All nurses—indeed, the whole healthcare workforce—have been crucial to the UK pandemic response, but the contribution of district nursing services has perhaps been less visible than others. This, in part, is due to the media bias towards hospital services over community-based provision, and television dramas that focus on more dramatic healthcare settings to garner high viewer numbers. However, most healthcare takes place in the home, with the support of primary healthcare and other care and support resources in the community, including district nurses.
The recently published Queen Nursing Institute's (QNI) (2021a) report, Untapped Potential: District Nursing Services and the Avoidance of Unplanned Admission to Hospital, not only celebrates the capabilities of district nurses, but also makes the case for their greater use to avoid unplanned admissions. Not only are district nurses already familiar with many of those living at home with long-term conditions, but they also possess the skills of advanced patient assessment and care management, enabling them to provide the necessary support during exacerbations of existing conditions. While evening community nursing services are widespread, night services are more limited, which restricts the potential of district nursing coverage. A key constraint is the reducing number of qualified district nurses (SPQDN), which has been a continuing trend over the last decade (QNI, 2021b).
If the objective of clinical commissioning groups, health boards and trusts across of the UK to minimise avoidable admissions through better use of district nursing services is to be achieved, it would be ideal if the current impetus to increase the recruitment of healthcare staff, which includes the expansion of initial nurse training places, could be extended to include recruitment into district nursing services. A commitment to a guaranteed number of SPQDN students in training every year, until the loss of qualified district nurse numbers over the last decade is remedied, would also be significant.
However, importantly, practising district nurses need to feel valued and appreciated, in order to minimise avoidable workforce attrition. This is especially significant at a time when NHS capacity and resources are stretched and there is a potential for further twists in the global COVID-19 pandemic. Just as the holiday period may have exacerbated some people's feelings of vulnerability and loneliness if they do not have the comfort of family or a close meaningful relationship, the festive period may exacerbate the feelings of district nurses and other healthcare professionals regarding the tensions of a work-life balance. Increased demands at home, alongside ongoing caseloads with perhaps some of the usual support services being interrupted or reduced, will place growing pressure on already stretched district nursing services. Green (2021) has described how district nursing services are perceived as ‘limitless’, with an expectation that they will step in when other services are unable to deliver care because, unlike hospitals, district nursing services do not have finite bed numbers or other physical constraints.
Here are two wishes for 2022: district nurses should feel valued and appreciated, and, the NHS should increase its investment in district nurses and district nursing services.