District nurses have been described as key to ‘unlocking the challenge’ of hospital discharges and admissions, as A&E departments in England report their busiest summer ever.
Latest figures from NHS England show a total of 4.6 million A&E attendances over the last two months – higher than any other June and July.
The data also raised fresh concerns over bed capacity – with only 44.8% of patients discharged when they were ready last month, leading to an average of 12,326 patients a day spending more time in hospital than needed.
Chief executive of the Queen’s Nursing Institute (QNI) Dr Crystal Oldman said the number of patients spending time in hospital unnecessarily ‘shows the huge potential to increase capacity in the community and in social care to enable them to be safely cared for at home’.
She told Nursing in Practice: ‘Most people prefer to be treated at home, or closer to home, and this includes care homes.
‘People grow more frail if they stay longer in hospital than needed, and clinical outcomes are worse.’
And she said that community health and social care services, led and manged by nurses across the UK, will ‘need to be expanded to meet the growing need that we know exists’.
As district nurses plummet to below 4,000 in England – down from 10,000 a decade ago – Dr Oldman stressed there ‘is an urgent need to support the education and training of these expert nurses to provide the capability and capacity to meet the challenge of more care closer to home’.
‘They are key to revolutionising the way people are cared for at home and unlocking the challenge of timely discharges and prevention of admissions,’ she added.
The latest figures follow a recent QNI report, which suggested more district nursing teams are working with 600 or more patients – an increase of 16.2% in a year.
It also comes after the Association of Directors of Adult Social Services (ADASS) said NHS funding for nursing care in residential homes is ‘insufficient’ to recruit and retain registered nurses, according to their 2024 Spring Survey published in July.
The data also saw hospitals report that the overall waiting list for elective care rose again in June to 7.62 million – with an estimated total of 6.39 million patients waiting.
At the end of June, only 58.9% had been waiting less than the constitutional standard of 18 weeks, against a target of 92%.
Nurse lecturer, former emergency care charge nurse and member of the Royal College of Nursing’s (RCN) Emergency Care Forum Matthew Osborne said overcrowding in A&E and capacity issues in the community often impacts vulnerable patients the most.
‘The biggest immediate problem is patient flow – hospitals rely on smooth flow of patients from emergency departments to wards and from wards back to the community,’ he told Nursing in Practice.
‘If the community is bottlenecked or has a lack of capacity, which it does at the moment, it means that the wards can’t discharge which means that the emergency department then can’t admit, that then has a knock-on effect to overcrowding of the emergency department which significantly impacts the quality of care, leading to things like corridor care.
‘And it always seems to be the elderly, vulnerable that require the emergency services that seem to be the ones that end up sitting in a corridor.’
Responding to the data, Professor Sir Stephen Powis, NHS national medical director, stressed that ‘waits for patients across a range of services remain unacceptable and there is much more to do to deliver more timely care for those who need it’.
‘Nobody in the NHS wants to see patients experiencing long delays and we are committed to working with the government to create a 10-year plan for health that includes a clear plan to bring waits down,’ he added.
‘In the meantime, staff continue to work incredibly hard to deliver the best possible care for patients, and it is vital that people continue to come forward when they have health concerns.’
