Community nurses have warned of rising referrals and caseloads of patients in their own homes with complex care needs, including long Covid.
Nurses from the Oxleas NHS Foundation Trust in southeast London told Sky News they are seeing an increase in community referrals for patients who need respiratory, occupational therapy and diabetes support – and also expected to look after patients with long Covid.
Laura Oyewole, team manager for heart failure and cardiac rehabilitation, told the broadcaster: ‘The pandemic is not over for us in the community. Actually, it has just begun because we are picking up on a lot of issues patients have.’
Her colleague Harriet Webster, a specialist respiratory nurse in the community, said referrals in her patch in Bexley, southeast London, are already up 10% on the previous year.
She told Sky News: ‘I think we’ve even seen an increase in referrals into our services over the past few months and year… Community sites are really good at looking after patients and managing their expectations but I think in the long term, services are going to have to grow to cope with the demand.’
Although Covid-19 cases are falling – with the latest Office for National Statistics data showing infections dropping in England by 40% from 90,000 in the week to April down to 54,200 in the week to 24 April – community services are dealing with a backlog of care and patients who would usually be in hospital.
Natalie Black, a neuro occupational therapist working with the team in the community, told Sky News she and her colleagues ‘are dealing with a population of people who have become unwell at home’.
She continued: ‘We are also having to deal with really complex cases coming out of hospital. What this means for us is that we now have a caseload of patients, who should be on inpatient wards, but actually they are out in the community.’
Meanwhile, diabetes specialist nurse Pippa Ashford told Sky News that treating Covid-19 with the steroid dexamethasone has led to an increase in diabetes.
She said: ‘The treatment pathway with high dose dexamethasone steroids is inducing diabetes in some people. The link between steroids and diabetes is already well known, but it has taken us by surprise – the sheer volume of steroid-induced diabetes that we have been seeing.’
Dexamethasone reduces mortality in people with Covid-19 who require ventilation or oxygen therapy, but the use of steroids can result in hyperglycaemia in people with diabetes and new-onset diabetes in those previously undiagnosed.