The recent report 'Ending 15-minute care' by the charity Leonard Cheshire Disability described the large number of local authorities which commission care to be delivered in the home in 15 minutes.
While this report dealt specifically with social care for disabled people living in their own homes, the report has many analogies with nursing care delivered in the same setting.
The QNI is currently undertaking a major study, commissioned by NHS England as part of the CNO's Community Nursing Strategy Programme, on case load allocation and workforce planning in district nursing. It is examining best practice in this area and consulting with frontline practitioners, managers, clinical and education commissioners to specify a caseload allocation and workforce planning tool.
The outcomes will be relevant to district nurses and their managers, service provider organisations, clinical commissioning groups and education commissioners. The outcomes will assist with operational caseload allocation as well as providing a predictive model to support workforce planning, which will support and inform the anticipated shift of resources from hospital to the community.
However, we are also mindful of operational constraints. A QNI survey of district nursing services has demonstrated that 25% of community nurses are still working on a paper based workload allocation system, with many having little or no access to mobile devices when visiting patients. Connectivity is also a huge challenge for those nurses working in areas not well served by mobile phone and broadband providers.
Practitioners working in the community see patients with increasingly complex needs and the need for nursing matches that of many hospital wards - but community nurses working in homes may not have immediate access to the clinical equipment, IT and team members that are available on the ward.
The challenges are significant, but the outcome of this piece of work will be essential to ensure that the right nurse with the right skills is allocated for the right amount of time to deliver expert care and achieve the best possible patient outcome in the home.