The need to plan the district nurse workforce is urgently required, says Crystal Oldman
In the UK we are undoubtedly in the enviable position of having longer life expectancies than any previous generation. This brings the joy of witnessing more generations of children grow during a lifetime, as well as benefits from scientific and technological advances that support a healthy, longer life - but we also know many people will experience multiple and complex long-term health conditions in their older years and nurses will be at the forefront of their care delivery.
The agenda in recent years has centred on a determination to move care from the hospital to the community. It is based on the premise that this is where most people would prefer to be treated if it is safe to do so and receive care at the end of life. A major challenge in planning that shift is knowing how the size and shape of the workforce in the community should look to meet the demand and, specifically, the profile of the district nursing service, which coordinates and supports the care of people in their own homes. Also critical to the delivery of a cost-effective service is using resources efficiently and knowing how district nursing teams are scheduled to deliver care in people’s homes, along with the patient caseload allocated each day.
“There is much that can be learnt from the IT systems established for planning the school nursing and the health visiting workforces”
The Queen’s Nursing Institute was recently commissioned by NHS England to explore the current scope of practice in terms of caseload scheduling in the district nursing service and the extent to which mechanisms are in place locally to predict future workforce requirements, with the right skills to deliver care in the right place. The resulting report confirmed the need for a nationally agreed, reliable and valid system, objectively assessing the population’s healthcare needs to forecast the district nursing workforce required to meet future demand, based on the demographic profile in any given locality. In tandem with this, a robust method is required to efficiently and effectively deploy the available workforce to meet the needs of those receiving the service.
There are some excellent examples of provider organisations making the best use of technology to support caseload scheduling. Those that remain paper based in their allocation systems could accelerate their development by learning from those that have developed sophisticated IT-based systems over many years. Fully embracing new technology and ensuring compatibility with other IT programmes used in the local health economy will also create recording, reporting and monitoring efficiencies.
There is much that can be learnt from the IT systems established for planning the school nursing and the health visiting workforces. These services are predicated on the delivery of the Healthy Child Programme, the need for which, by definition, is determined by the number and profile of the children and families in the locality.
Workforce planning for the district nursing service is arguably much more complex, with many factors to consider, including the need to have in place nationally agreed care pathways that will inform and help forecast the workforce. With increasing caseloads that are not limited by the number of hospital beds and where the geographic spread can vary hugely, planning the workforce to support more care in the community will be highly challenging.
The need to plan the district nurse workforce is urgently required if we are to adequately support the balance of care moving further in favour of delivering care in the home. A workforce fit to meet future patient, carer and family needs has been the theme of the QNI’s Right Nurse, Right Skills campaign for the last three years and we will continue to lead the way on developing the modern district nursing workforce.
Crystal Oldman is chief executive of the Queen’s Nursing Institute