Community care shift must see district nursing ‘expansion’, says NHSE chief

The transition towards more community-based care should trigger the ‘expansion’ of the district nursing workforce, the chief executive of NHS England has said.

Speaking at the King’s Fund annual conference last week, Sir Jim Mackey called for a ‘rebalance’ of the health system and pointed to reduced spending on community services in recent years.

‘If you compare our system now with really good systems internationally or when we performed better, we spent more in the community than we do now relative to hospital services, we spent more in primary care than we do now relative to hospital services, similarly on prevention,’ he told attendees.

‘So, we built a sort of odd shaped system that we’ve got to rebalance in the next few years.’

Sir Jim said that the move towards community-based care – in line with the government’s 10-year plan for the NHS – ‘should’ lead to a growth in the community workforce.

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‘If we really deliver what we say we’re going to deliver, there’ll be expansion in community services and district nursing.

‘And there has to be, otherwise we’ll not have shifted the road that precedes the possible. But it’s hard, it’s going to take time, but working together is the key,’ he noted.

The government’s 10-year plan is built around the its three key shifts, from hospital to community, sickness to prevention and analogue to digital.

A digital overhaul of community-based health services is expected as part of the 10-year plan, including a new digital platform which will be rolled out across NHS provider organisations, with new developments to the NHS App, like remote patient monitoring and a Single Patient Record.

The plan also mooted the creation of a new ‘national approach’ to support the safety of community NHS workers through the use of digital technologies.

However, fresh concerns have been raised about the challenges facing the district nurse workforce after a Nuffield Trust report found that one in four district nurses are at a lower pay band than the typical starting point for the profession.

The report also revealed that a growing proportion of staff working within district nursing teams are not registered nurses.

Nursing in Practice has also heard reports of some employers are creating ‘new roles’ at lower pay bands in ‘replacement’ of district nurses.

Related Article: Some employers ‘replacing’ district nurses with lower band roles

And the Care Quality Commission (CQC) recently 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.

Collaboration between services

Sir Jim also highlighted the need for primary and secondary care services to work closely together.

‘We’ve set the signal out about people working together in primary and secondary care in everything we’ve been doing this year, and I’m encouraging people to build those relationships closely together, to get systems working properly together,’ he added.

Flu and strike warning

During his address, Sir Jim also turned his attention to winter pressures, suggesting the incoming season would be one of the hardest seen by the NHS, especially given concerns around flu.

‘There’s no doubt this winter will be one of the toughest our staff have ever faced,’ he warned.

‘Since stepping into this role, the thought of a long, drawn-out flu season has kept me awake at night. And, unfortunately, it looks like that fear is becoming reality.’

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Last week, England’s chief nursing officer (CNO) issued an ‘urgent SOS’ appeal to those eligible for a flu vaccination to get their appointment booked in before the worst of the flu season hits.

This follows Duncan Burton’s earlier warning that this year’s flu season had seen an ‘unusually early’ start – with particular concerns around high record rates of flu among children and young people.

During the October half term, a series of vaccination pop-up sites were run in fire stations and other community spaces in England, meanwhile a new NHS service enabling community pharmacies to administer flu vaccinations to children aged two to three years was launched as a one-season trial from 1 October.