Interview: ‘District nurse pay bands have been a fight for a long time’

Last week the Nuffield Trust published a report which found that over a quarter of district nurses are paid below Band 6 and uncovered the stark decline in registered nurses in district nursing roles. Madeleine Anderson spoke with Thea Stein, Nuffield Trust chief executive, to hear her reaction to the findings and what she sees as the ‘artificial divide’ between district and primary care nursing.

Do you think the role of district nurses is well understood?

I think there’s a really poor understanding of what district nurses do, what they are capable of and how they act in the community. People have no idea of the complexity of care that can be offered by a district nurse in their own home, or the level of what’s possible.

In fact, the volume of care that we are going to need due to the ageing population and growing complexity of the population is going to be significant. We won’t be able to nurse those people, to look after them well, or to support them when they’re dying at home, without the community nurse workforce.

Why is it important district nurses are paid above Band 6 level?

It’s about recognising the seniority that district nurses have and what they bring. They’ve done extra training and they’re advanced practitioners.

You can’t build castles on sand, so the reality is you need a really well-qualified, embedded and respected district nursing workforce in the community in order to do the care that we need.

Otherwise, pressures on hospitals will remain and we simply aren’t going to be able to cope.

Were you surprised to see that over 25% of district nurses are lower than Band 6?

That wasn’t a particular surprise to me as the pay banding issue has been a fight for quite a long time. This is something that needs to be addressed, while recognising that we all know the answer will be ‘well, there isn’t enough money’, but there has to be.

Are there more opportunities for primary care, community and district nurses to work together?

I think that’s really important. Ideally, practice nurses, community nurses and district nurses should be able to work together as one team that recognises their different skills and recognises their specific responsibilities and differences. But I think that ideally, you should have the ability to include all these nurses in a team and support them to work together.

I think that’s really essential, because the artificial divide between these roles isn’t useful.

The pressures facing the hospice sector have been well-reported. Do you have concerns about how reduced hospice capacity could impact district nursing teams?

District nurses are core to enabling people to die well, to die with dignity in their own houses, and we’ve seen that issue highlighted in recent months when we’ve been talking about assisted dying.

People fear others will make a choice on assisted dying because they don’t have access to that really brilliant, comprehensive end of life care. And core to that is the skill set of the district nurse.