The district nursing profession is at “breaking point” according to a new report from the King’s Fund.
The report, Understanding quality in district nursing services, says that increasing patient demand on fewer district nurses and community health service, is now compromising patient care.
Although some aspects of staff shortages are being managed well, the report says services are “heavily reliant” on good-will.
The researchers found that this is negatively impacting staff wellbeing, with unmanageable caseloads leading to fatigue, stress and illness.
The report says: “We found examples of an increasingly task-focused approach to care, staff being rushed and abrupt with patients, reductions in preventive care, visits being postponed and lack of continuity of care.
“This is having a deeply negative impact on staff wellbeing, with unmanageable caseloads common and some leaving the service as a result. We heard of staff being ‘broken’, ‘exhausted’ and ‘on their knees’.”
Kathryn Yates, professional lead for primary and community care for the Royal College of Nursing (RCN), said: “District nurses are an essential lifeline to many people, managing diverse and complex health needs and enabling in particular the frail elderly to receive care closer to home, in their own home or in residential care.
Yates noted that the RCN warned that district nurses were “in danger of extinction” two years ago, “yet the situation is at least as bad today”.
She added: “It is very worrying that numbers are so out of step with demand, especially as the experienced and senior nurses are approaching retirement age.”
The King’s Fund makes three key recommendations in the report to address the problems in district nursing services.
Researchers encourage system leaders to recognise the vital importance of community health services in transforming and sustaining the health and social care system.
The report also highlights an urgent need to create a sustainable district nursing workforce by raising the profession’s profile and developing it as an attractive career.
The King’s Fund also calls for better monitoring to look at the staffing and resourcing of community health and care services for the older population.
Anna Charles, policy researcher at The King’s Fund said: “At its best, district nursing offers an ideal model of person centred, preventive, community-based care.
“For years, health service leaders have talked about the importance of providing more care in the community, but this objective cannot be achieved when district nursing is at breaking point and a poverty of national data means the quality of services is not properly monitored.
“It is worrying that the people most likely to be affected by this are often vulnerable and also among those who are most likely to be affected by cuts in social care and voluntary sector services.
“It is even more troubling that this is happening ‘behind closed doors’ in people’s homes, creating a real danger that serious failures in care could go undetected because they are invisible.”