Call for evidence outcome

Government response to the separate pay spine for nursing call for evidence

Updated 15 April 2025

Executive summary

This call for evidence was published by the previous government. Its aim was to support the delivery of a commitment made to look at the potential design, scope, implementation and legal aspects of a separate pay spine for nursing staff.

A significant number of responses were received to this call for evidence, from both the health and care workforce and from organisations. After carefully considering the evidence and perspectives that were put forward, the government will not be taking forward a separate pay spine for nursing staff.

The responses highlighted that the career progression challenges faced by nurses were also being experienced by other NHS professionals, and the evidence was not considered to present sufficient justification for separating nurses’ pay from the rest of the Agenda for Change (AfC) workforce. The decision not to proceed has also been based on the significant legal ramifications identified.

Although the government will not be pursuing a separate pay spine for nursing staff, we acknowledge that several issues were raised through this process. We are keen to address these issues through alternative approaches, including investing in measures to improve local job evaluation practice and providing a mandate to the NHS Staff Council to improve the pay structure.

This response summarises the evidence that was received and sets out the reasons behind the government’s position in more detail.

Introduction

Nurses play a crucial role in the operation of NHS services and delivering high quality care to patients.

In May 2023, the previous government agreed a deal for the AfC workforce through negotiations with the NHS Staff Council. During negotiations, concerns were raised about how the AfC pay structure is affecting the career progression and professional development of nurses, and the direct impact that this is having on recruitment and retention.

The Royal College of Nursing (RCN) suggested that a separate pay spine for nursing staff could address these concerns. As part of discussions with the RCN, the previous government committed to look at the potential design, scope, implementation and legal aspects of a separate pay spine for nursing.​ This commitment was separate to the deal agreed with the NHS Staff Council in May 2023.​

To fulfil the commitment to look at a separate nursing pay spine, a call for evidence was published.​ The call for evidence sought evidence from different perspectives across the health and care system to inform considerations of separating nurses’ pay from other staff under AfC in the NHS in England. The call for evidence specifically asked for evidence to enable the government to:

• identify any issues with nurses’ career progression and professional development under the AfC pay structure, and understand any impacts this is having on recruitment and retention
• assess whether any of the issues identified are unique to the nursing profession
• evaluate whether a separate nursing pay spine would address any issues raised
• understand the impacts of removing nursing staff from the harmonised AfC pay arrangements
• consider alternative solutions that could support any issues that are identified

This government response sets out a summary of the responses received to the call for evidence, and the government’s position on this matter. This should be read in conjunction with the original call for evidence document, which contains detailed background and context for the questions that were asked.

The call for evidence process

The separate pay spine for nursing call for evidence ran for 12 weeks from 11 January to 4 April 2024.

The call for evidence asked for responses via an online survey. The survey, hosted on GOV.UK, comprised of closed (quantitative) and open-ended (qualitative) questions. Several off-platform responses were also received via email which, unless they specifically referred to any of the closed-format call for evidence questions, were analysed alongside the open-ended responses.

In total, 11,037 responses were received through the online survey. 97% of these (10,712) were from individual members of the health and care workforce.​ 55% (5,847) of these individuals were registered nurses, and 45% (4,865) were other members of the workforce. 2% of the total responses (191) were from members of the public outside of the health and care workforce, and 1% (134) were on behalf of an organisation.

The organisations that responded to the call for evidence include but are not limited to:

• Association of Ambulance Chief Executives
• British Dietetic Association
• British Orthoptic Society
• Chartered Society of Physiotherapists
• GMB
• Federation of Clinical Scientists
• Managers in Partnership
• NHS Staff Council (a majority response, excluding the RCN)
• NHS Employers
• NHS England
• NHS Providers
• Royal College of Midwives
• Royal College of Nursing
• Royal College of Podiatry
• Society of Radiographers
• UNISON
• Unite

The above list does not include all organisations that submitted responses, such as individual NHS organisations, and instead focuses on the most relevant national organisations.

The analysis published in this response draws on the responses received from members of the health and care workforce and from organisations.

