District nurse shortage increasing admissions for older people

Age UK has called for reforms in how older people are cared for in its State of Health and Care of Older People in England 2023 report, published last week.

The report argued that over-reliance on acute hospital-based care needed to be replaced with a focus on prevention and early intervention, to enable older people to stay fit and well in their own homes and care homes.

“We need a district nursing workforce that has the capacity to support the number of people in need”

Crystal Oldman

At present, there were significant numbers of hospital admissions for older people that could be avoided if they received help earlier on, said the charity in the report.

It warned that in 2019-20 alone there were 855,000 emergency admissions to hospital of older people, which it argued could have been avoided with the right care at the right time.

These worrying statistics come because older people have found it hard to access the support they need from community and social care services, due to the lack of staff available, the report noted.

It said any growth in the number of nurses had been been “heavily tilted toward acute care”, with around 16% more adult nurses between 2016-17 and 2021-22, compared with just 7% more community nurses.

Meanwhile, it added that district nursing numbers had “consistently gone down during that period”.

The report said: “If there are insufficient numbers of district and community nurses, then hospitals may not only need to delay discharging patients but will also see increases in admissions and readmissions.”

Age UK described the workforce situation as a “vicious cycle” in recruitment and retention of community and district nurses.

The report said that understaffing was increasing the pressure on the district nursing workforce, which in turn was causing more nurses to leave the profession, resulting in an increased “demand-capacity gap”.

In addition, the report also described how the social care sector was experiencing similar recruitment and retention issues.

It comes as the body Skills for Care revealed last week in an annual report that there were still 152,0000 vacancies in adult social care in England.

Age UK echoed this, and warned that the vacancy rates for registered nurse, care workers and managers were all “the highest they have been since this data started being collected”.

It added that many registered nurses working in social care had “moved to jobs with better pay and conditions in the NHS”.

As a result, some care homes have had to stop providing nursing care, the charity report said.

However, the report argued that these trends could only be tackled with “strong political leadership from the government”.

Age UK called for a strong strategic push “reverse the decline” of primary and community health services and social care, so older people can get help earlier.

This would enable them “to stay well for longer at home” and reduce the reliance on crisis care in hospitals, it said. Meanwhile, it also highlighted the need for a “home first approach to care”.

The report cited parts of health and social care that were pioneering this kind of approach, including the development of community falls services, hospital at home services and virtual wards.

“All these approaches and more are already becoming part of the mix in some communities, we simply need many more, everywhere,” it said.

Crystal Oldman

Caroline Abrahams, charity director of Age UK, said: “We urgently need an ambitious social care workforce plan, one that recognises the fantastic contributions of our care staff and rewards them fairly.

“The drive to recruit more care workers from abroad has been pretty successful, at least for some care providers, more so than many of us had expected, but meanwhile we know we are haemorrhaging more experienced care workers, including registered managers in care homes.”

Responding to the research, Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “The Age UK report marshals the evidence to show what barriers are keeping older people in hospital unnecessarily and a shortage of district nurses in the community is one of the most significant factors.

“If we are to achieve the ambition of caring for people in their own homes in later life, and avoiding hospital admissions, we need a district nursing workforce that has the capacity to support the number of people in need.”

Meanwhile a Department of Health and Social Care spokesperson said: “We recently published our Next Steps to put People at the Heart of Care plan – setting out how we are spending up to £700m on adult social care reform over the next two years to make sure people get the right care at the right time, including £250m  for the workforce.”

In addition, the spokesperson added that the government was investing £1.6bn over the same period “to support timely and safe discharge from hospitals into the community”.