NHS experts urge Government action over ‘dire state of district nursing’

The Government’s aim to move more NHS care into the community will not be achieved unless action is taken over the “dire state of district nursing”, experts have warned.

A new report from the Nuffield Trust think tank said one in four district nurses left the workforce in the year to September last year, despite rising demand for care in people’s homes, community settings and care homes.

District nurses are expected to cover every region in England, and services mostly run 24 hours a day, 365 days a year.

Typical district nursing care includes managing wounds, leg and pressure ulcer treatment, end-of-life care and helping people with diabetes.

The new report pointed to a 43% fall in the number of full-time-equivalent NHS district nurses between 2009 and 2024.

Over the same period, there was an estimated 24% increase in the need for district nursing due to the increasing and ageing population.

At current rates, demand will increase further, by 34% in the next 15 years.

Overall, there were 2.8 million fewer recorded district nursing contacts in
2023/24 (29.2 million) than in 2009/10 (32 million).

The new report also said a rising proportion of staff working in district nursing services are not nurses.

The proportion of staff employed in other roles, including as healthcare assistants, has risen from 18% in 2009 to 28% in 2024.

There are particularly low proportions of nurses in some NHS regions, including the South East.

The report added: “As well as supporting the shift towards more person-centred, preventative care closer to home, district nursing services have the potential to save the NHS money.

“The estimated mean average cost to the NHS of a face-to-face district nurse visit – at £57 – is half that of an accident and emergency attendance and around a 40th of the cost of an average emergency short-term hospital admission.”

The Nuffield Trust said restoring the district nursing service to 2009 levels, relative to current population, could cost £376 million.

Nuffield Trust chief executive Thea Stein said: “District nurses make a huge contribution to the NHS through managing long-term conditions, supporting patients with severe illness, and providing palliative care, but for too long this staff group has been neglected by policymakers.

“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.

“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.”

Royal College of Nursing (RCN) general secretary, Professor Nicola Ranger, said: “This report shows the value of district nursing to the Government’s ambitions, but also how far this workforce has been allowed to fall.

“Numbers are half what they were over a decade ago, all while demand has risen and is set to continue to rise.

“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.

“District nursing is among the best investments a government can make.

“They are key to delivering expert interventions to help people live healthier lives in their communities, their visits are vastly cheaper than expensive hospital admission, and they will be absolute vital in the success of the planned neighbourhood health service.

“The Government’s focus on shifting care from hospital to community and from sickness to prevention is the right one, but it’s time for a reality check.

“It cannot be delivered on the backs of a depleted district nursing workforce or by damaging acute care provision at the same time.”

The Department of Health has been contacted for comment.