deliver …

Gov response: NHS England is working in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG) to support trusts to ensure optimal staffing levels are in place to provide high-quality maternity care services. RCOG provided a …

Partially Accepted

#12 — Suspension of RCOG safe staffing tool undermines maternity workforce stability.

Health and Social Care Committee

Recommendation: Suspending adoption of RCOG’s safe staffing tool has left Trusts without clear guidance on safe staffing levels, perpetuating poor workforce supply and undermining efforts to stabilise and support maternity teams. (Conclusion, Paragraph 64) 33

Gov response: NHS England is working in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG) to support trusts to ensure optimal staffing levels are in place to provide high-quality maternity care services. RCOG provided a …

Not Addressed

#19 —

Public Accounts Committee

Recommendation: 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 …

Gov response: 3. 1 The government agrees with the Committee’s recommendation. Ta rget implementation date: Autumn 2021 3.2 The commitment to 50,000 more nurses is underpinned by a robust costed delivery programme which will be achieved through …

Not Addressed

#1 —

Public Accounts Committee

Recommendation: 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 …

Gov response: In 2019, the NHS employed around 320,000 nurses in hospital and community services, making up a quarter of all NHS staff, with a further 24,000 employed in GP practices. Around one in ten registered nurses …

Not Addressed

#22 —

Health and Social Care Committee

Recommendation: We further recommend that workforce reports be undertaken in consultation with the Devolved Administrations to ensure that a clear picture is given on the health and care workforce throughout the United Kingdom. (Paragraph 88) Additional powers for the Secretary of …

No Published Response

#21 —

Health and Social Care Committee

Recommendation: We therefore recommend that the Government include in the Bill, provisions to require Health Education England to publish objective, transparent and independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years …

No Published Response

#20 —

Health and Social Care Committee

Recommendation: We do not believe that the duty to publish an update on the roles and responsibilities once every five years is an adequate response to workforce shortages that are endemic in the NHS. We are very sympathetic to the detailed …

No Published Response

#30 —

Health and Social Care Committee

Recommendation: The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic. (Paragraph 183) 58 Workforce burnout and resilience in the NHS …

Gov response: 5.9 The Committee recommended HEE publish independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years, and that these projections should also cover social care as …

Under Consideration

#16 —

Health and Social Care Committee

Recommendation: We recommend that the Department develops an NHS and social care national policy framework around migration to support national and local workforce planning and identify the balance between domestic and international recruitment in the short, medium and long-term. (Paragraph 91) …

Gov response: 3.22 We hugely value the contribution of international staff from across the world who provide excellent care. International recruitment has long been part of the NHS workforce strategy. The NHS People Plan recognizes that international …

Under Consideration

#17 —

Health and Social Care Committee

Recommendation: We recommend that the Government undertake an urgent review of short-term recruitment and retention issues within the health and care workforce, including productivity improvements, sharing of best practice through data, removal of professional demarcation, use of technology, additional training places …

Gov response: Accept in principle. The Government recognises the importance of addressing short-term recruitment and retention issues within the health and care workforce. NHS England is working to address these issues, and will publish a refreshed People …

Under Consideration

#15 —

Health and Social Care Committee

Recommendation: We note that the Government decided to resist an amendment to the Health and Care Bill that would have required it to publish independently verified assessment of health, social care and public health workforce numbers at least once every two …

Gov response: Accept in principle. The Government recognises the importance of supporting frontline staff and the need for independently verified assessment of health, social care and public health workforce numbers. The Government publishes independently verified assessment of …

Under Consideration

#21 —

Public Accounts Committee

Recommendation: Among comparable OECD countries the UK has relatively low numbers of hospital beds, nurses and doctors per 1,000 population and also carries out relatively low numbers of advanced diagnostic examinations.46 NHSE&I told us that it would take two to three …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Target implementation date: Spring 2023 2.2 The government published the Elective Recovery Plan which set out the goals for tackling the elective care and cancer backlogs over …

Not Addressed

#10 —

Public Accounts Committee

Recommendation: Between 2010 and 2019 the NHS saw an average annual growth in emergency admissions of more than 3% and in urgent cancer referrals from GPs of more than 10%. Although there was relatively strong growth in the number of consultants …

Gov response: 1.1 The government agrees with the Committee’s recommendation. Target implementation date: Spring 2023 1.2 The mandate to NHS England sets out the strategic goals that the government has set for NHS England in the year …

Not Addressed

#3 —

Public Accounts Committee

Recommendation: The NHS will be less able to deal with backlogs if it does not address longstanding workforce issues and ensure the existing workforce, including in urgent and emergency care and general practice, is well supported. NHSE&I believes it will be …

Gov response: 3.1 The government agrees with the Committee’s recommendation. Target implementation date: Spring 2023 3.2 Ensuring that the NHS has a workforce in the right numbers and with the right skills to deliver service commitments to …

Accepted

#18 —

Health and Social Care Committee

Recommendation: The Government need to publish an evidence-based plan, supported by up-to-date workforce modelling, setting out how it will increase the capacity and sustainability of all sectors of the specialist palliative and end of life care workforce, as part of the …

Gov response: Partially Accept Generalist Workforce We are committed to training the staff we need to ensure patients are cared for by the right professional, when and where they need it. Standards of proficiency, conduct and performance …

Partially Accepted

#17 —

Health and Social Care Committee

Recommendation: Current shortages in the specialist workforce are putting palliative care services in an unsustainable position which threatens their ability to deliver equitable and high-quality palliative and end of life care. Extensive consultant vacancies, impending retirements, limited training places and widespread …

Gov response: Partially Accept Generalist Workforce We are committed to training the staff we need to ensure patients are cared for by the right professional, when and where they need it. Standards of proficiency, conduct and performance …

Partially Accepted

#22 —

Women and Equalities Committee

Recommendation: The Government must work with the Royal College of Nursing to ensure that menstrual health is included in the standard training offer for all nurses. The renewed Women’s Health Strategy must include this as an objective together with a clear …

Response Pending

#21 —

Women and Equalities Committee

Recommendation: We were dismayed to learn that training modules in menstrual and gynaecological health for nurses are very limited and typically undertaken only by those who choose to “specialise” in women’s health. Nurses are at the frontline of sexual and reproductive …

Response Pending

#2 — Provide Committee with update on reducing NHS staff shortfalls and improving retention rates.

Public Accounts Committee

Recommendation: NHS England’s improvement plans rely on better staff recruitment and retention to address significant shortfalls in the NHS workforce, but we are not convinced that NHS England’s current approach will achieve its very optimistic assumptions. NHS England has identified a …

Gov response: The government agrees with the Committee’s recommendation. cost of living impacts and the need to maximise workforce capacity during the extremely challenging winter. The Exemplar programme was launched in April 2022 and is based on …

Accepted

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

Health and Social Care Committee

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 …

Gov response: Recommendations 1 and 2 have been grouped together for an overarching response to the Committee. We agree this recommendation. We agree with the need for robust, long term, workforce planning and have commissioned two large …

Not Addressed

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

Health and Social Care Committee

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 …

Gov response: The NHS has faced significant challenges in recent years, including the COVID-19 pandemic, and this has had an impact on staffing levels across the board. However, we are committed to ensuring that the NHS has …

Not Addressed