The policy message has been transmitted and understood. Delivery of care needs to shift from the hospital setting into the community. Where possible, it is best for patients to be cared for in their own home. Shorter stays in hospital, delivering what patients want, enhances recovery, reduces risk of hospital-acquired infection.
This all makes sense. If you were in charge of this policy what would your first step be? How is care delivered? By nurses of course. So you would increase not only the number of nurses delivering care in the community but also ensure that they had sufficient skills and training to give increasingly complex care. And to do that you would strengthen and reinforce the backbone of community nursing – district nurses. How hard is that? Well impossible apparently.
A major new survey has found that community nurse teams report they lack staff with the right skills and qualifications to deliver care needed by patients.
The Queen’s Nursing Institute survey of 1,035 community nurses found less than a third thought their teams were adequate for the work that they cover. And compared with five years ago, 36% said the proportion of qualified nurses on their team had fallen, 54% said it had stayed about the same, while just 10% said it had increased.
The number of district nurses has fallen by 44% between 1999 and 2012, down from 11,500 to 6,400. This decline has taken place as care has shifted into the community. This is so obviously going to impact negatively on the care that patients receive that it is hard to believe. But this is the reality. More community care – fewer community nurses. Action needs to be taken urgently to address what any thinking person can see is madness.