We need better data on district nursing to safeguard services

District nurses provide a vital service to communities by reducing and avoiding hospital admissions and supporting timely discharge. They work tirelessly to improve the health of vulnerable people. 

However, constraints on funding and staff numbers, coupled with increased demand for their services, are dramatically affecting their ability to provide quality care. A recent King’s Fund report pointed to staff acting as ‘shock absorbers’, working longer hours and more intensely to protect patient care.

NHS Improvement is looking at ways to secure sustainable staffing, but how does it fit in with the current situation out in the field?

There has been little data on demand for district nursing and the level of activity currently taking place, but research indicates significant growth stretching back over many years. This trend looks set to continue.

There is also a lack of information on spending, but the King’s Fund found that many services have had static or reducing budgets, despite a significant rise in activity.

'Ensuring safe staffing isn’t enough when district nurse numbers continue to fall'

Collecting this type of evidence on district nursing is difficult because of the nature of block contracting. There is a significant gap between demand for district nursing and the available resources in terms of funding and staff numbers. Providers are finding it difficult to limit demand for district nursing, but there is evidence of providers tightening access criteria and of increasing delays for non-urgent referrals. Quality of care in district nursing is also being affected.

NHS Improvement’s draft guidance for Safe, sustainable and productive staffing in district nursing services is meant to be used by staff across provider organisations, from team leaders to the board of directors.

It recognises the integral role of district nurses in the community and the need for safe staffing levels. By drawing together expertise from across the nursing profession, it is a step in the right direction for improved workforce planning. It advocates monitoring and taking action if insufficient members of staff are available to meet patients’ needs.

The evidence is clear that poor staffing levels have a serious impact on patient care. However, ensuring safe staffing isn’t enough when district nurse numbers continue to fall and relenting pressures put further stress on staff.

About the author


Kathryn Yates, RCN Professional Lead for primary and community care