Plans to Axe District Nurse Role in Health Shake-up

Ministers are proposing to abolish the distinct roles of district nurses and health visitors, leading to fears that thousands of patients will not receive the specialist care they need. Under the plans, the extensive range of titles currently used by more than 8000 NHS nurses who work outwith hospitals would merge into one new “community health” job. But nurses’ leaders are concerned the proposed shake-up will ultimately turn all community nurses into generalists and dilute their specialist skills.

Gavin Fergie, professional officer for Community Practitioners’ and Health Visitors’ Association, which represents staff through the Amicus union, compared the proposal to asking a chemistry teacher to teach French.

He said: “We doubt the ability of these proposed community nurses to cover the full clinical range found in community nursing. Thousands of Scottish families won’t necessarily get the nursing specialist they need for a particular problem.”

Anne Thomson, acting deputy director of the Royal College of Nursing in Scotland, said: “We would clearly have concerns about such a radical change. We will be consulting widely with our members and working closely with the Scottish Executive to implement the outcomes.” One nurse with 27 years experience, who did not wish to be named, told The Herald that while district nurses played a significant role in looking after people who were dying or sick, health visitors were more involved in promoting good health, and visiting new mothers.

She added: “All the health promotion stuff is going to go because they are not going to radically increase the numbers. If you have a person who needs terminal care or you have the choice to do a ‘safe sun’ campaign what are you going to do? I feel it is the beginning of the end of the community nursing system.”

Mr Fergie also expressed concern the review gave “little weight” to the preventative work performed daily by health visitors and school nurses. A meeting between Andy Kerr, Health Minister, and union officials has now been scheduled to discuss the issue.

The executive’s proposals are laid out in the draft report which follows a review of community nursing in Scotland. It says an extensive range of titles is used to describe the many different duties performed and the review presented an opportunity to “stand back” and look at the whole set up.

The report continues: “The elements of the disciplines of district nursing, public health nursing [health visiting and school nursing] and family health nursing should be absorbed within the new service model. The elements common to each of these disciplines will be assumed by a new core community nursing discipline, called community health nursing.”

Shona Robison, SNP MSP, expressed particular concern about school nursing. She said: “The role would inevitably be diluted. It could eventually disappear if other priorities were seen to be more important.”

A spokesman for the executive said the needs of the public had been at the forefront of the review.

He said: “We’ve said consistently that improving Scotland’s health is our highest priority, and ‘preventative’ and ‘health improvement’ work is a vital part of this. The community nursing review always supported the view that public health is an integral part of the way forward for nursing in the community.

“We are aware of concerns that we had not highlighted this health improvement aspect enough. We will take full account of those comments in our final proposals.”

The spokesman added: “The proposed community health nurse would be supported by a range of multi-disciplinary colleagues.”