The familiar term ‘winter pressures’ is most often associated with hospital-based care, but they also impact on the community.
In December, district nursing teams continued to visit housebound patients, and winter conditions meant nurses spent more time travelling and digging their way through the snow to access patients’ homes.
“The loss of competent district nurses will lead to more care being given in the hospital”
Regardless of the weather, patients, carers and families still require district nurses to provide palliative and end-of-life care with skill and dignity; central line dressings still need to be changed and medications need to be administered.
Where the district nursing service is fully staffed and led by an expert specialist practitioner, they have the potential to work in harmony with the local hospitals and care homes to ensure that the winter pressures are minimised for the whole system. However, there is a risk in the system that the Queen’s Nursing Institute (QNI) raised at the end of 2017
- ‘Alarming’ fall in district nurses exacerbating NHS winter crisis
- Multiple warnings that NHS has reached ‘watershed moment’
- Surge in flu cases prompts fresh call to make all nurses have jab
Cuts to the funding of district nurse training in England has led to 50% of universities offering programmes considering closure, as there is no guaranteed supply of future trainees.
This will leave parts of the country with no specialist practice training programmes, the loss of role models and the loss of district nurses who are so well-respected and trusted for their high level of technical and relational skills by patients, families, carers and the multidisciplinary team in the community.
- ‘Major concerns’ about future of district nurse education
- Slump in district nurse workforce amid overall nursing rise
- Growth of district nurse workforce may be ‘tailing off’
The loss of competent district nurses will lead to more care being given in the hospital. There will be a loss to comprehensive caseload management and strategic care planning, including a risk of ‘over-visiting’ and practising defensively, of which the QNI has evidence.
“There are consequences for the team, with high staff turnover and the risk of a poorly led service”
The QNI has evidence that where district nurse programmes have closed in previous years and team leaders of the service are no longer trained through a specialist practice programme, the service becomes task-oriented and risk-averse, leading to poorer outcomes of care with greater risks of unplanned admissions and delayed transfers of care.
In these situations, there is no opportunity for the development of clinical, managerial and leadership skills and there are consequences for the team, with high staff turnover and the risk of a poorly led service, with no continuity of care.
Northern Ireland, Wales and Scotland are not facing the same issue of funding withdrawal. In December, the Welsh Office announced that the number of district nurses in training is to double in 2018.
The loss of district nurse programmes with all the knowledge, skills and competencies of this specialist area of the workforce, would be the equivalent in medicine of a decision to approach general practitioner training as CPD for junior doctors, with the consequent loss of training for the specialism and significant consequences for the care of the registered population. Such a move would be unthinkable.
“Ring-fenced funding for the district nurse programme in all areas of England is urgently required”
The QNI is calling for support for the funding of district nurse training in England to be reviewed against a robust workforce plan that supports the delivery of appropriate highly skilled care in people’s homes and communities and reduces unplanned admissions and delayed transfers of care.
Confirmation of ring-fenced funding for the district nurse programme in all areas of England is urgently required and supported by central, regional and local workforce plans.
This investment will see a patient-centred approach return to our district nursing services in the community, and reduce the pressures currently being felt in our hospitals.
Crystal Oldman is chief executive, Queen’s Nursing Institute