A new report by the Nuffield Trust finds that one in four district nurses left the NHS in the past year, putting plans to shift more care into the community at serious risk
The UK’s district nursing workforce is facing a significant and urgent challenge, with roughly 25% of nurses leaving the NHS in just one year, according to the Nuffield Trust. Experts warn that without immediate and urgent reforms, efforts to shift more health and care services from hospitals into the community could be seriously jeopardised, threatening patients’ access to vital local care.
District nurses face unprecedented pressures
District nurses, who are dedicated to providing care for patients and supporting their families at home, in clinical settings, and in care homes, 24 hours a day, 365 days a year, are facing unprecedented pressures. However, these services are in a state of crisis.
The number of district nurses is depleting while the demand for care has risen, and will continue to increase. Figures from 2009/10 to 2023/24 show that the number of district nurses has fallen by 43%, while the need for the service has increased by 24%. As more people live longer, demand is expected to grow by another 34% over the next 15 years, reaching 2040. Furthermore, there were 2.8 million fewer district nursing contacts in 2023/24 than in 2009/10.
The analysis revealed a 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).
Strikingly, district nurses typically start on NHS pay Band 6; however, the analysis found that over one in four staff recorded as ‘district nurses’ are in a lower pay band.
Expert commentary
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.”
Commenting on the report, Steph Lawrence, Chief Executive of QICN, who were involved in facilitating early input into the research, said: “Thank you to the Nuffield Trust for undertaking this critical research, which shows the extent of the demise of District Nursing in recent years. There are many factors that have contributed to this, but policymakers have overlooked the District Nursing workforce for too long. If the 10-year plan and shift of care from hospital to community are to be realised, urgent action is required, as it will not happen without a robust District Nursing workforce.
“This is growing evidence as to why we are seeing care left undone – this represents the corridor care of the community, with increasing numbers of coroners’ reports citing lack of District Nursing resource as a factor in patients’ deaths.
“The QICN has been calling on Government and NHS England to ensure we train adequate numbers of District Nurses for a number of years. We now say this has to be seen by Government as a critically urgent issue. More funding to train District Nurses is required, alongside ensuring we have continuation of level 7 Apprenticeships and finally ensuring we remunerate at the correct Agenda for Change band for the specialism – a minimum of band 7 to reflect the advanced and autonomous practice of District Nurses today.”
Responding to a new report from the Nuffield Trust warning that a lack of district nurses risks jeopardising plans to shift care closer to home, Rory Deighton, acute and community director at the NHS Confederation,said: “District nurses are the bedrock of NHS community services and their importance will only grow as the NHS works towards the Government’s ambition to shift care away from hospitals and closer to people’s homes. But it is clear from this report that these services are under immense pressure from a combination of growing patient need and fewer staff.
“NHS England’s recent Medium-Term Planning Framework predicts that a three per cent annual growth in community services’ activities will be needed to keep pace with rising demand. This will require more district nurses, not fewer – both to maintain existing services and to bring care closer to, or into, patients’ homes. We look forward to feeding into the upcoming workforce plan abo
