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District nursing shortage leaving patients in pain, report warns

A district nurse shortage is leaving patients in pain and putting pressure on staff across the health service, a new report warns.
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A district nurse shortage is leaving patients in pain and putting pressure on staff across the health service, a new report warns.

The King's Fund report, Understanding NHS Financial Pressures: how are they affecting patient care? looks at four areas where rationing has affected patient care district nursing, planned hip operations, sexual health and neonatal care.

The think tank said people at the end of their life are being left for hours without pain relief due to nursing shortages, while other patients are denied access to operations for non-clinical reasons.

It found district nursing services are under significant financial pressure, with funding either static or reducing, despite rising demand.

The number of

A district nurse shortage is leaving patients in pain and putting pressure on staff across the health service, a new report warns.


A think tank report has found district nursing services are under
significant financial pressure. Picture: iStock

The King's Fund report, Understanding NHS Financial Pressures: how are they affecting patient care? looks at four areas where rationing has affected patient care – district nursing, planned hip operations, sexual health and neonatal care.

The think tank said people at the end of their life are being left for hours without pain relief due to nursing shortages, while other patients are denied access to operations for non-clinical reasons.

It found district nursing services are under significant financial pressure, with funding either static or reducing, despite rising demand.

The number of district nurses in England fell by almost half between 2000 and 2014, and fell by a further 15% between 2014 and 2016 for full-time posts.

Work redirected

Some regions have one in five posts unfilled, the study found.

It also warned that patients are also facing tougher scrutiny over whether they qualify for district nursing.

Patients who can attend a GP surgery, even if it is a struggle, are being barred from accessing district nurses, it said.

The King's Fund found evidence that more work is being redirected to nurses in GP surgeries, hospices and carers.

One hospice manager told the King's Fund: 'The district nurses working at night are not able to give effective response times.

'Tsunami' effect 

'You can wait up to eight hours...for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact.'

Hospices also described a 'tsunami' effect caused by sparse end of life care, with staff having to step in and do things normally undertaken by district nurses.

Other workers raised concerns that informal carers are expected to provide an increasing amount of care as services fall away.

District nurses are being forced to work significantly over their contracted hours, with a reliance on the goodwill of staff, the report said.

Compromising safety 

RCN general secretary Janet Davies said: 'This report lifts the lid on the dangers of trying to provide nursing care on the cheap.

'Patients waiting for district nurses at home are being let down as the funding pressures bite. Nursing staff are straining to hold things together for their patients but they can only hold the fort for so long.

'Safety for patients is compromised when district nurses are asked to do more with less, as lost colleagues are not replaced.'

On hip replacements, the study found some regions such as York have been restricting access by telling people who are obese to lose weight.

Funding slowdown

The report said such measures are already starting to affect access to care, with the number of hip replacements in 2015-16 falling for only the second time in 16 years.

Waiting times for operations are also rising, meaning some people are left in pain for longer.

The King's Fund also found severe cuts to sexual health funding, despite increasing demand for services. Neonatal services are also under pressure.

The report said there had been a significant slowdown in funding growth. Between 2010-11 and 2014-15, health spending increased by an average of 1.2% a year in real terms – far below the historic annual growth rate of 3.7%.

Future investment

It added: 'The current rate of funding growth is not sufficient to cover growing demand.'

NHS England has written to clinical commissioning groups (CCGs) reminding them not to use 'arbitrary cut-offs' for who can and cannot access hip and knee surgery.

An NHS England spokesperson said: 'Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate.'

A Department of Health spokesperson said: 'We're investing £10 billion to fund the NHS' own plan for the future, supported by an immediate cash injection of £2 billion for social care and £100 million for accident and emergency, to help to improve care in the community and ease the pressure on hospitals.'


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