Healthcare delivery
care, and general practice. “GP numbers are lower in poorer areas, where health care needs are higher. All this can leave people without the support they need in the community and make it harder to free up space in hospitals.
“Labour is right to talk about shifting care
out of hospital and strengthening care in the community. But – a year in – our analysis shows how far the government is from having a coherent policy agenda to make these promises
a reality. Detail on how change will happen is lacking and resources to deliver reform are limited. A more concrete plan is now needed – including for rapidly testing and evaluating innovations that could improve local services.” The Patients Association pointed out that
behind every statistic is a patient who expects safe, timely, and compassionate care, yet the CQC’s findings show that the health and care system is often falling short in delivering these basic standards.
Alf Collins, a Trustee at the Patients
Association, concluded: “This decline cannot continue. Health and
care services must improve, and patients must be at the centre of every reform, every redesign, and every decision about the future of the NHS. “True partnership with patients is the only
way to rebuild confidence in the system and ensure care is accessible, safe, equitable, compassionate, and fit for the future.”
Fix district nursing or risk jeopardising plans to shift
care closer to home, warns think tank Government plans to move more NHS care into the community and out of hospitals won’t be achievable unless action is taken to address the dire state of district nursing, with an estimated one in four district nurses having left the workforce in the year to September 2024. A recent Nuffield Trust report details the consequences of a failure to invest in district nursing, just when it is needed as a cornerstone of community health care. The authors set out how district nursing
services, which are intended to provide care for patients and support for their families at home, in clinical settings and in care homes - 24 hours a day, 365 days a year - are in a state of crisis. The supply of nurses is plummeting while demand for care has risen, and is set to rise further. From 2009/10 to 2023/24, the number of district nurses fell by 43% (an estimated 55% when taking into account growing patient need), while the need for the service is estimated to have risen by 24%. It is projected that, as more people live for longer and with more complex health needs, demand will increase by another 34% over the next 15 years to 2040. The Nuffield Trust says this trend must be urgently addressed, and restoring the service to 2009 levels, relative to current population, could cost £376 million. The analysis also found concerning variation in patient access to services across the country, with the number of staff recorded in district nurse roles significantly higher in the North West (13.7 nurses per 100,000 needs-weighted population) but lower in the East (2.8), South East (3.3) and South West (4.4).
Further findings include: l There were 2.8 million fewer recorded district nursing contacts (such as face-to- face or telephone appointments) in 2023/24 (29.2 million) than in 2009/10 (32.0 million).
l There was a fourfold unexplained variation in reported average cost of a face-to-face
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appointment between providers of district nursing services in 2023-24 (ranging from £23 to £98).
l In 2023/24, fewer than half of training places led to qualified district nurses.
l District nurses are expected to typically start at NHS pay Band 6, but the analysis found that over one in four (27%) of staff recorded as ‘district nurses’ are at a lower pay band. This could represent an undervaluation of the role and limit the level of skills and experience on the frontline.
l An increasing proportion of the staff working within the district nursing workforce are not nurses – the proportion of staff employed in other roles, including as healthcare assistants, has risen from 18% in 2009 to 28% in 2024.
Previous studies have highlighted issues with district nurses’ experience of work. Up to a fifth (19%) of district nurses’ time is spent on administrative tasks, and in a 2023 survey, a quarter of the workforce reported that they are carrying out more than seven hours a week of unpaid work. The heavy workload is regularly cited as a factor by those leaving the workforce, while the lack of senior roles and access to professional training and development also impacts retention. The Nuffield Trust report sets out a range of
clear recommendations to reverse these trends and improve the supply and retention of district nurses. This includes calling for the Department of Health and Social Care and NHS England to work with employer representatives to ensure there is a mechanism and funding in place, so all newly qualified district nurses have an appropriate role available to them. Nuffield Trust Chief Executive, Thea Stein said:
“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.” Commenting on the report, Steph Lawrence,
Chief Executive of the Queen’s Institute of Community Nursing (QICN), who were involved in facilitating early input into the research, said: “Thank you to the Nuffield Trust for undertaking this critical research, which shows the extent of the demise of District Nursing in recent years. There are many things that have contributed to this, but the District Nursing workforce has been overlooked by policy makers for too long. If the 10-year plan and shift of care from hospital to community is to be realised, urgent action is required, as it will not happen without a robust District Nursing workforce. “This is growing evidence as to why we are seeing care left undone – this represents the corridor care of community, with increasing numbers of coroners’ reports citing lack of District Nursing resource as a factor in patients’ deaths. The QICN has been calling on Government and NHS England to ensure we train adequate numbers of District Nurses for a number of years. We now say this has to be seen by Government as a critically urgent issue. More funding to train District Nurses is required, alongside ensuring we have continuation of level 7 Apprenticeships and finally ensuring we remunerate at the correct Agenda for Change band for the specialism – a minimum of band 7 to reflect the advanced and autonomous practice of District Nurses today.” View the report at: https://tinyurl. com/4w4zx5x5
CSJ
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