With one in four district nurses leaving the profession, a question mark remains over government plans to move healthcare to the community.
Despite government plans to move more NHS care into the community and out of hospitals, an estimated one in four district nurses left the workforce in the year to September 2024.
A report from the Nuffield Trust sets out how district nursing services, which are intended to provide care for patients and support for their families at home, in clinical settings and in care homes, are struggling.
The report outlines that the supply of nurses is plummeting while demand for care has risen and is set to rise further. From 2009 to 2024, the number of district nurses fell by 43%, while the need for the service is estimated to have risen by 24%.
It is projected that, as more people live for longer and with more complex health needs, demand will increase by another 34% over the next 15 years to 2040. The Nuffield Trust estimates that restoring the service to 2009 levels, relative to the current population, could cost £376 million.
“The consequences we have uncovered are stark – far fewer patients are getting crucial support from district nurses, despite the ever-growing need for these services,” said Nuffield Trust chief executive Thea Stein.
The analysis also found concerning variation in patient access to services across the country, with the number of staff recorded in district nurse roles significantly higher in the North West (13.7 nurses per 100,000 needs-weighted population) but lower in the East (2.8), South East (3.3) and South West (4.4).
Impossible workloads
Previous studies have highlighted issues with district nurses’ experience of work. Up to a fifth (19%) of district nurses’ time is spent on administrative tasks, and in a 2023 survey, a quarter of the workforce reported that they are carrying out more than seven hours a week of unpaid work. The heavy workload is regularly cited as a factor by those leaving the workforce, while the lack of senior roles and access to professional training and development also impacts retention.
“Under these circumstances, it is little wonder these nursing experts face impossible workloads, with unpaid work the norm and now many choosing to quit altogether. You can draw a straight line through the failure to invest in district nursing and the crisis we see today in hospitals, crammed full of vulnerable people who should not be there,” said Royal College of Nursing general secretary and chief executive Nicola Ranger.
The report sets out a range of recommendations to reverse these trends and improve the supply and retention of district nurses. This includes calling for the Department of Health and Social Care and NHS England to work with employer representatives to ensure there is a mechanism and funding in place, so all newly qualified district nurses have an appropriate role available to them.
“If the government doesn’t begin to address the glaring issues with district nursing and build a workforce plan that better supports this pillar of community care, it will be a core weakness of efforts to shift more care from hospital to home. Urgent action is needed to ensure the training pipeline for district nursing is fit for purpose,” said Stein.
