RCN & NMC will need to be proactive in supporting Community Services as the caseload is very heavy and it is increasing daily. Workforce is reducing. Community Nurses are visiting 12-17 patients daily per staff in my organisation. Staff are working like headless chickens and the morale is low, sickness is high. Turnover is high, recruitment & retention is low.
I found this article at 2am by searching google with 'does anyone else have problems with bad district nurses.' I was feeling at my whits end, scared feeling very lonely and vulnerable our my situation.
I am part way through reading this report and I am so relieved that this isn't just happening to me and that someone is recognising some, and from what I have read so far, only some, of the problems and issues with the District Nursing care as it stands today.
I am left to manage with my mum on my own, our district nurses have been out 3 times in 6 months, they have been rude and ill mannered towards both me and my mum but particularly me, my data protection has been breached and one of the nurses brought up some of my medical history in front of my Mum which caused pure embarrassment to me and upset to my mum and was information I have no idea how she had due to her not having anything to do with my healthcare, they have at times seemed argumentative and it has been clear on their visits that they haven't wanted to be here at all.
We have been given wrong information on who to call or what to do when my Mum has an exacerbation or deteriorates. I could list a catalogue of dangerous and unprofessional incidents involving the District Nurses which I have tried to complain about or highlight but finding out who and where to go is absolutely impossible, the NHS structure is a very messy machine indeed. The pathways to contact them or how to raise concerns or complaints are very guarded, I have been put through to a variety of people and departments. I phoned one of 3 local CCG's and asked if they commission the District Nurses and the phone was immediately put down on me. I have been to see my local MP who told me it's political and I can't change or influence the politics.
I have felt very scared the lack of medical care my mum has but after the last visit form the district nurse on Thursday, where she seemed that angry it was uncomfortable and intimidating. During the visit my mum was spoken to very badly and handling quite roughly, she is 31kg in weight too, and I was given a dressing down about money they have to pay out over a mattress we managed to get for her as the district nurses have to pay a daily rate for it. My Mum cried when she went and was scared of them having to be the ones we rely on when she gets worse. I'm very scared of that too.
Something really needs doing and someone needs to really get their hands dirty and investigate thoroughly the true extent of the worse hit areas. As I do believe that the district nursing has some amazing nurses giving excellent and valuable care. The district nurses that cover my area for example are made up of community nurses and health care assistants. Apparently the funding for Matrons was pulled and we do not have any community matrons.
Before I took a break in my employment to look after my Mum I worked in the public sector for a Police Force as a Crime Scene Investigator; I guarantee you all sectors of the community, including criminals are treated with a lot more respect and dignity by that profession than they seem to be getting away with in areas of Health Care.
I hope something positive comes out of this report.
loads of reports by loads of authoritative persons, ending in little or now change. DN's of the future it is your chance to change a culture and an attitude and to nurse the had hoped
Ami David www.questhealth.co.uk
Thanks for the kind words about the report.
We were keen to ensure the work to describe quality in district nursing was grounded in the experiences of patients and staff and what they thought was important. The care actually ongoing and the ideal care that people described didn't involve much in the way of telecare.
This could be because it's not much used in those areas at the moment or because people weren't aware of potential, or because they didn't see it as being much of a benefit to their particular situation. We don't know but it would be interesting to understand further.
We did hear a little bit in one trust about how mobile technology was working well for staff and wrote about this in the report. But in some areas, there are infrastructure barriers to overcome before this can be useful.
Of course, we're very interested to hear your thoughts about how the kind of technology you have in mind can help with quality in district nursing.
As the programme leader for programmes teaching the specialist qualification in district nursing and for supporting pre-registration student nurses in their community placements, I am passionately committed to encouraging more people to consider community nursing as an area of practice to move into. I have had 20 district nursing students who have all successfully completed their programme this year and will have 17 starting later this month on the next cohort. This is fantastic but a drop in the ocean in terms of what is needed to address the service requirements across the country. The challenges are multiple but three key areas not highlighted in the report are:
1- the experienced district nurses who can mentor students are less available as recruitment and retention is affected by the issues raised in the report. (The qualification to be a practice nurse and assess student district nurses can take up to 4 years to achieve after initial qualification.)
