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King’s Fund report warns of threat to quality ofdistrict nursing care
Unmanageable caseloads and shortages of staff in district nursing services are compromising quality of care for some patients according to a new report from The King’s Fund. Although government policy is for more care to be delivered by these types of services, new research carried out for the report found district nursing at breaking point due to a profound and growing gap between capacity and demand.
Although limitations to national data make it difficult to establish a robust account of changes to activity and staffing, the report draws together a range of evidence to show: l Activity has increased significantly in recent years both in terms of the number of patients seen and the complexity of the care provided.
l Available data indicates that the number of nurses working in community health services has declined over recent years, and the number working in senior ‘district nurse’ posts has fallen dramatically over a sustained period.
The report highlights that these pressures are compromising quality of care for some patients; the researchers found evidence of an increasingly task-focused approach to care, staff being rushed and abrupt with patients, reductions in preventive care, visits being postponed and lack of continuity of care. Although some aspects of staff shortages are being managed well, services are generally over-stretched and heavily reliant on staff good- will. The researchers found that this is having a deeply negative impact on staff wellbeing, with unmanageable caseloads leading to fatigue, stress and in some cases ill health. They heard reports of staff being ‘broken’, ‘exhausted’ and ‘on their knees’, with some leaving the service as a result. The report makes three key
recommendations to address the problems in district nursing services: l System leaders must recognise the vital strategic importance of community health services in realising ambitions for transforming and sustaining the health and social care system.
l There is an urgent need to create a sustainable district nursing workforce by reversing declining staff numbers, raising the profile of district nursing and developing it as an attractive career.
l Robust mechanisms for monitoring resources, activity and workforce must be developed alongside efforts to look in the round at the staffing and resourcing of community health and care services for the older population.
The report also found that staff, patients and carers have a strongly aligned view of what constitutes good quality care. It sets this out as a framework, which it argues should be developed for assessing and assuring the quality of care delivered in community settings. 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 at breaking point 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.”
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Calls to tackle language skills of doctors from the EU
The Royal College of Surgeons (RCS) are concerned that patient safety is being put at risk because testing of the clinical English language skills of dentists, doctors and nurses from the European Economic Area (EEA) is insufficient due to EU rules. They say the Government should use post-Brexit negotiations to rectify the situation. New General Medical Council (GMC) data provided under a Freedom of Information request reveal that 29 doctors from the EEA (excluding UK) have faced allegations relating to ‘inadequate knowledge of English language’ during 2014-2015. Four doctors from the EEA (excluding UK) have been suspended or had restrictions put on their practice because of
problems with their English with a number of cases still yet to be decided. By comparison, 10 doctors from non-EEA countries, where UK regulators are able to test the clinical language skills of applicants, faced such allegations in the same period with none being suspended or facing restrictions. This is despite the fact that there are more doctors from non-EEA countries: 26% of doctors on the medical register are from outside the EEA compared to 11% from the EEA. Professor Nigel Hunt, dean of the Faculty of Dental Surgery at the Royal College of Surgeons, said: “The NHS would struggle to provide care in hospitals, clinics and dental practices without the very skilled doctors,
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dentists, and nurses that come from both the EU and non-EU countries – it’s absolutely vital that the Government find ways to ensure they can remain working in the NHS post-Brexit. That said it’s unquestionable that such staff should be able to communicate clearly with patients in English about their clinical problems, illnesses and treatment. “While the professional regulators are able to require proof of the clinical language skills of non-EU applicants, the same checks do not apply to EEA applicants and our fear is that this could be putting patients at risk. We want the same rules to apply to all non-UK professionals, regardless of where in the world they come from.”
OCTOBER 2016
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