The decline in the size of the district nursing workforce must be halted urgently in order for community services to develop, the head of the Queen’s Nursing Institute has warned.
Speaking at the institute’s annual conference in London this week, QNI chief executive Crystal Oldman said: “We urgently need more district nurses.
“There are simply insufficient numbers of district nurses to provide the care needed.”
She highlighted that 90% of all clinical interactions now took place in community settings and the NHS was facing a “tsunami of long term conditions”.
Ms Oldman cited a QNI report, published in June, that revealed “widespread and significant concerns” over the number of new district nurses being educated.
She called for a “master plan and commitment” to enable the “excellent work” already being done by community nurses to “continue to grow and develop”. “Part of that master plan includes investment into the education of our community specialist practitioners,” she told delegates.
Ms Oldman added that the QNI was “delighted” to have been involved in drawing up the Department of Health’s district nursing strategy, which was published in January. But she said the strategy – A new vision and service model for district nursing – must be backed with investment.
She said local NHS and education commissioners must work together to fund the nursing teams required to “deliver the care that patients, their families and carers want outside of hospital”.
“Let’s not forget that district nursing is a specialist area of practice…it’s not CPD that can be acquired along the way by taking a few modules and study days,” she warned.
A National Nursing Research Unit report also highlighted similar concerns this week and called for more “robust mechanisms for workforce planning”.
It questioned whether the district nurse workforce was “sufficient, in terms of overall numbers and skill mix”, highlighting the number being trained was exceeded by the number leaving and retiring.
The report cited official data showing the number of district nurses had fallen by 44% between 1999 and 2012, down from 11,500 to 6,400.
It also revealed that the balance between staff groups providing care in the community had shifted. In 2005, district nurses accounted for 20% of NHS staff recorded in the community, but this had fallen to 12% by 2012.
Ms Oldman also used her speech to call for the term “acute care” to be replaced by “hospital-based care”, in order to get away from the myth that community-based care was less complex.
“Nurses talk about working in the acute sector or the community sector,” she said. “There is something fundamentally wrong about this.”
“We’re comparing apples and oranges,” she said, noting that acute described the state of a patient’s health needs while community referred to the environment where the patient was looked after.
“We need to rethink out terminology, because it perpetuates the view that hospital-based care demands a higher level of skill and community-based care demands a lower level of nursing…which couldn’t be further from the reality,” she added.
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