District nursing at ‘breaking point’, warns think tank

Overstretched district nursing services are functioning on nurses’ goodwill, says new report.
Breaking point

Overstretched district nursing services are functioning on nurses’ goodwill, and health service leaders must recognise their vital, strategic importance, urges a new report.

District nurses have described feeling ‘broken’ and ‘exhausted’, says King’s Fund report. Photo: Alamy

Health think tank the King’s Fund argues that unmanageable caseloads and staff shortages are compromising the quality of patient care in its analysis of district nursing services, published today (Thursday, 1 September).

The research shows evidence of rising numbers of patients, as well as increasing complexity of care, and data showing a decline in numbers of nurses working in community health.

Unpaid overtime

District nurse and Queen’s Nursing Institute (QNI) transition project manager Candice Pellett said patient demand does not match up with staff numbers.

She said: ‘District nurses go without breaks and work much longer hours than they are paid for, because they will not neglect their patients.

‘We are looking after many more people who wish to be looked after in their homes with an ageing population and much more complexity of care.’

Tick-box nursing

The report cites examples of an increasingly task-focused approach to care, staff being abrupt and rushed with patients, postponed visits and a 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,’ the report said.

‘We heard of staff being “broken”, “exhausted” and “on their knees”.’

The Understanding Quality in District Nursing Services report makes three key recommendations:

  • NHS leaders must recognise vital importance of community health services.
  • A sustainable district nursing workforce must be created – urgently.
  • Robust methods of monitoring resources, activity and workforce must be developed.
Running on empty

King’s Fund policy researcher Anna Charles said: ‘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.’

QNI chief executive Crystal Oldman welcomed the report and praised the King’s Fund for including the perspective of patients, families and carers.

‘We have been flagging these issues for some time and I think the system is now waking up to the importance of the district nursing service,' she said.