Summary of evidence received

This section summarises the evidence that was received from each of the 4 sections of the call for evidence. These sections were:

• understanding the problems
• separate pay arrangements for nursing staff
• design of a separate nursing pay spine
• other approaches

Understanding the problems 

This section of the call for evidence asked for evidence:

• demonstrating whether the AfC pay structure is creating career progression issues that are specific to nursing staff
• demonstrating the impact of this on the recruitment and retention of nursing staff
• regarding the specific features of the pay structure that may be creating these issues

Over 70% of healthcare staff (both nurses and other staff groups) who responded agreed that the AfC pay structure is an important factor that impacts career progression and professional development choices.

A common issue raised by respondents was that there was not a strong incentive for staff to seek promotion because there was not enough of an increase in pay between different AfC pay bands in comparison to the additional responsibilities that would be required in that higher banded role. This was highlighted as a disincentive to staff seeking promotion. The gap between bands 7 to 8 was specified as a particular problem, given the potential increase to NHS Pension Scheme member contributions and the likely loss of pay enhancements at this level.

Many of the responses received from representative organisations, including trade unions, NHS employers and the NHS Staff Council, argued that these issues with the pay structure were well understood and impacted all staff groups, not just nursing. They called for a way to fix these issues in a way that benefitted all AfC staff groups.

NHS Job Evaluation Scheme

The NHS Job Evaluation Scheme (JES) underpins AfC pay arrangements to ensure equal pay for work of equal value and is used to assign AfC roles to the appropriate pay band. The local application of the JES is critical to ensure that the pay structure is implemented correctly for all AfC staff. However, many respondents raised concerns about inconsistent local implementation.

The RCN highlighted that nursing practice has advanced since the introduction of AfC in 2004 and suggested that AfC has not kept pace with this. It highlighted specific concerns that the JES is not accessible to nursing, and that the national nursing job profiles do not reflect modern nursing practice. This view was shared by the responses received by nurses, with many nurses reporting that their banding does not reflect their experience, skills, responsibility and workload.

Respondents from the wider NHS workforce and their representatives also raised inconsistent implementation of the JES as an issue outside of nursing. Examples were provided of staff across many workforce groups being asked to undertake additional work above their pay band without this being reflected in their job descriptions and therefore accounted for within their job weighting under JES. It was clear from the responses received that both nurses and other staff groups feel they would benefit from the same set of improvements to the JES.

Many organisations advocated for the JES to be adequately resourced and managed at both national and local levels. The NHS Staff Council noted the work that it is already undertaking to complete a review of all nursing and midwifery job profiles to ensure they reflect current practice, and that the non-pay workstream from the 2023 AfC deal has developed recommendations to help improve local implementation of the JES.

Impacts of these issues on recruitment and retention

Evidence was provided in relation to the broader recruitment and retention challenges facing the nursing workforce. However, the responses highlighted that there are multiple complex and inter-related factors impacting these challenges, and the evidence therefore did not directly link career progression issues created by the AfC pay structure to the recruitment and retention of nurses or other NHS staff.

The RCN felt that the scale of the recruitment and retention issues facing the nursing workforce demonstrates that this issue is unique to nursing, and that it therefore requires a solution that is specific to nursing.  According to NHS England’s latest published data on leaver and joiner rates, joiner rates within nursing are slightly lower than for other AfC staff groups. However, the leaver rate within nursing is also lower compared to other AfC staff groups.

Broader issues affecting career progression and professional development

As the government was considering the benefits and challenges of taking nurses out of the AfC pay structure, we wanted to understand the problems that the pay structure was creating. However, many respondents also raised broader issues that were impacting career progression and professional development.  

These broader issues included:

• lack of clear career pathways
• limited opportunities for further education
• limited funding for higher paid roles (particularly advanced clinical roles)
• the use of ‘Annex 20  - Development of professional roles’ (in the National Terms and Conditions) for clinical roles including nurses
• unfair management practices and discrimination
• the inability of the AfC system to reward experience within clinical roles

Separate pay arrangements for nursing staff

This section of the call for evidence looked for evidence around the benefits that a separate pay spine may bring to nurses and the nursing profession, as well as consideration of the wider implications of removing nursing staff from the harmonised pay and contractual arrangements provided by AfC.

In terms of the overall desirability of separating nurses’ pay arrangements, the responses received showed a clear contrast between nurses (and the RCN) and other respondents.

