District nursing report warns of increasingly ‘poor quality and unsafe care’

Patients who need care in their own homes are increasingly faced with “rushed and abrupt” district nurses, a new report suggests.

District nurses are having to take a “task-focused” approach to care as a result of mounting caseloads and shortages of staff, according to a report by The King’s Fund.

The health think tank warned that as a result of these pressures, care for some of society’s most vulnerable people could be being compromised.

“The dissonance between the frequently stated policy ambition to offer ‘more care close to home’ and the apparent neglect of community health services over recent years is striking,” the report states.

The document highlights the “vital” role that district nurses play in the NHS – with their input often making the difference between people being able to stay in their own homes or moving into residential care settings.

District nursing services are most commonly used by older or disabled people, or those nearing the end of life.

In recent years there has been a “growth in the volume and complexity of the work”, the authors wrote. But at the same time there has been a decline in the workforce and growing problems in recruiting new staff.

The report – based on information from a variety of sources including a review of literature, focus groups with district nurses and interviews with carers and patients – highlights examples of “poor quality and unsafe care”.

These include: staff being rushed and abrupt with patients; delays to treatment; less frequent visits; reductions in the amount of preventive care being given; a deterioration in the continuity of care; a reduction in the use of a person-centred approach to care and an increase in the use of a task-focused approach to care.

The authors wrote: “Each of these responses is an example of classic forms of ‘rationing’, which occur when resources are strained in health care.

“Although our research does not report on the scale of such incidents, there is good reason to fear that poor quality will become more prevalent unless action is taken.”

The authors called on health leaders to reversing declining staff numbers to create a sustainable workforce.

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.”

Commenting on the report, Kathryn Yates, professional lead for primary and community care at the Royal College of Nursing (RCN), said: “It’s two years since the RCN (Royal College of Nursing) warned that the district nurse role was in danger of extinction, yet the situation is at least as bad today.

“District nurses and their teams are being stretched to the point where quality is at risk – and there is no sign that the rise in demand will abate.

“This report shows the huge value of the service to patients, especially those with long-term conditions and complex needs.

“It is very worrying that numbers are so out of step with demand, especially as the experienced and senior nurses are approaching retirement age.

“There is much to take away from this report which the RCN will want to work with other organisations on.

“However, the main message is that to meet the level of need for high quality care, the long-term problem of staffing has to be tackled now.

“To let the decline continue would be to knowingly deprive patients of care which makes a proven difference.”

Commenting on the report, Janet Morrison, chief executive of the charity Independent Age, said: “District nursing is a vital service helping keep frail elderly people out of hospital so it’s appalling that staff have less and less time to help.

“We need more, not fewer, district nurses as our ageing population continues to grow. A lack of support for these crucial community health services is ill-judged and short sighted, which is likely to result with more elderly people ending up in hospital.”

Hilary Garratt, director of nursing at NHS England and deputy chief nursing officer for England, said: “We recognise the hard work of district and community nurses and the pressures many are feeling as they continue to provide valued and high quality care for patients.

“It is vital we are able to attract the right numbers of nurses and other clinical staff where they are needed. The NHS continues to work with others including Health Education England to support the recruitment of new and returning nurses, to retain nurses already in post and to help all services, including those in the community, reach their planned staffing levels.”

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