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District nursing is a piece of the healthcare jigsaw we can’t afford to lose

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“We cannot continue to invest in the same service models of the past. We need a radical shift in how the NHS sees itself, from a hospital service for the ill, to a nationwide service to keep us healthy.”

So said health and social care secretary Matt Hancock in his keynote address to the annual general meeting of the International Association of National Public Health Institutes earlier this month.

The minister used his speech to launch Prevention is Better Than Cure – the government’s vision for a new national strategy on illness prevention.

”A report from the Queen’s Nursing Institute showed that numbers of district nurse students had declined”

He told delegates at the event that an “overwhelming majority” – £115bn – of the NHS budget was currently spent on acute care, while £11bn was spent on primary care, and vowed to redress the balance with a funding boost for community and primary care services.

“With an ageing society and people living with multiple complex conditions it is imperative that this rebalancing happens – to keeping people well, living in the community, and out of hospital for longer,” he said. 

It is therefore alarming that earlier this month fears were raised about the future of district nursing.

A report from the Queen’s Nursing Institute showed that numbers of district nurse students had declined.

QNI chief executive Crystal Oldman said this decline in students was against a backdrop of a 46% plunge in district nurses since 2010.

Between 2013-14 and 2014-15, the number of people entering a district nurse specialist practitioner programme increased by 32% from 427 to 566 and stayed stable in 2015-16 at 565. However, in the last academic year the number of new students fell to 551.

There was also a 10% drop in the number of people qualifying from a district nurse specialist practitioner course in 2017, compared with 2016, and a slight reduction in universities offering the qualification, from 44 in 2016 to 42 in 2017.

Dr Oldman said funding and workforce issues were preventing healthcare bodies from releasing nurses for training.

She said provider organisations were “crying out” for more support to enable their nurses to enrol on a district nursing programme, but warned of the barriers standing in their way – namely funding to pay nurses a decent wage while they trained and finding the backfill nurses to cover students while they were studying.

Her message was clear: “At a time when more care is required to be delivered in the community, when we want to free up as many hospital beds as possible – we have the potential to fix this problem … and yet we are not investing in any kind of intentional way into that workforce. When we all need a district nurse in the future where will they be?”

Mr Hancock’s message has also been clear. At the Conservative Party conference he announced a £240m funding injection for adult social care to be used to tackle winter pressures and free up hospital beds.

“Mr Hancock has been consistent in his call to protect the long-term sustainability of the NHS”

Chancellor Philip Hammond went further in his Budget and announced an additional £410m for social care. The Budget red book said: “Where necessary, local councils should use this funding to ensure that adult social care pressures do not create additional demand on the NHS. Local councils can also use it to improve their social care offer for older people, people with disabilities and children.”

Mr Hancock has been consistent in his call to protect the long-term sustainability of the NHS – and in acknowledging the importance of a strengthened community healthcare sector in achieving that end.

He now needs to demonstrate that he understands exactly what that will mean and what it will need – it will mean drawing on the clinical expertise and social reach of community nurses and will need a strong and strongly protected district nursing profession. It will also need a conversation with the QNI to ensure this can – and does – happen.

Mr Hancock appears to have grasped the huge contribution the nursing profession makes to national health and wellbeing.

He must surely realise that with so many pieces of the long-term healthcare strategy jigsaw now being identified and acknowledged, overlooking and ignoring such a vital piece as the future of district nursing is not an option.

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