Of the nurses that responded:

• 94% thought that a separate nursing pay spine would improve career progression and professional development for nursing staff
• 89% thought that a separate nursing pay spine would have additional benefits beyond career progression and professional development
• 39% thought that separating nursing staff from the current AfC pay arrangements would generate risks or potential unintended consequences

The responses received from nurses and the RCN suggest that a separate pay spine for nursing staff could improve the career progression and professional development of nursing staff, making nurses feel more valued. It was felt by respondents that this would ultimately lead to improved recruitment and retention outcomes for the nursing workforce.

Many of the nurses’ responses indicate that they assumed a separate nursing pay spine would mean a pay rise for nurses without any changes to their wider terms and conditions. The nurses who responded tended towards the view that this would fix ongoing issues around recruitment, retention, morale, and reduce agency costs for NHS trusts.

In contrast, of the individuals that responded from other staff groups:

• 24% thought that a separate nursing pay spine would improve career progression and professional development for nursing staff
• 17% thought that a separate nursing pay spine would have additional benefits beyond career progression and professional development
• 93% thought that separating nursing staff from the current AfC pay arrangements would generate risks or potential unintended consequences

Overall, other members of the health and care workforce did not support a separate nursing pay spine. Their view was that the issues raised also impact other members of the AfC workforce, and that solutions should therefore benefit the whole workforce. Examples were provided that set out where other professionals took on similar (or in some cases identical) roles to nurses, for example in theatres, and that paying nurses differently would have a significant impact on morale and working practices within the multidisciplinary team.

While a handful of organisations did not provide a definitive view either way, the vast majority of organisations (including NHS England, NHS Employers, and all other trade unions) did not agree with the principle of a separate nursing pay spine.

The main risks and challenges that were identified were that:

• NHS organisations must deliver equal pay for work of equal value. Nurses’ work has already been shown (and legally tested) to be of equal value to other AfC roles through the JES, and paying nurses differently without strong justification would create significant legal (and financial) risk for NHS organisations
• many nursing roles are similar to those delivered by other AfC professionals (for example allied health professionals). Paying nurses differently has the potential to generate division and inequity within the NHS workforce that could disrupt multi-disciplinary teams from working together effectively. In the responses received to the call for evidence, this view was held by some nurses, whereas other nurses felt that other professionals would recognise that nursing is a unique profession
• if a separate pay spine was introduced for nursing, other staff groups would expect similar arrangements to be introduced for their profession, recreating a similar scenario to the previous Whitley arrangements for pay, terms and conditions. This would exacerbate the other risks that have been highlighted and would increase industrial tension
• individuals can move between these roles over the course of their careers. Separate pay arrangements for nurses would create barriers for staff moving in and out of nursing roles
• if nursing staff were taken out of existing AfC arrangements, new collective bargaining structures would need to be set up. Respondents raised concerns about the impact this might have on the NHS Staff Council, as well as the bargaining power of other professions

Design of a separate nursing pay spine

The call for evidence set out 2 different ways in which the pay arrangements for nursing staff could be separated from the rest of the AfC workforce. The options were to introduce:

• a separate nursing pay spine within the existing AfC contract
• a separate nursing pay spine as part of a new contract for nursing staff

More detailed information about these 2 options is provided in the call for evidence document.

This section looked for evidence and views on the practical considerations that would be needed to design and implement a separate nursing pay spine.

Preferred design option

The RCN’s view was that a separate nursing pay spine should be included in a new nursing contract, outside of AfC. It considered that this new contract should be applied to all nursing roles, from nursing support workers to senior nursing directors, and that its pay spine should be underpinned by a professional framework that recognises the different levels of nursing practice.

Nurses that responded were relatively evenly split between the 2 options presented.

Other trade unions and national organisations did not have a preference on the design of a separate nursing pay spine, on the basis that they thought neither option would work.

Practical considerations

Respondents highlighted a number of practical issues that would need to be considered in order to introduce a separate nursing pay spine.

These points included but were not limited to:

• determining the scope of the new pay spine or contract
• agreeing new pay setting and collective bargaining arrangements, and considering the impact on existing arrangements
• designing and implementing a new job evaluation system for nursing in England
• considering how to mitigate the significant equal pay and legal risks that would be generated
• supporting employers to understand and implement new contractual arrangements

Significant concerns were raised about the amount of time and resource that would be needed at both a local and national level to deliver the above.

