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Community nursing shortage will scupper the game plan

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We must move care into the community to improve how we deliver services for patients. How long and how often has that goal been proclaimed over the last 20 years or more?

It was reiterated in the Five Year Forward View with the plan to shift care out of acute hospitals and closer to patients’ homes – the idea being that it would reduce the pressure on acute care and make savings in hospitals.

It certainly feels like the savings have been made in hospitals but unfortunately that money has not reappeared in the community. That has been confirmed by an alarming report out earlier this week from the organisation NHS Providers on the state of community services.

The report – titled NHS Community Services: Taking Centre Stage – highlights a decline in the community nursing workforce, which has reduced by 14% since May 2010 and amounts to the loss of 6,000 posts.

“The report paints a picture of an over-stretched community sector struggling with a shortfall in both funding and staffing”

It cited a survey of 71 trusts that found most community providers were deeply worried about staffing and feared current workforce plans would not deliver enough district nurses, health visitors, and specialist nurses to realise that long-vaunted goal of providing more services closer to home.

The report paints a picture of an over-stretched community sector struggling with a shortfall in both funding and staffing. How will that sector ever deliver the Five Year Forward View?

Nearly half of the trusts surveyed are currently “worried” or “very worried” about whether they have the right number and skill mix of staff to deliver high-quality care. Meanwhile, 62% are worried about being able to maintain adequate staffing in 12 months’ time.

In particular, it described the role of district nurse as “vital”, yet flagged up that the number of district nurses has reduced by 44% since 2010, with the community nursing vacancy rate currently at around 9.5%.

The report said there are not enough district nurses to meet current or future demand, and district nursing has an ageing workforce making supply an even more pressing issue.

Efforts to increase the number of health visitors with a specific target was successful for a while but once the target was not renewed in 2015 the numbers have been allowed to drop again.

“The report showed that community trusts were facing ever-shrinking budgets”

“There is some evidence that these nursing shortages are risking the quality of patient care in community settings, as they put pressure on staff and their caseloads,” warned the report.

The report showed that community trusts were facing ever-shrinking budgets, with 52% who took part in the survey reporting that funding in their area had fallen in this financial year.

Many – 44% – said they were cutting costs while 30% said they had cut staff. In all, 82% said they were “worried” or “very worried” that community health services would not receive the investment they need to deliver the ambitions of the Five Year Forward View.

The new report led the Queen’s Nursing Institute to warn that the movement of services out of hospitals and closer to patients’ homes has failed to happen at the “scale and pace required”.

Community services play a key role in transforming services and are working hard to deliver new models of care outside of hospitals. However, this report makes clear that the process is underfunded and short staffed.

Community nurses have been described by some commentators as the “glue” that holds the whole health and care system together. Unless the numbers of community nurses increase, that glue will surely fail to stick and patients will not receive the improvement in care that has long been envisaged. How many more warnings do we need?

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