Dying patients go without care as community nurses ‘on their knees’

Across England a third of district nurses say they are now being forced to delay visits to end of life care patients because of surging demand and a lack of staff. This is up from just 2 per cent in 2015.

Dying patients are going without care in their own homes because of a collapse in community nursing services, new data shared with The Independent reveals.

The situation means some patients may have to wait for essential care and pain medication to keep them comfortable.

Other care being delayed includes patients with pressure ulcers, wounds which need treating and patients needing blocked catheters replaced.

More than half of district nurses said they no longer have the capacity to do patient assessments and psychological care, in an investigation into the service.

Professor Alison Leary, director of the International Community Nursing Observatory, said her study showed the country was “sleepwalking into a disaster,” with patients at real risk of harm.

She said the situation was now so bad that nurses were being driven out of their jobs by what she called the “moral distress” they were suffering at not being able to provide the care they knew they should.

“People are at the end of their tether. District nurses are reporting having to defer work much more often than they did two years ago. What they are telling us is that the workload is too high. This is care that people don’t have time to do.”

The findings come as community nursing is being leaned on by other parts of the NHS to keep patients out of hospital. This is happening alongside a 36 per cent rise in patients dying at home during the pandemic, and tens of thousands of Covid survivors being discharged from hospital with long-term needs.

The numbers of district nurses working in England have halved in the past decade and while England is training around 700 a year, the Queen’s Nursing Institute has said the numbers need to double to at least 1,400 a year.

In the study of activity carried out in 26 areas across England as well as data from more than 922 district nurses, Prof Leary found a significantly worsening picture in the amount of care nurses were being forced to delay each shift.

In 2019, more than 60 per cent of district nurses said they did not defer visits to patients. In 2021, less than five per cent said they never delayed visits. A total of 15 per cent said they always had to delay visits, while 30 per cent said this was usual most days.

Nine out of 10 district nurses say they are working unpaid overtime, with more than a third working up to three hours extra a week. Another 30 per cent said they are working between four and six hours unpaid while more than 15 per cent said they were working between seven to 10 hours a week extra without pay.

Prof Leary, chair of healthcare and workforce modelling at London South Bank University, told The Independent: “The risks are catastrophic. If patients’ needs are not being assessed, there is no way you can meet them. The numbers of nurses have gone down but the complexity of the work and demand for their service has gone up.”

She said the care by district nurses was among the most specialist and skilled she had ever seen adding: “There is no difference between acute care in the community and acute care in a hospital but district nurses have no ability to say no and they are picking up work from other services.”

One district nurse from the northeast of England, who had worked in the community for more than five years, told The Independent she had sleepless nights over the care she was unable to give.

“It is just horrendous. The workload is just unrelenting, there are too many patients and no one stands up for district nurses. We just have to keep saying yes.”

She added the teams often had crisis calls come in at the end of the day with a two-hour response time: “We have to put everything on hold including things like palliative care. We don’t have the capacity so these calls come in at 4pm and we have to leave some things.

“Some people are going without care.”

The nurse, who asked to be anonymous amid fears for her job, said her team already had five vacancies and two more staff preparing to leave.

She said she often lies awake at night worrying about the patients who she was unable to see.

“My daughter turned to me recently and said ‘I hate your job. You are never at home and we never do anything because you are always working.’ This was gut-wrenching to hear.”

The Queen’s Nursing Institute, the world’s oldest nursing charity, which champions community nurses, is pushing for a proper workforce plan to try and reverse the crisis in care and is also consulting on new workforce standards.

Its chief executive Crystal Oldman told The Independent the state of services were a “high risk situation” adding: “We know these problems are happening and we are not addressing it. I don’t understand why we are not paying more attention to this and learning from those areas that are getting it right.

“A clear and detailed workforce plan for community nursing is essential.”

She added the problems with care being delayed meant there had to be a risk to patients’ health: “There is a great risk of harm if we are deferring care.”

She said staff were exhausted and were burning out: “We are seeing people who have been doing this job at relentless pace for years and are now on their knees and saying they can’t do the job they trained to.”

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