Alternative approaches

The purpose of the call for evidence was to explore the scope of a separate pay spine for nursing staff as a way to address concerns with career progression and professional development. This section of the call for evidence sought views on other potential approaches to addressing the issues that were identified in the ‘understanding the problems’ section.

82% of nurses and 80% of wider NHS staff  who responded agreed that there are adjustments that could be made to better address the issues identified through the call for evidence.

The key alternative approaches that respondents identified included:

• changes to the AfC pay structure to support career progression, such as increasing the increments between pay points and bands to make promotions more attractive
• investment in the capacity and consistent application of the JES to ensure that AfC staff are paid at the correct rate for the work that they do
• considering how existing flexibilities within the AfC contract could be used more widely to support career progression
• higher levels of basic pay that recognise specialisms and experience

We note that the above suggestions were intended to apply to all staff groups, not just nursing.

Other suggested measures to support career progression and professional development

A number of measures were suggested to support career progression and professional development of nursing outside of the scope of the AfC pay structure. These can broadly be categorised as:

• greater availability of advanced clinical roles for nursing
• improving organisational culture around development, including the prioritisation of continued professional development
• clearer career pathways that were tied to education strategies

Government’s position on a separate nursing pay spine

We are grateful to the individuals and organisations that responded to this call for evidence.

Having carefully considered the evidence that has been submitted, the government has decided not to take forward a separate pay spine for nursing staff.

Although the evidence does not support a direct link between issues with the pay structure and recruitment and retention outcomes, the government acknowledges that this is likely to be a contributing factor. The evidence suggests that the reported barriers to career progression caused by the AfC pay structure are not unique to nursing, and we have not seen evidence that would justify addressing these issues for nurses and not for other AfC staff groups.

The responses have also highlighted a number of significant risks with the concept of a separate nursing pay spine. The government’s view is that the risks that have been highlighted could not realistically be mitigated to an acceptable level.

We have also considered the significant amount of time and resource that would be needed to design, implement and maintain a separate pay spine for nurses. While this is not the primary reason for the government’s decision not to proceed, it is our view that this would not be the best use of both national and local resources.

Work to address the issues raised

Although the government will not be pursuing a separate nursing pay spine for the reasons outlined above, there were several issues raised through the call for evidence that government is keen to address through alternative approaches.

We will continue to work closely with both trade unions and employers on these matters.

Pay structure reform

Many respondents highlighted issues with the AfC pay structure as a barrier to career progression for all members of the AfC workforce.

In July 2024, the government accepted 2 recommendations from the NHS Pay Review Body’s (NHSPRB’s) 2024 to 2025 report in relation to the AfC pay structure. The first was to introduce a new intermediate pay point to bands 8a and above to incentivise promotion into these pay bands. This was implemented in November 2024 and was backdated to 1 April 2024.

Government also accepted a recommendation to provide the NHS Staff Council with a funded mandate to address outstanding concerns with the AfC pay structure. We have asked the NHSPRB to consider the level of funding and we remain committed to delivering this recommendation. This will provide the NHS Staff Council the opportunity to agree improvements to the pay structure that support career progression.

Broader issues impacting nurse career progression

A number of respondents highlighted barriers to nurse career progression that did not relate to the pay structure.

One of the non-pay commitments from the 2023 AfC deal was to look at ways to improve nurse career progression, and this has resulted in a number of recommendations for government to consider. This work involved interviews with nurses, as well as research into the barriers to career progression using data from the NHS national electronic staff record, the NMC, comparisons of different graduate professions and data used to inform the NHS Long Term Workforce Plan.

This government will be taking forward a number of recommendations from this work, including interventions to:

• undertake a piece of research to understand:
  • the current deployment model for nursing (looking at the ratio and mix of nursing roles in different settings), based on accurate job descriptions
  • whether this model is suitable for the future (in line with the 10 Year Health Plan)
• improve development culture within organisations and increase consistent support for nurse career development
• increase career support for nurses from ethnic minority backgrounds
• review Annex 20 of the AfC contract to clarify that these provisions do not exclude nursing

NHS England and the NHS Staff Council will work with NHS organisations to deliver these measures.

NHS job evaluation scheme

Implementation of the JES was another key theme of the responses. Individual NHS organisations have responsibility for ensuring equal pay for work of equal value, and for implementing the JES correctly at local level.

