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District nursing: urgent need for more investment

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There are just over 4000 district nurses There are just over 4000 district nurses providing care for a population of around 55.8 million in England

The number of district nurses working in the NHS has dropped by almost 43% in England alone in the last ten years, according to a new report by the QNI and the RCN.

There are just over 4000 district nurses providing care for a population of around 55.8 million in England, a ratio of only one nurse for every 14,000 people, compared with one GP for every 1600 people.

‘This new joint report illustrates the central position of the district nurse as the key professional in delivering outstanding healthcare to people in the home and the community. Working with GPs and other members of the multidisciplinary team, district nurses have the knowledge and skills to support people living with complex long term conditions to manage their own health and avoid unplanned hospital admissions,’ said Dr Crystal Oldman CBE, the QNI’s chief executive.

‘Conversely, lack of investment in the district nursing service leads to greater strain on other parts of the health service, including GP practices and hospitals. With a rising and ageing population, many of whom are living with multiple long term conditions, we need a deliberate and intentional investment to support district nurses to continue to deliver complex care to the patients, families and communities that they serve.’

Additionally, the report states that district nurses are working to capacity, at sometimes unsafe staffing levels, and are unable to provide consistent high-quality care due to pressures on their service.

The report also identifies retention and recruitment challenges, with an older workforce and insufficient numbers of qualified nurses to replace those who retire. There is uncertainty around future educational funding for the role. Finally, locating of district nurse teams away from general practice has resulted in disjointed care delivery across primary and community services.

‘Given the fundamental role district nurses play in delivering personalised care close to home, and in reducing the burden on hospital providers, the chronic underfunding of this service is an outrageous false economy,’ said Yinglen Butt, Associate Director of Nursing at the Royal College of Nursing.

‘District nurses provide a lifeline for patients, many of them frail and elderly, who often can’t leave their own homes to get care elsewhere. It’s time Ministers undertook a proper assessment of staffing needs based on the fundamental principle of patient safety, and enshrined explicit accountability for delivering this into law.’

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