District dilemmas

The Queen’s Nursing Institute is a lone voice on the demise of district nursing, a workforce that is needed more than ever as bureaucrats threaten more telecare and more care at home.

But older patients and carers, to whom these threats largely apply, are not able to manage their own conditions with only a mobile phone and Skype for support. They are generally frail in mind and/or body, simultaneously suffering from at least three of the five common chronic diseases (coronary heart disease, respiratory disease, stroke, diabetes and dementia) and unable to navigate a health and social care service reformed beyond the comprehension even of its own staff.

These people need expert monitoring, many caring interventions and most of all, strong professionals who can negotiate the right care.

What is needed now is a large cohort of clever senior nurses able to manage those five diseases without physician intervention, to develop the home care service to be exactly that and to act as the proponents of struggling patients and carers.

The extent to which today’s district nurses are prepared for such a role needs to be examined. Some would need updating and some would need re-training, while considerable investment will be necessary to expand their numbers. Unless these points are acted on and quickly, a policy of preferred care at home will remain the paper exercise it has been for the past 20 years.

About the author

Frances Pickersgill is Nursing Standard’s development editor