Having an accurate count of the community nursing workforce is ‘critical’ to the success of shifting care out of hospitals and closer to home, an influential committee of MPs has been told.
The Health and Social Care Committee today held its first inquiry session since the change in government, in which those behind the Darzi review – a major investigation into the state of the health service – were questioned on their findings.
Cancer surgeon and former Labour minister Lord Ara Darzi and chairman of NHS community and mental health providers in North West London Tom Kibasi gave evidence to the inquiry, which is centred on the development of the government’s 10 Year Health Plan.
A recurrent theme of the session was the lack of data on services and the workforce outside of hospital settings.
Mr Kibasi, who supported the analysis of the Darzi review, reiterated its findings that workforce data for nurses working in community settings was hard to pin down.
For example, he said that where an acute trust ran both hospital and community services in a local area, ‘you can’t differentiate in the datasets between a nurse who’s working in the community setting from a nurse who’s working in the main hospital building’.
He said this was particularly problematic for the government’s aim of shifting care away from hospitals and into the community.
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‘That limitation is really critical if the stated strategy is to shift care from hospital to the community, and you don’t know what the division is in terms of the workforce – that’s a very big data limitation,’ Mr Kibasi told the committee.
The Darzi review, published in September, warned that a lack of investment in community services and its nursing workforce had left the NHS in a ‘critical condition’.
And it claimed the UK has ‘far fewer’ nurses working outside of hospitals compared to other countries and ‘too few resources in the community’.
When asked of the data barriers today, Mr Kibasi said: ‘The first thing we have to do is to start counting it properly, because if we don’t, how can we know whether we’re succeeding or failing?’
And he agreed that ‘what gets measured gets mended’.
‘If we don’t start measuring it, we’ll never know whether we’re fixing it or not,’ he added.
Mr Kibasi said one of the first steps needed was to ‘choose to count’ this data.
‘It’s as technical and simple as you need to flag as to whether a nurse is working in the community setting or working in a hospital setting, or are they working in both, in which case, what’s the division of their time between the two?’ he said.
More widely, he claimed that there was a ‘data desert’ for all care that exists outside of hospitals and that this was largely down to a lack of financial incentives to record data and because hospital data sets were ‘much more advanced’.
As part of the evidence session, Lord Darzi also discussed his findings and warned of the ‘huge amount of strain’ on both clinical and managerial colleagues in the NHS.
‘It’s not easy to work at the National Health Service at the moment, and we should all recognise that, and we have to address that,’ he told the inquiry.
‘If you’re not going to address that, sadly, that moves more patient facing which is tragic.
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‘Because the last thing patients need when they come in for support and for care, [is] having someone who is really overstretched, hadn’t slept overnight because [they’re] on call in the morning, [and where] everything is delayed.
‘You could see how it could end up into a bad place.’
Responding to the comments made today, Queen’s Nursing Institute (QNI) chief executive Dr Crystal Oldman said her organisation has ‘highlighted the paucity of community data for many years and specifically community nursing data’.
‘We have worked with governments to assist in the definitions needed in data collection, as there are many fields of practice within community nursing services,’ she added.
‘For integrated trusts delivering community services, it is vitally important that they measure the care provided by community nurses.’
‘What happens in the community cannot be an “unknown” for systems to function effectively. Provider organisations should share best practice if we are to make quick progress in this area.’
She added that while nurses also know the importance of gathering data about care being delivered, some have been ‘hampered by systems that make it challenging to collect data’.
Dr Oldman also suggested that the ‘importance of good data’ is not always ‘communicated through the system’.
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She added that the QNI was ‘actively working with several parts of the current government to demonstrate the value of investing in and strengthening the district nursing service as the core service, available 24/7 in every village town and city’.
Today’s evidence session comes as part of the Health and Social Care Committee’s inquiry into the development of the government’s 10 Year Health Plan.
The plan is supported by the publication of Lord Darzi’s review which highlighted the overarching need to shift spending away from secondary care and towards community and primary care and prevention.
