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Health & Social Care Committee

Community & District Nurses (pdf)

Published: 21st August 2019

“If we are to support individuals and their families to manage their health at home, avoid unnecessary hospital admissions, enable early discharges and help maintain people’s independence then we need a clear picture of what the community nursing situation is in Wales at the moment and investment in the service. “For the service to improve and thrive we need to make sure that staffing levels are right, that nurses are provided with the mobile technology they need to do their jobs effectively and that community nursing is seen as an attractive career.”

– Committee Chair, Dr Dai Lloyd AM (Plaid, South Wales West)

1. District nursing is an “invisible service” that urgently requires better management

Despite district and community nurses providing a link between acute health services, primary care, palliative/end of life care and the promotion of independent living, there’s no clear vision for the sector.

There’s no information regarding the skills mix, number of district nursing teams, number of specialist children’s community nurses or even the number of patients being seen by them. Without this kind of information, it’s nearly impossible to plan the workforce and it results in the service becoming “invisible”. This makes the proper integration of health and social care (something the Welsh Government and Plaid Cymru have long supported) far more difficult.

“Morale is quite low, I think, particularly at the senior levels, in community nursing because of the tremendous pressure they’ve been under and feel that they’ve been under for a long time, and also this feeling, as I say, of being invisible to the wider service.”

– Lisa Turnbull, Royal College of Nursing Wales

The Committee called for an urgent audit of district nursing (particularly children’s nurses) and for district nursing to be properly recognised in recruitment campaigns and workforce planning.

However, the Chief Executive of NHS Wales, Dr Andrew Goodall, said that the direction of travel was towards broader approaches focusing on all specialities at the same time instead of individual strategies. The Nurse Staffing Levels Act currently doesn’t apply to district nurses but there are early discussions on extending it.

2. The number of district nurses has increased…..or has it?

There were 989 district nurses in Wales during 2018, an increase from 827 in 2017. The Royal College of Nursing (RCN) Wales, however, believed the statistics were inaccurate due to coding errors, with all nurses working in a community setting in some health boards being counted as district nurses, when it should only count those with a specific district nursing qualification. The Committee also heard of a lack of data regarding the number of palliative care patients being seen by district nurses.

Several organisations – notably Macmillan and Hospice UK – said district nursing services were over-stretched and under-staffed. Enrolments on district nursing courses across the UK have been steadily falling and the workforce is ageing. However, three Welsh health boards said they had few problems recruiting replacements – though the number of replacements required soon will become an issue. Some community nurses called for smaller teams lead by one or two experienced nurses.

The Welsh Government accepted problems with data collection and the issue has been raised with health boards. Dr Andrew Goodall believed the overall figures on the number of district nurses were broadly accurate.

3. District nurses need to be able to access technology to do their jobs effectively

Access to technology was described as the single biggest issue raised during the inquiry. Half of district nurses who responded to the inquiry said they didn’t even have a mobile device to access basic administrative software.

It’s been a problem for patients as well, some of whom try to contact nurses to change or cancel appointments but have been unable to do so.

Cwm Taf health board has piloted Malinko scheduling software and in the short time it’s been in use it’s already being seen as beneficial for staff and patients. The system has also been developed with nurses’ needs in mind.

The Committee recommended the Welsh Government work with health boards to ensure district nurses are provided with hand-held devices – with instant access to patient information, appointments and e-mails – as standard.