The report, Understanding quality in district nursing services investigates what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff and puts forward a framework for understanding the components involved. It also looks at the growing demand–capacity gap in district nursing and the worrying impact that this is having on services, the workforce and the quality and safety of patient care. The report makes recommendations to policymakers, regulators, commissioners and provider organisations as to how to start to address these pressures.

Key findings include:

• Staff, patients and carers have strongly aligned views about the components of ‘good’ district nursing care, valuing a ‘whole-person approach’ with a focus on relational continuity, involvement of family and carers, patient education and self-management support, and care co-ordination.
• Activity has increased significantly over recent years, both in terms of the number of patients seen and the complexity of care provided. However, there are significant problems with recruitment and retention of staff, and available workforce data indicates that the number of nurses working in community health services has declined over recent years, and the number working in senior ‘district nurse’ posts has fallen dramatically, creating a growing demand–capacity gap.
• This is having a negative impact on staff wellbeing, leading to poor morale, stress and fatigue. Some staff are leaving the service as a result.

The King's Fund says that these workforce pressures risk compromising quality of care. The report's authors found examples of an increasingly task-focused approach, reductions in preventive care, visits being postponed and lack of continuity.

Responding to the new report, Janet Morrison, Chief Executive of Independent Age, said, 'District nursing is a vital service helping keep frail elderly people out of hospital, so it’s appalling that staff have less and less time to help. We need more, not fewer, district nurses as our ageing population continues to grow. A lack of support for these crucial community health services is ill-judged and short sighted, which is likely to result with more elderly people ending up in hospital.'