Our CEO Deborah McCain and I were invited by our partners The Queen’s Institute of Community Nursing (QICN) to attend the District Nursing Event at the House of Lords in May. 

This event was to discuss the future of District Nursing and the support of the 10-year NHS plan to deliver care closer to home within communities. One of the things discuss was the recent work undertaken by Nuffield Trust on commissioned by the QICN.

I think it’s extremely important to share and discuss their analysis on this. The main points as below:

43% Collapse in Workforce Since 2009

• The number of NHS district nurses dropped from 7,643 in 2009 to just 4,322 in 2024, a decrease of 43%
• This decline is juxtaposed against a 43% rise in hospital-based adult nurses over the same period
• Relative to Community Need – Over Half the Capacity Lost
• Even more striking: when scaled to population and community care demand, district nurse staffing levels have plummeted by around 55%
• That equates to losing the equivalent of 4,200 full-time district nursing roles.

Underpaid, Underqualified – A Shift in Skill-Mix

• 27% of those recorded as district nurses are in pay bands below the expected Band 6
• Only 3,171 nurses at Band 6 or above remain—just one in 117 of all NHS nursing staff
• The deskilling trend removes senior leadership in district nursing—missing a vital linchpin in quality care.

Fragmentation of Services & Missing NHS Data

• Part of the drop may stem from the shift of services into the voluntary and independent sectors – services now invisible in NHS employment data
• However, this only partly explains the long-term decline, with data showing a sustained downward trajectory even after adjusting for external providers.

Impact on Patient Care & Staff Wellbeing

• Royal College of Nursing warns district nursing is running at “sometimes unsafe” staffing levels, risking missed care and burnout
• A 2024 Queen’s Nursing Institute survey highlights high caseloads, unpaid overtime (often >4 hours weekly), widespread delays/cancellations, and IT and administrative deficits
• Common consequences? Cutbacks in psychological support, unsatisfactory assessments, and incomplete continence care .

Voices from the Field

Community nurses describe the profession as “truly holistic and person centred,” yet express deep frustration with limited IT, administrative support, and soaring caseloads.

What Needs to Happen

1. Urgent investment in district nursing capacity and skill levels—especially Band 6+ roles
2. National workforce planning, including data collection and safety benchmarks—such as maximum caseloads and time-per-visit standards .
3. Technology and admin upgrades to reduce clinician burden and improve efficiency
4. Better integration with Primary Care Networks and voluntary sectors, with transparent data to capture the full picture

At Hallam Medical, we are committed to ensuring that the value of Community and District Nurses is not overlooked. By continuing to invest in and advocate for this specialty, we can help our healthcare clients deliver the highest quality of care where it matters most – within the comfort of patients’ homes.

As the NHS moves forward on delivering care outside hospitals, we must ensure district nursing needs to be the cornerstone of that strategy. This analysis makes it clear that without reversing these workforce declines and improving support structures, the promise of community care will not be able to be delivered.

So, now is the time to support our community colleagues and their call to improve funding and aid them in the facilitation of excellent care.