An East London trust is being forced to cut a fifth of its community nursing staff, in a move experts have described as “logically unsustainable” and a “risk to the quality of patient care”.
The 20% reduction in community nurse numbers by Homerton University Hospital NHS Foundation Trust follows a decision by City and Hackney Clinical Commissioning Group to stop funding the One Hackney initiative.
“In the long-term adding two patient visits to a full case load is logically unsustainable”
The trust has warned it will lose 14 district nurse posts from a total of 63 at the start of April. As a result, it estimated that it would need to add an extra two patients to each remaining nurse’s daily caseload, acknowledging this move could affect the length of time they can spend with patients.
Board papers for the trust’s December meeting said: “The impact of this, at service level will be to remove funding for four community matrons, four senior staff nurses and 10 staff nurses from April 2017.
“The trust had itself, due to recruitment difficulties, agreed to remove the community matron posts form October 2016, but the loss of the 14 district nursing posts will be significant (although a possibility given the non-recurrent nature of the funding),” said the papers.
“Given an establishment in this context (band 5 and band 6 nurses of 63 whole-time equivalent), the reduction equates to 20% of current available posts,” it stated.
The trust’s board paper added that it was “unhappy” about the reduction in nurses, warning that “the service’s ability to proactively engage in wider integration initiatives and develop its interface with primary care will inevitably be compromised”.
“If you take that expertise away, there is going to be some inherent risk”
The One Hackney project, funded by City and Hackney CCG, was part of the Better Care Fund – a £5.3bn programme spanning both the NHS and local government that was designed to incentivise more integrated health and social care.
The project was initially set up for an 18 month period and was designed to treat adults, in particular over 75s, with complex needs and help reduce inappropriate hospitals admissions, as well as improve the number of discharges and patients who die at home.
Crystal Oldman, chief executive of community nurse charity the Queen’s Nursing Institute, told Nursing Times’ sister title Health Service Journal there was a “potential risk to the quality of patient care if time is reduced [by] adding two patients per day to each nurse’s case load”.
“By definition this will mean that something does not get done, or the nurses will need to work additional hours every day, which may not be paid,” she said.
“It may not be nursing work in the patient’s home that does not get done, it may be administration or training, but in the long-term adding two patient visits to a full case load is logically unsustainable,” said Dr Oldman.
She added: “If we don’t invest in district nursing services, we must expect an increase in A&E attendances, unplanned admissions, fewer people dying in their place of choice and patients not being discharged in a timely way.”
The reduction in district nursing numbers at Homerton is contrary to national policy, which calls for a shift in activity from acute settings into the community. The North East London Sustainability and Transformation Plan aims to reduce acute inpatient demand, referrals and outpatient activity by 2020.
Professor Alison Leary, professor of workforce modelling at London South Bank University, also said the move was “risky”, depending on what the trust planned to do.
“We know there is a benefit of maintaining frontline expertise in terms of outcomes for patients and, if you take that expertise away, there is going to be some inherent risk in that. It depends how that risk is managed [but] it is unlikely that it will be risk free,” she said.
“The trust is disappointed that the [One Hackney] pilot will not continue”
A spokeswoman for the trust said: ”Following a review of its effectiveness, the CCG has decided to de-commission large elements of the non-recurrent One Hackney. The trust is disappointed that the [One Hackney] pilot will not continue but understands the CCG’s position.
“The trust will be able to subsume the loss of these posts through expected turnover and vacancies, and there will be no expected redundancies,” she said.
Ms Adam added that City and Hackney CCG had approved funding for a new pilot that would have community nurses working out of two local GP practices.
A CCG spokesman said: “The One Hackney and City programme was set up as a pilot to test a model of enhanced community support for vulnerable people in addition to the mainstream community services delivered by Homerton and other local partners. It was only ever funded as a pilot to try out a new model and way of working.
“Although some elements of the additional One Hackney model were good, it didn’t achieve all the aspirations we set and didn’t realise the savings in hospital spend we were hoping for,” he added.
Trust board papers