‘Significant need’ to expand community workforce, says NHSE lead

There is a ‘significant need’ to increase capacity in the community nursing workforce if the government is going to deliver on its promises in the 10-year plan, especially around palliative care, a senior NHS England (NHSE) figure has said.

Appearing before the Health and Social Care Committee today, Dr Amanda Doyle, national director for primary care and community services, said non-acute services must have capacity to provide appropriate care in the community, a core goal of the 10-year plan.

The meeting followed a report published by the committee last month which found that around 10% of all district and community nurse face-to-face contacts relate to people in the last three months of life.

Providing care in the community

‘There’s a significant need to increase the capacity of the community nursing workforce if we are going to succeed in what we say in the 10-year plan and the cohorts we’re asking integrated care boards (ICBs) to focus on supporting out of hospital’, Dr Doyle said.

The 10-year plan, first published in July, is based around the government’s three shifts from hospital to community, sickness to prevention, and analogue to digital care.

She explained how ICBs were being told to prioritise bringing severe frailty and end of life services into the community and stressed the ‘key’ role that primary and community nursing teams will play in delivering that care.

‘It’s absolutely key that we have a community nursing and primary care workforce who can support those [end of life and severe frailty] patients, and that’s what the left-shift is going to start with,’ Dr Doyle said.

She added that funding may need to be taken from acute services and given to the community, to deliver on this change.

‘But we do need to ensure that, along with the patients and the services that we deliver to them, that we pull the funding from the acute sector into primary and community services in order to build that capacity,’ Dr Doyle explained.

The workforce plan

Also appearing before the committee, care minister Stephen Kinnock noted that ‘the vast majority’ of palliative and end-of-life care was provided by primary care and community nursing services.

Responding to a question on the widely anticipated workforce plan, which is due to be published this spring, Mr Kinnock said it would be ‘quite difficult’ to structure the plan around the ‘specific aspect’ of what different primary and community professionals could offer to palliative and end-of-life care patients.

‘But what we do need to recognise is the impact of shifting and focusing more on palliative and end-of-life care on what the workforce capacity requirement in both community nursing services, but also general practice will be, and those are very much part of the workforce plan,’ he told the committee.

The discussion comes amid growing pressures from assisted dying campaigners to request extra time for peers to scrutinise the assisted dying bill which is currently making its way through the House of Lords.

There is growing concern among supporters of the bill that it won’t pass all the necessary parliamentary hurdles to become law given the significant amendments suggested and the limited time available to debate these proposed changes.

Members of the House of Lords have proposed over 1,000 amendments to the bill, which is thought to be a record number for a bill proposed by a backbench MP.

Last month, Nursing in Practice published analysis which found that funding pressures on hospices are seeing district nursing teams increasingly caring for patients who are at the end of life and with complex needs.

In recent months, hospice leaders have called for longer-term funding to secure the future of the hospice nurse workforce and avoid cuts amid rising staffing costs.

Last summer health and social care secretary, Wes Streeting, said he has ‘never been comfortable’ with how funding for hospices is reliant on public donations and that the government should ‘leverage more support’ for the sector.