On 30th January 2018, NHS Improvement (NHSI) published five improvement resources focussed on supporting providers to consider the ways in which the staffing levels within their services are established and maintained, in order to provide the patient, family and carer with the right nurse with the right skills at the right time and place.
The improvement resource for the district nursing service is particularly welcome, at a time when there is a greater demand for the service and a diminishing number of district nurses working in the community.
Since 2010, the number of district nurses has fallen from around 7700 to 4175 at the most recent count.
District nurses manage teams of nurses and health care assistants (and sometimes other health and social care professionals) to support patients to be cared for safely and holistically at home. There is an urgent need to review the demand for the service and to recognise that the district nursing service is a critical part of the whole health and social care system.
If we are unable to meet patient, family and carer need for skilled nursing care in the home, there will continue to be an increase in the number of people suffering from delayed transfers of care, an increase in the number of patients presenting at A&E and higher levels of unplanned admissions.
District nurses are providing nursing care for patients with more complex care than ever before. They are supporting hundreds of thousands of frail older people to be safely cared for at home. They are providing nursing interventions which would, until recently, only have been delivered in the hospital, such as the administration of intravenous chemotherapy, along with the responsibility for total care and support of the patient receiving this medication and their family.
Recognising rising need, the number of district nurses in training in Wales is set to double this year. In England, where the funding for district nurse training has been withdrawn, it is anticipated that 50% of district nursing programmes face closure this year. This presents a huge risk in the system. It is time for this to be fully acknowledged.
This welcome publication from NHSI will be the catalyst for conversations locally and nationally about the supply of the qualified district nurse. If we are to truly transform care, with more people being cared for at home, then the supply, recruitment and retention of district nurses must now be urgently addressed.
NHSI’s five improvement resources can be accessed via the following link: https://improvement.nhs.uk/resources/