For generations District Nurses have provided vital care for patients in their own homes, but now the NHS service is at breaking point according to a new report.
It comes from The King's Fund, an independent charity working to improve health and care in England by shaping policy and practice through research and analysis. Worryingly the new report suggests the quality of care for some patients, including the elderly and frail, is being compromised by staff shortages and unmanageable caseloads in District Nursing.
Researchers compiling the report found the way that national workforce data was recorded made it difficult to fully assess staffing levels in District Nursing services. But data available to them showed the number of staff recorded as working in District Nursing posts has fallen dramatically – by 48% between September 2000 and September 2014 (based on annual statistics) and 13.6% between March 2014 and March 2016 (based on monthly statistics).
At the same time demand for home-based care has risen sharply, largely due to the UK's ageing population, while the complexity of care needed has also increased. Despite Government policy aimed at providing more home-based care, research for The King's Fund report found District Nursing to be "at risk of crisis due to a profound and growing gap between capacity and demand".
Researchers found evidence of an increasingly task-focused approach to care, staff being rushed and abrupt with patients, reductions in preventive care, visits being postponed and lack of continuity of care. Yet interviews with patients and unpaid carers highlighted the key role that District Nurse services play and their value for many people living with complex health and care needs.
The report also suggests that people working in District Nursing services are suffering through understaffing and overwork. Although some aspects of staff shortages are being managed well, services are generally overstretched and heavily reliant on staff goodwill. Researchers found this is having a deeply negative impact on staff wellbeing, with unmanageable caseloads leading to fatigue, stress and in some cases ill health. They heard reports of staff being "broken", "exhausted" and "on their knees", with some leaving the service as a result.
Anna Charles, Policy Researcher at The King’s Fund said: "At its best, District Nursing offers an ideal model of person-centred, preventive, community-based care. For years, health service leaders have talked about the importance of providing more care in the community, but this objective cannot be achieved when District Nursing is on the edge of crisis and a poverty of national data means the quality of services is not properly monitored.
"It is worrying that the people most likely to be affected by this are often vulnerable and also among those who are most likely to be affected by cuts in social care and voluntary sector services. It is even more troubling that this is happening ‘behind closed doors’ in people’s homes, creating a real danger that serious failures in care could go undetected because they are invisible."
The report makes three key recommendations to address the emerging crisis in District Nursing services:
· System leaders must recognise the vital strategic importance of community health services
· There is an urgent need to create a sustainable District Nursing workforce by reversing declining staff numbers, raising the profile of District Nursing and developing it as an attractive career.
· New and reliable ways of monitoring resources, activity and workforce level must be developed, alongside efforts to look at the staffing and resourcing of community health and care services for the older population.
In response to the report, NHS England said attempts were being made to attract nurses back into community care and training places for District Nurses were increasing. A spokeswoman added: "We recognise the hard work of district and community nurses and the pressures many are feeling as they continue to provide valued and high quality care for patients."