As part of the 2023 AfC deal, the NHS Staff Council led the development of a piece of work that made a number of recommendations that aim to ensure that the JES is applied fairly and consistently across the NHS. Following careful consideration, the government is pleased to accept these recommendations. We have committed to investing in these measures to support the improvement of job evaluation practice to ensure that NHS staff are paid correctly for the work that they do.

This work will be managed by the NHS Staff Council, NHS England and NHS Employers.

National nursing job profiles

Some of the responses highlighted that current nursing job profiles do not reflect modern nursing practice.

The NHS Staff Council’s Job Evaluation Group is currently undertaking a comprehensive review of all nursing and midwifery profiles, with a view to ensuring that these are reflective of current clinical practice.

Along with the measures to improve local job evaluation practice that are outlined above, we expect that the updated national profiles will address staff concerns around banding not reflecting contemporary responsibilities, and will also improve consistency across NHS organisations. These profiles are expected to be published later this year.

Annex: analysis methodology

Descriptive statistics of the quantitative responses were produced to describe and summarise the characteristics of the call for evidence responses, not to make inference or prediction, or assess the interaction between variables. For each question, distributions of responses were calculated as percentages of those who provided an answer to that question. We received more detailed evidence from organisations, some of which were provided separately to the online survey. Organisational responses were reviewed in full.

Responses to the call for evidence are not representative of the groups referenced, but only of those who chose to respond to the call for evidence. Where particular groups are referred to or compared, this refers only to those who responded to the call for evidence and cannot be taken to represent the views of that group more generally. As such, statistical significance testing has not been used to analyse results. Differences between responding groups have been highlighted using judgement .

We have assumed in analysis that respondents submitted responses in good faith which, if given, accurately represent their characteristics and their view. For example, we take at face value that those selecting ‘registered nurse’ are indeed from this group, as verification was not sought.

For ease of reading, we have sometimes aggregated positive or negative responses. For example, if 28% were unsupportive and 5% slightly unsupportive, we have written this as ‘33% unsupportive’. These aggregated figures are derived from the frequencies rather than the rounded percentages. In most cases, this would result in the same figure, but may in some cases result in a 1 or 2 percentage point difference from adding together rounded percentages. Results are reported as a percentage of those that responded to the question (for instance, “75% of nurses agreed with…” should be understood as “75% of nurses that responded to this question agreed with”). This is omitted for ease of reading, but results should be read this way throughout. This report also uses ‘nurses’ as shorthand for registered nurses.

There were 8 open text questions for members of the workforce, which received between 1,400 and 4,600 responses each. Broadly, these cover:​

• views on the current progression system, including barriers and enablers, and how this can be improved​
• views on a separate nursing pay spine, either within AfC or in a separate contract​

We have analysed these using a data science technique known as ‘topic modelling’ to identify different topics within the answers based on patterns in the text. Topic modelling uses advanced statistical methods to find words that often appear together in large volumes of text. It looks for recurring patterns and groups them into ‘topics’ based on how frequently certain words co-occur. We then review these groups and label them with a short, clear name that describes the theme. This results in labelled clusters of text that highlight different issues or focus areas in people’s answers.

Where there were enough responses, we separated nurses and other professional groups before conducting the topic modelling. For each question, we have given a summary of perspectives from both groups (including any crossover points).​

While this sort of analysis is not intended to show exactly how many people held a certain view, we have endeavoured to provide an indication of the weight of opinion in responses, using words such as ‘many’, ‘some’, ‘several’ or ‘a few’.

We have also presented the breakdown of responses to the quantitative portion of each question where possible (see ‘summary of questions’ section for tables). Percentages reflect the proportion of responses that were not blank or ‘don’t know’ to that question unless otherwise specified.

Summary of responses

Question

If you have experienced any barriers to your career progression and/or professional development in the NHS, please indicate which below.

As this question allowed multiple responses, totals do not add up to 100%.

