District nurses demand support to prevent patient suffering

Those from across the nursing community have taken to social media to warn of patient risks and suffering caused by underfunding, poor staffing levels and increasing caseloads within district nursing.

One nurse said they were ‘heartbroken when patients suffer’ but stressed that without proper recognition and funding, ‘this will keep happening’.

The comments come in response to concerns raised in a coroner’s report about how a lack of district nurse wound care – driven in part by staffing levels – contributed to the death of an elderly woman under the care of Whittington Health NHS Trust.

The report had found that district nurse numbers were ‘thin on the ground’ at the trust at the time of 86-year-old Mary Fitzpatrick’s death.

‘This isn’t new’

Responding to the story on Facebook, Nursing in Practice readers warned against placing too much blame on district nurses working in an increasingly overstretched system.

‘No decent nurse wants to give substandard care,’ said one Nursing in Practice reader.

‘On our caseload we are devastated when a pressure ulcer deteriorates. But caseloads are ballooning with more complex social issues, staff are overloaded, sickness is high, and consistency is lost when gaps are plugged with bank staff,’ they added.

Another added: ‘This isn’t new. How many patients have to suffer before district nursing is recognised and funded?’

Others described a system at breaking point, with community services struggling to meet the needs of patients discharged from hospital earlier.

‘District nursing is badly understaffed,’ one commenter said.

‘Patients are discharged home early to free up beds, with little thought to capacity within the community. Community services need to be recognised as much as hospital services,’ they urged.

‘Blame the budget’

Those from across the nursing profession pointed to chronic underfunding as the root cause of the crisis.

‘Blame the budget,’ one commented. ‘There are too many patients and not enough staff. Prevention of future death reports can be reduced if trusts had the funds to employ an efficient number of nurses in every setting.’

‘This will keep happening’

Nurses shared their frustration at the government’s ‘lack of support’ for district nursing services, an issue which many said they had been speaking about for years.

‘We’ve been shouting for help for years.

‘We need more staff, more support, more funding for the NHS. It’s not the nurses’ fault, it’s the government’s lack of support,’ one commenter wrote.

Another said: ‘We are heartbroken when patients suffer. But until community nursing is properly recognised and funded, this will keep happening.’

Links with GP services

A different comment highlighted how the strain was also being felt beyond district nursing, with some reporting that GP practices have scaled back wound care services increasing pressure on community teams.

Another warned that patients were also returning to A&E to receive wound dressings that they would typically get in general practice but can’t because of falling nurse numbers.

‘We need to change the narrative’

Steph Lawrence, chief executive of the Queen’s Institute of Community Nursing (QICN) said she was ‘saddened’ by the story and shared her condolences to those involved.

‘This all links to what I have been saying for a number of weeks – the work is hidden as well as not being resourced properly and this has to change.

‘This is yet another preventable death; we have to take this very seriously and change the narrative and also understand nationally how we have oversight of care not done in the community,’ Ms Lawrence said.

The QICN head says she wrote to the secretary of state to discuss the issue of district nurse staffing ‘several weeks ago’ but is yet to receive a response.

Writing for Nursing in Practice last month, Ms Lawrence warned that a lack of district nurse capacity was being flagged in coroner’s reports and in prevention of future deaths notices, like where the Whittington staffing issue was discussed.

Last month, the Care Quality Commission (CQC) issued a warning that a shortage of district nurses was driving ‘task-based’ care and risked undermining the government’s plans to shift care from hospital settings into the community.

In June, a report from the QICN exposed how district nurses were up against increased workloads and more complex patient needs.

It revealed that more teams are carrying bigger caseloads, with the number of district nursing teams working with 600 or more patients having risen by 16.2% in 2023.

In May early findings from a report by the Nuffield Trust revealed that the number of district nurses working in the NHS in England has fallen by 43% between 2009 and 2024.

Latest findings from the report showed that over a quarter of district nurses were lower than Band 6, while a growing proportion of staff working within district nursing teams are not registered nurses.

The government has been contacted for comment.