Not enough specialist nurses to provide palliative care in rural communities 

Some district nurses are having to employ ‘less qualified staff’ to fill roles that require specialist palliative care skills because of recruitment challenges, a new report has warned.

The Bringing the Care Closer to Home report, from Hospice UK, has called for urgent action to increase access to palliative and end of life care in remote populations across the UK and warned of the damaging impacts of staff shortages.

The results come from a survey of 235 health and care staff who provided care and support to patients with life limiting conditions in rural and remote communities.

Hospice UK also held a series of stakeholder interviews with professionals including hospice and palliative care staff, district nurses, pharmacists and district nurses and surveyed 49 people with lived experience of accessing palliative care services in rural communities.

Two-thirds of rural health and care staff responding to the report said there were not enough workers with the right skills to support people with life-limiting conditions. 

And the most common workforce shortages highlighted in the report was a lack of community nurses and other social care staff. 

The impact of staff shortages 

Concerningly, Hospice UK warned that palliative nursing vacancies and overstretched teams mean district nurses are having to employ less qualified staff to fill specialist posts.

‘The most consistent workforce shortages highlighted were a lack of social care staff and community nurses, particularly out of hours,’ the report said.

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‘Recruiting staff with appropriate palliative care skills was also challenging.

‘District nurses said that they were sometimes unable to recruit into positions, so had to employ less qualified staff.’

Staffing shortages had led to examples of poor care, said the report, with palliative care patients facing long delays in being seen.

The report also describes how shortages in community and social care staff meant that patients and unpaid carers have less support at home and are more likely to reach a crisis point where they need unplanned care and emergency admissions into hospital. 

Hospice UK has called for better collaboration between nurses, pharmacists, GPs, hospices and social care and out-of-hours teams and communities to plug rural care gaps, especially in at-home care, medicine delivery and training. 

An aging workforce

Staff were also concerned about the high number of people delivering palliative care who are nearing retirement age. 

According to Hospice UK, more than a third of the UK’s hospice clinical workforce is over 55. 

The issue is greatest in Wales, with almost half of the workforce aged 55 or above, the report said.

A community driven approach 

The report describes people being forced to choose between home and care, with many choosing to move hours away from family and friends to get the support they need. 

It revealed that families of children with life-limiting conditions living in rural areas face additional challenges in accessing care, with staff lacking the necessary confidence and experience to provide high-quality specialised services.

Hospice UK said over-stretched staff working in rural areas require a ‘creative, community-driven’ approach which can adapt to the specific and changing needs of patients and families. 

One hospice at home nurse described struggling to keep up with rising demand for palliative care nursing services in their area. 

‘Workload is unpredictable as there are times when staff have no work and times when there are too many patients for the number of staff available,’ they said. 

The carer’s perspective

The report shares testimonies from parents and bereaved carers struggling to access palliative care in their remote and island communities.

‘We need to get this right. It’s too important to rely on the goodwill of the limited resources available. The impact on families is catastrophic,’ one carer said. 

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Another carer said: ‘I found it extremely distressing and frightening. I was frightened because I didn’t think we were meeting his needs because the district nurses during the night weren’t able to get to him in time.’ 

The report also highlights the positive experience of some families, with one carer recalling the positive relationship she had with her local district nurses, GP staff and palliative care team during around the time of her husband’s death. 

‘It felt like we were the sole focus of these professionals, which was a very powerful feeling,’ she explained. 

What needs to change?

Helen Malo, senior policy and public affairs manager at Hospice UK, said the report ‘lays bare’ the challenge rural communities are facing in getting the care they need close to home. 

‘It shines a light on the experiences of people in remote and rural areas – from long costly journeys to access care, to delays getting vital pain relief medication, and a shortage of skilled staff. 

‘Too often, people in these communities are forced to choose between the place they love and the care they need,’ she said. 

Despite these challenges, Ms Malo said health and care staff show ‘incredible dedication’ in supporting families ‘against the odds’.

‘We are calling on governments to fund a major shift towards care in the community and tackle rural staff shortages,’ she added. .

‘With the right planning and stronger community partnerships, we can build a system that delivers high-quality palliative care for everyone, wherever they live.’

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The report comes as MPs last week voted to legalise assisted dying in England and Wales. 

The Terminally Ill Adults (End of Life) Bill passed by 23 votes, with some opponents highlighting the already overstretched and underfunded palliative care sector as a reason to vote against the bill.