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'I worry about the future of community nursing'

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Earlier this week, I witnessed 119 nurses being given the Queen’s nurse title for exceptional community practice at the Queen’s Nursing Institute Awards. As the QNI chief executive Crystal Oldman pointed out to the nurses bestowed with the honour, it represented both an achievement and a responsibility. She said those Queen’s nurses now practised not just in their name, but in that of the QNI.

To see community nurses delivering this care at such a level made me feel really proud. But it cannot overthrow my sense of fear for the profession. Here were these outstanding nurses, delivering great care to their patients, but where are their successors?

Earlier in the same day as the QNI’s awards ceremony, a think-tank published a concerning report on workforce. The Health Foundation concluded that the number of nurses working in the NHS had fallen in the past year – mostly due to a decline in the number of community and mental health nursing staff employed by the service.

The report – titled Rising pressure: the NHS workforce challenge – highlighted an alarming fall in the number of nurses in community and mental health settings, and remarked how these two areas had been previously identified as critical to the success of NHS England’s Five Year Forward View strategy.

The number of community nurses in post between April 2016 and April 2017 fell by 970 to 32,750. In addition, the number of staff working in community health services (including school nursing) was 1,000 (2.8%) lower at 35,210. And over the same period, health visitor numbers, which peaked at 10,300 full time staff in October 2015, also declined, dropping to 8,830 in April 2017.

This is a downward trend that experts say is unlikely to be reversed by any of the current “strategies” in place to tackle the workforce.

As the report eloquently stated, there is a “gap between national rhetoric and the reality for the NHS workforce”. A gap that the authors warn is growing.

While the health secretary and other politicians proudly boast of more nurses under their tenure than their predecessors, the grim truth is that the numbers, in general, are not growing, only the needs of patients are. And we are left in a situation where the ambition of providing safe, high-quality care in the community, rather than in a hospital, remains just that – an ambition, rather than a reality.

Someone somewhere needs to work out exactly what we need to provide care closer to home – how much it would cost and how quickly that investment would be returned.

”Where is the government plan to support community nurses?”

Community nursing – providing support for people with long-term conditions, helping prevent illness and caring for older people – is of immense value. But despite the aims set out in the Five Year Forward View, we see very little of that making a difference. School nurses and health visitors are being cut, thanks to local councils having been handed commissioning responsibility for their provision and deciding to seek to make savings. No one seems to be standing up and pointing out the error of this, or the problems it might be storing up for the future health of the population – and the health of the NHS budget – by making these sorts of decisions.

Where is the government plan to support community nurses? Where is the response to this report about the gaps?

I was delighted to clap loudly for those nurses receiving their Queen’s nurse badge on Monday night. But I worry about their future, and the future of community nursing. Because quite frankly, there looks to be very little to applaud in this area.

  • 4 Comments

Readers' comments (4)

  • A very timely article. Thank you.
    It's quite clear to me that very key influencers really do think that Community Nursing is just about kind, well-meaning people, who should get the minimum wage, and be spread thinly, for what is, after all, for them uncomplicated applied common sense and the undertaking of simple practical tasks, based on basic instruction; probably from someone in a hospital or at a local medical practice. ...Of course, I know that, these days, most Strategic Nurses, Medical practitioners and operational health care managers don't think like that. I really do think it must be somewhere in Government, though, otherwise how do we account for such sloppy political, economic and philosphical thought?

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  • Hi Jenni, I worry about the future of community nursing too. I was interested to read your opinion piece but surprised to see you write; “No one seems to be standing up and pointing out the error of this, or the problems it might be storing up for the future health of the population – and the health of the NHS budget – by making these sorts of decisions.”

    I would have thought that you’d be aware that there’s plenty of people that have been ‘standing up’ and pointing out the absolutely ridiculous situation that the government is causing by cutting community nurse numbers. I’d argue the problem isn’t that nurses aren’t standing up, it’s that the current government don’t have an ideological interest to do something about it, so ignore the complaints.

    I know I’ll be keeping ‘standing up’ either till we get a change from the current government or we get a change in government to one that knows the value of community nursing, and proves this by real action.

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  • Defo agree with all the above - flexibility is essential to retain a nursing force including the community, especially where there predominant nos whom are female and with families, but not excluding anyone of course. NHS is stuck in the dark ages still but has made some progress. Corporate government installed values and false PR are decimating the profession. NHSI, Brexit, placid nursing leadership and government are definatley a prob. For the clued up the big agencies are a resonation of how well the NHS is doing and so where agencies suffer so is the NHS. IR35, over capping, too many demands, anxious over Safeguarding and not understanding many agency staff are NHS is forcing nurses out, including the community. The NHS corporate, CQC and NHSI under Mackey have got to realise they are now becoming the problem by fuelling disrespectful gov TQM, lean and false QI rhetoric.

    It's not about tight processes as outcomes with what we have and is indeed about higher nos with the right skills. A message to all you at the top 'STOP THROWING YOUR PAPER PLANES AROUND AND DEFENDING NURSES IN ALL AREAS.

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  • As a new grandmother I am horribly aware how different the health visitor input is for my grandchild in contrast to how it was for my own child. In the ED we are snowed under by parents of young children who come in because they have no community support, no one to say this is normal/natural/not a problem. How can we support new mothers or identify at risk children/parents when young mothers only see a health visitor less than 6 times in the first year! (I saw our health visitor weekly for the first few months, if I couldn't get to her she came to me! Then there were all the milestone checks, no longer compulsory or even encouraged!) In the wake of such tragedies as 'baby P' how can it be justified to have less input and contact with the most vulnerable in society?

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