The health secretary has acknowledged that a “big push” is needed to increase the number of nurses working in community settings in order to move more care out of hospitals.
Jeremy Hunt said last week that a similar increase in nurses to that seen over the last year in hospitals – dubbed the “Francis effect” – would be needed in the community to deliver the government’s new Five-Year Forward View policy.
“We need to look at the nursing manpower outside hospitals”
His comments, made at the chief nursing officer’s summit in Manchester, came in the same week that the head of the Royal College of Nursing warned MPs about the well-documented decline in the number of district nurses over recent years.
Mr Hunt said: “We need a different model of care that is based around keeping people healthy and happy at home, and trying to prevent the onset of illness and trying to prevent people developing long-term conditions.
“We will always need fantastic hospitals and we’ll need as many hospitals, and frankly as many beds as we currently have,” he said. “But what we need to see over the next five years is better out of hospital care. What we need to make [it] possible is more district nurses, more practice nurses, more community nurses. We need a big, big push on nursing in the community.
“Just in same way we as the NHS has responded so brilliantly to the Francis report by getting in the last year alone 5,000 more nurses on regular contracts on out wards, we need to look at the nursing manpower outside hospitals as well,” added Mr Hunt.
Meanwhile, RCN chief executive and general secretary Peter Carter urged the government not to recruit additional health visitors at the expense of district nurses, after latest workforce figures indicated a continual decline in posts.
Mr Carter claimed the government’s recruitment target of 4,200 additional health visitors by April 2015 was part of the reason for the reduction in district nurse numbers.
Giving evidence to the health select committee last week, he highlighted latest official figures showing there are now just 5,595 district nurses in England, compared to 12,000 in 2003.
“We have seen a massive reduction in the very workforce that is needed as part of a team to keep people out of hospitals”
The figures – published this month by the Health and Social Care Information Centre – show a 28% decrease in the number of district nurses since May 2010, when the government introduced its health visitor target. It represents a loss of 2,218 nurses, down from 7,813 in May 2010 to 5,595 in August 2014.
In contrast, the figures show there has been a 27% uplift in health visitor numbers in England over the same period – an increase of 2,173 from 8,092 in May 2010 to 10,265 in August 2014.
Mr Carter said: “The government are committed to creating an extra 4,200 health visitors – and we think that’s a very good thing – but please, don’t recruit them at the expense of district nurses.
“People are robbing Peter to pay for Paul. That’s no way to run a health service,” he told the committee.
He also echoed Mr Hunt’s points by saying that district nurses played an important part in keeping patients out of hospital, which addressed a key ambition of NHS England’s five-year plan to shift care to community settings.
“In 2003, there were 12,000 district nurses. What did they do? They kept a lot of people out of hospital that would have developed conditions that required admission and also facilitated appropriate discharge from hospital,” said Mr Carter. “In a decade or more, we have seen a massive reduction in the very workforce that is needed as part of a team to keep people out of hospitals.”
He said district nurses represented a link in the workforce that “do so much to lessen the pressure that is currently being felt” and needed to be “reinserted”. The number of district nurses needed to be improved beyond the 12,000 last seen in 2003, he said.
A Department of Health spokesman strongly denied that the government’s recruitment of additional health visitors had caused a greater decline in district nursing numbers.
He said: “The increase in the number of health visitors is a result of new additional funding, not a reduction in other nursing budgets. We are working hard to boost the number of district nursing students, which are now increasing.”
The DH spokesman highlighted a number of initiatives that were underway to boost levels of district nurses, including Health Education England’s plan to increase commissioning places by around 7% and the launch of a working group by the chief nursing officer to review how to increase provision.
He also said the DH was committed to training 10,000 more frontline community staff by 2020.