A new report by the Nuffield Trust has revealed a stark warning: the government’s ambition to shift more NHS care into the community will be unachievable unless urgent action is taken to address the severe decline in district nursing across England.
The report, published ahead of the government’s forthcoming NHS Workforce Plan, highlights that one in four district nurses left the workforce in the year to September 2024, leaving a critical gap in frontline community care.
Between 2009/10 and 2023/24, the number of district nurses fell by 43%, or an estimated 55% when adjusted for rising patient need. Over the same period, demand for district nursing services rose by 24%, and is projected to increase by a further 34% by 2040 due to an ageing population with complex health needs.
The Nuffield Trust estimates that restoring district nursing services to 2009 levels, relative to today’s population, would require an investment of £376 million.
Some of the key findings include:
- 2.8 million fewer patient contacts in 2023/24 compared to 2009/10
- Fewer than half of training places result in qualified district nurses
- 27% of district nurses are paid below the expected Band 6 level
- 28% of the workforce are now non-nurses, up from 18% in 2009
- 19% of nurses’ time is spent on admin tasks
- 25% of nurses report doing over 7 hours of unpaid work weekly
Thea Stein, Nuffield Trust Chief Executive, commented:
“District nurses make a huge contribution to the NHS through managing long-term conditions, supporting patients with severe illness, and providing palliative care, but for too long this staff group has been neglected by policymakers. The consequences we have uncovered are stark – far fewer patients are getting crucial support from district nurses, despite the ever-growing need for these services.
“If the government doesn’t begin to address the glaring issues with district nursing and build a workforce plan that better supports this pillar of community care, it will be a core weakness of efforts to shift more care from hospital to home. Urgent action is needed to ensure the training pipeline for district nursing is fit for purpose.”
These issues are contributing to burnout, poor retention, and a shrinking talent pipeline.
The Nuffield Trust is calling on the Department of Health and Social Care and NHS England to work with employers to ensure that every newly qualified district nurse has a suitable role available, backed by proper funding and support.
Without decisive action, the report warns that the government’s plans to decentralise NHS care and reduce pressure on hospitals will falter—leaving vulnerable patients without the care they need at home.
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