The media is currently full of stories about winter pressures in the NHS; stories of ambulances waiting for hours outside A&E and of record numbers of patients being seen in GP surgeries. Many of the people waiting to be seen in these contexts are older people.
The increase in average life expectancy in the UK is a cause for celebration and the needs of older people should be appropriately accommodated. But without planned and sustained growth in the capacity and capability of health and social care services, these stories will surely only get worse year on year.
One of the ways to address this would be to recognise the significant contribution that the District Nursing services make in supporting people to be cared for at home. District Nurses have a unique skill set that is frequently overlooked by those who have never witnessed their practice and refer to District Nursing as simply ‘nursing in another context of care’.
This could not be further from the truth; District Nursing is a specialist area of practice, requiring study for a qualification that is recorded and regulated by the Nursing and Midwifery Council. The full extent of the expert knowledge, skills and competence required, as an autonomous clinician and team leader, is described in the QNI/QNIS Voluntary Standards for District Nurse education and practice.
At a time when there are increasing numbers of people living with multiple, complex long-term conditions, it is the District Nurse that can coordinate and manage care, prescribe medications and ensure patients are cared for in their own homes, avoiding A&E and the GP surgery.
At a time when we want to give more people the choice to receive end of life care in their own homes, it is again the District Nurse who can orchestrate the provision of equipment and services to ensure that the person and their family are properly supported at that time.
A GP recently described the District Nurse to me as ‘the GP in the home’. It is extraordinary then that in England, 50% of all universities are now considering the closure of their District Nursing programmes in 2018 as the funding for training students is to be withdrawn.
In Wales, the number of District Nurse training places has been doubled for 2018, with the recognition that these highly skilled nurses have a significant role in supporting the whole system by leading the provision of a service which prevents hospital admissions, facilitates timely discharges and enables more people to be safely cared for at home.