NHS has lost over four in ten District Nurse positions in ten years
A new report from the Royal College of Nursing (RCN) and Queen’s Nursing Institute (QNI) calls for urgent investment in District Nursing, as new figures show the number of District Nurses working in the NHS has dropped by almost 43 per cent in England alone in the last ten years. As a result, there are only some 4,000 District Nurses providing care for a population of around 55.8 million in England, a ratio of only one District Nurse for every 14,000 people. This compares with one GP for every 1,600 people.
The report, Outstanding Models of District Nursing, is published today at the RCN’s annual Congress in Liverpool, where the 5,000 nursing staff attending include large numbers of District Nurses from around the UK. It calls for a commitment to investment and training to meet the challenges caused by simultaneous rising patient demand and falling numbers of these highly-qualified staff.
Recent government strategy has called for more nursing care to be delivered in the community and in people’s homes in order to reduce patients’ lengths of stay in hospital and avoid unplanned admissions. The NHS Long Term Plan has identified the District Nursing service, which provides vital care for people in their own homes and in the community, as a key part of this strategy. However, government policies have not been followed by the investment needed to make the vision a reality, says the joint report.
The report warns that:
- The District Nursing service is significantly under-resourced, with the number of NHS District Nurses having dropped from 7,055 to 4,031 in the last 10 years.
- District Nurses are working to capacity, at sometimes unsafe staffing levels. They are unable to provide consistent high-quality care due to pressures on their service.
- There are serious retention and recruitment challenges, with an older workforce and insufficient qualified nurses to replace those who retire.
- There is uncertainty around future educational funding for the District Nurse role.
- Location of District Nurse teams away from General Practice has resulted in disjointed care delivery across primary and community services.
The report, Outstanding Models of District Nursing, explores all the elements which need to be in place to support an Outstanding District Nursing service. It includes the views and experiences of a wide range of stakeholders including patients, carers, commissioners and GPs. It recommends that the Government and NHS:
- Urgently increase investment in the District Nursing service in order to secure the capacity and capability to meet the challenges of the 21st century.
- Maintain the post-qualifying District Nurse Specialist Practice Qualification (DNSPQ) which develops DNs’ personal and professional growth and enhances their clinical skills to lead and educate teams, patients, carers and families.
- Develop a strategy to expand commissioners’, providers’ and the public’s understanding and knowledge of the District Nurse role, enabling them to recognise the added value they bring to the local health economy and particularly to the wider Health and Social Care system.
- Develop a national standardised data collection system and data set within England, collecting meaningful data which recognises value for money, thus promoting a strong economic case for investment in the District Nursing service and providing systems to prepare, support and maintain a sustainable District Nursing service.
- Develop a national standardised approach to the assessment of quality in order to measure District Nurse effectiveness in England, providing structured methods and reliable data, enabling innovation and cost-effective practice to be captured, recognised and disseminated.
- Explore the co-location of District Nursing teams within Primary Care Networks to provide personalised care, continuity of care and enhanced working relationships across primary and community care teams.
Dr Crystal Oldman CBE, the QNI’s chief executive said:
"This new joint report illustrates the central position of the District Nurse as the key professional in delivering outstanding healthcare to people in the home and the community. Working with GPs and other members of the multidisciplinary team, District Nurses have the knowledge and skills to support people living with complex long term conditions to manage their own health and avoid unplanned hospital admissions.
"Conversely, lack of investment in the District Nursing service leads to greater strain on other parts of the health service, including GP practices and hospitals. With a rising and ageing population, many of whom are living with multiple long term conditions, we need a deliberate and intentional investment to support District Nurses to continue to deliver complex care to the patients, families and communities that they serve.
"The success of the NHS Long Term Plan depends on the capacity and capability of District Nursing teams and renewed investment in their education, recruitment and retention is urgently needed.’
Yinglen Butt, Associate Director of Nursing at the Royal College of Nursing, said:
“Given the fundamental role District Nurses play in delivering personalised care close to home, and in reducing the burden on hospital providers, the chronic underfunding of this service is an outrageous false economy.
"District Nurses provide a lifeline for patients, many of them frail and elderly, who often can’t leave their own homes to get care elsewhere.
"It’s time Ministers undertook a proper assessment of staffing needs based on the fundamental principle of patient safety, and enshrined explicit accountability for delivering this into law."
Notes to Editors
1. The number of District Nurses in September 2009 was 7,055. In January 2019 this had fallen to 4031, a decline of 42.9 per cent according to figures from NHS Digital.
2. The District Nursing service is typically commissioned by the clinical commissioning group (CCG) as part of a community services contract. It provides nursing services to people in their own homes and communities within a local population, defined by a geographical location or a GP registered list (NHSI, 2018).
3. District Nurses play a crucial role in caring for patients, who often have complex care needs, in their own home and in the wider community setting where frequently the care environment adds to the complexity (NHSI, 2018).
4. The NHS Long Term plan sets out a vision for integrated community health services including District Nursing in Chapter 1.5 to 1.20.
5. The new report, Oustanding Models of District Nursing, covers England only, due to divergent community healthcare policies in the other countries of the UK.
6. According to NHS figures there are 34,510 FTE GPs in England. Further data on GP numbers is at NHS Digital.