Table 1a: nurses

Response	Count	Percentage
Limited opportunities for promotion	2,462	59%
Job description (and therefore pay band) not accurately reflecting the work that you do	2,221	53%
Barriers within the AfC pay structure	1,918	46%
Lack of clear career pathways	1,366	33%
Limited availability of training and education courses	1,182	28%
Insufficient career and development support provided by line managers and team leaders	968	23%
Poor organisation or team culture	679	16%
Other	92	2%
Total responses	4,194	Not applicable

Table 1b: other staff groups

Response	Count	Percentage
Limited opportunities for promotion	1,613	62%
Job description (and therefore pay band) not accurately reflecting the work that you do	1,241	47%
Lack of clear career pathways	975	37%
Barriers within the AfC pay structure	880	34%
Limited availability of training and education courses	769	29%
Insufficient career and development support provided by line managers and team leaders	562	21%
Poor organisation or team culture	529	20%
Other	143	5%
Total responses	2,614	Not applicable

Question

In your view, how important is the AfC pay structure as a factor that impacts your career progression and professional development choices?

Table 2a: nurses

Response	Count	Percentage
Very important	2,360	56%
Important	1,134	27%
Moderately important	446	11%
Slightly important	140	3%
Not important	125	3%
Total	4,205	100%

Table 2b: other staff groups

Response	Count	Percentage
Very important	1,189	43%
Important	869	31%
Moderately important	388	14%
Slightly important	187	7%
Not important	148	5%
Total	2,781	100%

Question

Do you think the introduction of a separate nursing pay spine would improve the career progression and professional development of nursing staff?

Of the 3,505 responses received from nurses:

• 3,310 (94%) answered ‘yes’
• 195 (6%) answered ‘no’

Of the 3,075 responses received from other staff groups:

• 727 (24%) answered ‘yes’
• 2,348 (76%) answered ‘no’

Question

Do you think there are any additional benefits to introducing a separate nursing pay spine that are not directly related to career progression and professional development?

Of the 3,097 responses received from nurses:

• 2,745 (89%) answered ‘yes’
• 352 (6%) answered ‘no’

Of the 3,398 responses received from other staff groups:

• 561 (17%) answered ‘yes’
• 2,837 (83%) answered ‘no’

Question

Do you think there would be risks or potential unintended consequences of separating nursing staff from the current AfC pay arrangements?

Of the 2,679 responses received from nurses:

• 1,052 (39%) answered ‘yes’
• 1,627 (61%) answered ‘no’

Of the 3,642 responses received from other staff groups:

• 3,371 (93%) answered ‘yes’
• 271 (7%) answered ‘no’

Question

If a separate nursing pay spine were introduced, which of the following would you prefer?

Table 3a: nurses

Response	Count	Percentage
Introduce a separate nursing pay spine within the AfC contract (option 1)	803	31%
Introduce a separate nursing pay spine as part of a new contract for nursing staff (option 2)	999	39%
No preference - both options would work	699	27%
No preference - neither option would work	92	4%
Total	2,593	100%

Table 3b: other staff groups

Response	Count	Percentage
Introduce a separate nursing pay spine within the AfC contract (option 1)	295	19%
Introduce a separate nursing pay spine as part of a new contract for nursing staff (option 2)	197	12%
No preference - both options would work	99	6%
No preference - neither option would work	1,003	63%
Total	1,594	100%

Question

What changes could be made to better support your career progression and/or professional development in the NHS?

As this question allowed multiple responses, totals do not add up to 100%.

Table 4a: nurses

Response	Count	Percentage
Increased opportunities for promotion	1,428	55%
Ensuring your job description (and therefore pay band) accurately reflects the work you do	1,304	51%
Changes to the AfC pay structure	1,195	46%
Improved access to training and education courses	1,033	40%
Clearer career pathways	920	36%
More career and development support provided by line mangers and team leaders	689	27%
Improved organisation or team culture	505	20%
Other	42	2%
Total responses	2,579	Not applicable

Table 4b: other staff groups

Response	Count	Percentage
Ensuring your job description (and therefore pay band) accurately reflects the work you do	995	52%
Increased opportunities for promotion	946	50%
Clearer career pathways	772	41%
Improved access to training and education courses	769	40%
Changes to the AfC pay structure	625	33%
Improved organisation or team culture	489	26%
More career and development support provided by line mangers and team leaders	469	25%
Other	113	6%
Total responses	1,902	Not applicable

Question

Are there any adjustments that could be made to the existing AfC pay structure to better support any issues you have identified in the ‘Understanding the problems’ section?

Of the 1,814 responses received from nurses:

• 1,487 (82%) answered ‘yes’
• 327 (18%) answered ‘no’

Of the 1,431 responses received from other staff groups:

• 1,150 (80%) answered ‘yes’
• 281 (20%) answered ‘no’