District nursing ‘crisis’ putting care in the community aims at risk

District nurses are struggling to deliver care because staff numbers are not keeping pace with demand, the King’s Fund has said.

A new report from the think tank, based on research into three district nursing services which provide care at home, found staff at all three are reporting a dramatic increase in the number of patients and the complexity of their conditions.

This also meant nurses were required to provide more complex services, with one team leader saying they were acting “like hospitals at home”. This was combined with a high staff turnover and decreasing numbers, with one service having lost half its staff in the past three years.

Nationally, the number of full-time equivalent district nurses fell by 13.6% in March 2014-16.

The report said nurses were trapped in a “vicious circle” where the pressure on staff was encouraging nurses to leave their jobs, making the work harder for the remaining nurses, which makes it harder to recruit more.

Staff were also likely to leave to work in primary and specialist care, which are perceived as less stressful, or to work as hospital nurses and health visitors, where the government is seeking to boost numbers.

Anna Charles, policy researcher at The King’s Fund, said: “At its best, district nursing offers an ideal model of person centred, preventive, community-based care. For years, health service leaders have talked about the importance of providing more care in the community, but this objective cannot be achieved when district nursing is on the edge of crisis and a poverty of national data means the quality of services is not properly monitored.

“It is worrying that the people most likely to be affected by this are often vulnerable and also among those who are most likely to be affected by cuts in social care and voluntary sector services. It is even more troubling that this is happening ‘behind closed doors’ in people’s homes, creating a real danger that serious failures in care could go undetected because they are invisible.”

Interviewees said the staffing shortage could also be due to an increasingly ageing workforce, as older nurses take early retirement or reduce their hours and are not replaced.

The report also suggested that the staffing shortage meant services were struggling to keep up with training requirements for their staff, and inexperienced nurses were often being promoted to senior roles.

The NHS faces clinical staff shortages of up to 5.9%, which the Public Accounts Committee has said is partly due to the government’s ‘mismanagement’ of the health workforce.

Nurses also identified problems with primary care leading to an increase in their workload, and that they were increasingly taking on work previously done by social workers because of cuts to social care.

Interviewees said that district nursing was “an unknown quality” to senior NHS figures, with commissioners either not seeing the point in commissioning community nursing or lacking the resources to do so.

The King’s Fund said that more support for district nursing is vital to fulfil the aim of more community-based care, part of the Five Year Forward View. It recommended that district nursing service leaders are included in local plans for service redesign.

It also said that national mechanisms for healthcare oversight need to be adapted to provide better scrutiny of district nursing, and that district nurses should be encouraged to take up digital technologies in order to make their work more efficient.

Kathryn Yates, professional lead for primary and community care for the Royal College of Nursing (RCN), said: “There is much to take away from this report which the RCN will want to work with other organisations on.

“However, the main message is that to meet the level of need for high-quality care, the long-term problem of staffing has to be tackled now. To let the decline continue would be to knowingly deprive patients of care which makes a proven difference.”

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