QICN urges stronger government oversight of community nursing

The Queen’s Institute of Community Nursing (QICN) is pushing the government to introduce stronger oversight of community nursing services.

The institute has warned that a lack of national and regional grip on staffing levels and the safety of services within the community risks undermining plans to shift care out of hospitals and into the community.

Steph Lawrence, chief executive of the QICN, met with health minister Karin Smyth this month to discuss issues facing the sector and the need for stronger oversight of the situation in community nursing services.

Ms Lawrence explained that oversight should focus on how much care cannot be delivered in the community, due to lack of staff capacity.

Having better regional and national oversight would help provide systems with ‘understanding’ around the extent of different issues, such as how many people have missed out on care due to lack of capacity on a given day.

Her comments follow remarks from the health minister, Ms Smyth, who recently said responsibility for the ‘number and quality’ of district nurses sits with local integrated care boards (ICBs) and NHS trusts rather than central government.

Ms Smyth was responding to concerns raised by a coroner after an inquest into the death of a woman who was not seen by district nurses on several occasions because of staffing shortages. The inquest did not directly link the staffing issues to the woman’s death, but it warned there was a risk that future deaths could occur unless action was taken.

Related Article: Nursing in Practice returns to Scotland with CPD event this September

While accepting that ICBs hold responsibility locally, Ms Lawrence warned that without clearer oversight and direction nationally, the risks highlighted by coroners would remain unresolved.

And she suggested there was now a widening gap between the government’s ambition to move care closer to home and the evidence of progress on the ground, particularly around workforce capacity, training and accountability.

Ms Lawrence said the minister was ‘very clear that the government is not going to make any national mandates around safety and community nursing’.

‘She said there needs to be local and regional oversight, which I don’t disagree with,’ she said.

‘The problem is that nobody’s mandating regional integrated care boards to have that oversight, and we know that the only rural places where you’ve got oversight of what’s happening is where it’s based in community trusts, and that’s a real concern.’

During the meeting, Ms Smyth had suggested that NHS England could potentially mandate some regions to have clearer oversight of community nursing services, according to Ms Lawrence.

Ms Lawrence said the QICN was working with NHS England to develop tools to better understand what is happening locally, regionally and nationally.

However, she was clear that central government still needed to take some responsibility for ensuring oversight actually happens.

‘Karin Smyth stressed that the mandate was the responsibility of ICB managers,’ Ms Lawrence said.

‘I think the government has to take some responsibility for this mandate. Even if that is mandated regionally, the government needs to make sure local regions have the data they need.’

Related Article: New QICN faculty and network for health and justice nursing

She said clearer mandates would help ensure community nurses ‘felt listened to and not invisible’, while also giving patients a better understanding of services in their area.

‘If patients know what’s going on they can speak up locally, if need be, to their MPs, local councillors or whoever it may be,’ added Ms Lawrence.

‘Hugely worrying’

Ms Lawrence also described how the QICN has heard reports of some areas closing out-of-hours community nursing services, which she said raised serious questions about how the shift towards community care was being delivered.

‘That’s hugely worrying,’ she said.

‘Given the 10-year plan and the shift towards community, it actually seems that the government isn’t doing much about the move towards community at all.’

She added: ‘I think the narrative is right, I think the ambition is right, but I’m not seeing the evidence that actually it’s really going to happen.’

Ms Lawrence said she had also recently met with Samantha Jones, permanent secretary at the Department of Health and Social Care, and described the meeting as positive, but said there remained a lack of understanding at national and regional level about the scale of community nursing workforce gaps.

The government is currently developing a workforce plan, due to be published in Spring, which is expected to include new details on staffing in different healthcare settings including in the community.

Related Article: Reframing eating disorder recognition in primary care

Responding to a question in parliament last month, care minister Stephen Kinnock highlighted the ‘essential role’ of district nurses and wider community nursing teams as he set out the government’s commitment to strengthen the workforce amid rising demand.

In May, first findings from a QICN commissioned report by the Nuffield Trust found that district nursing numbers in England were down 43% on 2009.

Nursing in Practice approached the Department of Health and Social Care for comment.