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Wednesday, March 3, 1999 Published at 01:18 GMT


District nursing 'needs modern face'

District nurses' role has become more complex and demanding

The image of district nursing needs a complete revamp to attract younger nurses into the profession, says an Audit Commission report.

One district nurse in 10 is over retirement age and the number of new nurses coming into the profession has shrunk by a third since 1990, it says.

There is also a big variation between the nursing service provided by different health trusts.

District nurses treat 2.75 million patients a year and demands on them are rising.

This is due to the growing number of elderly patients, fast-track hospital discharge programmes and a move towards treating patients with serious or terminal illnesses in their homes.

Complex care

The report, First Assessment, says district nurses spend less time now on routine tasks and more on managing complex care arrangements for patients.

The setting-up of primary care or local health groups in England and Wales in April will bring a further expansion of their role.

[ image: District nurses have changed a lot since actress Nerys Hughes played the part]
District nurses have changed a lot since actress Nerys Hughes played the part
But some of the £650m currently being spent on district nursing is being wasted because of poor management.

For example the Audit Commission finds services vary greatly between health trusts.

Moreover, many managers have not got any strategic plan for district nursing and how it fits in with other agencies.

This can cause gaps and duplication in the service provided to patients.

The report says:

  • Referral rates vary and criteria for referring patients are often unclear. A tenth of referrals are inappropriate and a fifth do not contain the right information. This can cause delays in patients receiving the care they need;
  • The number and skills of staff are often not properly matched to the number of patients they have or their care needs;
  • The quality of care offered by district nurses can fall below good practice guidelines. For example, only a half of patients with leg ulcers should have access to ultrasound screening. This may partly be due to a lack of clinical supervision. Only a half of all nurses had received supervision in the last year;
  • Many trusts do not understand that patients may need more district nursing services at night. Only a third offer services after midnight.

The report recommends that trusts consider operating a more flexible service for patients, with district nurses working shifts to meet peaks in demand.

They could link up with out-of-hours doctors.

One trust which works evening shifts is Community Healthcare Bolton which is commended in the report for listening to patients' needs.

The report also recommends that district nursing be co-ordinated with services offered by other care agencies, that referral procedures be reviewed, that services are kept up-to-date and that more care be taken to ensure nurses' workload is not too heavy.

Andrew Foster, controller of the Audit Commission, said: "In order to manage changing and rising demand, trusts and health authorities should listen closely to the experiences of patients and carers when they review district nursing services."

Image overhaul

A spokeswoman for the Royal College of Nursing said the image of district nursing had not been attractive to young nurses.

However, the service offered had changed considerably in recent years and was much more challenging now.

She welcomed the idea of working more flexible hours, but said a shortage of staff might make this difficult.

The RCN says the service has been seen as a soft target for cuts.

But the report gives "a clear and practical action list" which needs to be backed up with resources and training.

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