District nursing "on edge of crisis"

District nursing is being pushed to the brink of crisis by a "profound and growing gap" between capacity and demand at a time when the Government expects the service to take on more care, according to a new report.

The study by the King's Fund warned that unmanageable caseloads and shortages of staff are compromising the quality of care for some patients.

The think tank said limitations on national data make it difficult to establish a robust account of changes to activity and staffing but the available evidence shows activity has increased significantly in recent years, both in terms of the number of patients seen and the complexity of care provided.

At the same time, the number of nurses in community health services has decline and the number in senior district nurse posts has fallen dramatically over a sustained period.

The research found evidence of an increasingly "task-focused" approach to care, staff being rushed and abrupt with patients, reductions in preventative care, visits being postponed and a lack of continuity of care.

Some aspects of staff shortages were being managed well but services were generally over-stretched and "heavily reliant on staff goodwill". However, unmanageable caseloads were found to having a deeply negative impact on wellbeing, with employees fatigued, stressed and, in some cases, in ill health.

The report calls on leaders to recognise the "vital strategic importance" of community health services in realising ambitions for transforming and sustaining health and social care.

There is also an urgent need to reverse declining staff numbers in district nursing to create a sustainable workforce by developing it as an attractive career.

Finally, the report calls for robust mechanisms for monitoring resources, activity and the workforce, alongside efforts to look "in the round" at staffing and resources for community health and care services for older people.

"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 on the edge of crisis and a poverty of national data means the quality of services is not properly monitored," Anna Charles, policy researcher at the King's Fund, said.

"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."