2- Following the implementation of changes to nurse education funding outlined in DH (2016) Reforming healthcare education funding: creating a sustainable future workforce, the funding for the specialist educational programme for district nurses is no longer coming from the local Health Education England offices and future sources are not yet clear, This means that the source of funding (if any) for places for students hoping to commence in September 2017 is not yet know.
3- as NHS Trusts and other employers providing district nursing services are facing increasing financial pressures and are looking to make savings, often freezing vacancies or expanding teams to cover ever larger areas, are quick ways to make achieve these goals which they are compelled to achieve to avoid triggering "red lights". Thus despite the evidence that care is improved with the key role of the specialist practitioner in district nursing as the team leader (QNI (2015)The Value of the District Nurse Specialist Practitioner Qualification), not all successful students on these challenging programmes secure posts at the end of their studies.
In our local area we have some excellent collaborative relationships with local Trusts, practitioners, commissioners and I feel very lucky to have this as it has ensured that investment in the specialist practitioner qualification in district nursing has been maintained over a difficult time and grown in more recent years. I hope that these wider pressures outlined in the report and above, are not ignored as the current situation described by the King's Fund is not sustainable. Feedback from a patient, to one of my students recently was "She cared." I hope I can see that in future too.
Question: Why is telecare / care technology not mentioned?
Firstly, whilst I run Nursing Homes, I nevertheless genuinely believe in the desirability of living in ones own Home, so far as is desirable, beneficial and safe. However, in my view, the pendulum has swung too far, to the point whereby living in ones own Home is seen as an desirable end in itself, irrespective of the conditions (i.e. difficulty coping, loneliness & isolation) and consequences.
Secondly, I comment that conversely, (and inappropriately) Care Homes, are simplistically denigrated as institutions, in a somewhat binary fashion (as if Home = good / Institutions = not good) and with the many unsavoury connotations of that manipulative use of language which is now commonplace.
I suggest that instead we should be both improving the support for those desiring, benefiting and able to live safely at Home, and also support the development of better quality of life in Residential care for those who can't, rather than perpetually demeaning those who need them, negatively manipulating the language we use in regard to Residential Care, and constantly undermining its residents through underfunding, poor commissioning, and excessive and destructive safeguarding by the very same commissioning authorities.
Thirdly, turning to the purpose of the report which highlights concerns about District / Community Nursing, I comment on my own experience. District Nurses are also expected to attend Residential Care Home Residents. In that respect, I echo or extend many of the comments made in the report. I speak from both the experience of my late mother's care in her own Home, and also the decreasing support in Residential Care generally over 15 years, which has led to poor / inconsistent Nursing care, and a deterioration of working relationships (through pressure of work on the DN).
Fourthly, whilst I shall not repeat the points made, I will add that this report is sadly reminiscent of the Francis report upon Mid Staffs, and no doubt with similar risks.
Fifthly I highlight the perversity of the graph of reducing Nurse numbers, which is truly shocking given the rise in the numbers of elderly people at Home, and the promoted concept of care at Home which is at best patchy.
Sixthly, I point out the same 'malaise' applies to the commissioning of Nursing beds. Nursing placements have dropped exponentially, which is also paradoxical, given that if there are less Nursing placements, and less District Nurses yet more people with Nursing needs and living longer with them, something is clearly very wrong.
We seem to be on a trend started with grave consequences in 1990, when Government policy was then in theory to support more people at Home (which did not materialise) and back then residential care was decimated, as is happening again now. It seems that cost reduction prevails over all else and a result of that, political dogma and a lack of support for the elderly, our systems for caring for our elderly are in a truly shocking state, at every level.
Geoffrey Cox MSc LLb