Palliative care report warns of ‘decimated’ district nurse workforce

District nurses are the ‘backbone’ of community care for people nearing the end of life, but their workforce is ‘decimated’ with poor training and retention, according to a report published by MPs.

An independent expert panel report commissioned by the Health and Social Care Committee found that around 10% of all district and community nurse face-to-face contacts relate to people in the last three months of life.

However, one participant who gave evidence to the panel said: ‘The district nurse workforce is decimated, training is poor, and retention is terrible, yet it is them that are doing the really hands-on care.’

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The report found there is now fewer than one district nurse per 15,000 of the population, or one district nurse for every 62 deaths out of hospital with palliative and end of life care needs per year. And it reiterated that the number of district nurses in England has fallen 47% since 2009.

Participants giving evidence felt there was not enough capacity to support people in the community. One said: ‘We have one county where there are one or two community nurses to cover the entire county’s needs, not just for palliative care.’

The decline in district nurse numbers was attributed to an ageing workforce, changing environment, and a fall in the number of training places. Training opportunities in palliative and end of life care for district nurses were described as poor.

The panel’s report follows an evaluation of palliative care services which began in March 2025, and echoes concerns recently expressed by the Care Quality Commission on dwindling district nurse numbers and the impact this is having on care.

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It also warned about a lack of a nation-wide framework for how integrated care boards (ICBs) should commission palliative care services and suggested this was leading to differences in quality of services across the country.

ICBs were often found to not be equipped well enough to understand the palliative and end of life care needs of their local populations, in some cases due a lack of access to data, the panel added.

A recent report commissioned by the Queen’s Institute of Community Nursing found that one in four district nurses are at a lower pay band than the typical starting point for the profession.

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In addition, some employers are creating ‘new roles’ at lower pay bands in ‘replacement’ of district nurses, according to the Royal College of Nursing District and Community Nursing Forum.

Following the publishing of the independent expert panel report, the Health and Social Care Committee said it plans to hold an evidence session in the new year with the minister for social care, Stephen Kinnock, to discuss the findings.