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Norfolk community nurses warn they are struggling to cope

PUBLISHED: 10:01 22 May 2012

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Community nurses in Norfolk are warning they are struggling to cope and fear the situation will only get worse as more emphasis is placed on treating patients in their own homes.

Their concerns are voiced in a Royal College of Nursing report to be considered by Norfolk councillors later this week.

And one MP fears Norfolk’s ageing population will only make matters worse in years to come,

More than two thirds of district nurses who responded to a union survey in Norfolk, Suffolk and Cambridgeshire say they are too busy to deliver the quality of care as it should be.

In Norfolk 53pc of district nurses, who can also be referred to as community nurses, said they did not agree that they had capacity to visit more patients if needed, with one Norfolk nurse branding the staffing levels as “dangerous”. This compared to 45pc in Suffolk and 66pc in Cambridgeshire.

The survey results are contained in a report by the Royal College of Nursing is to be considered by members of the Norfolk Health Overview and Scrutiny Committee at a meeting on Thursday.

The report details concerns that community services do not have the capacity to cope at a time when both the new health act and NHS savings plans are based on moving patients care out of hospitals into the community.

Earlier this year the union revealed that during a six-month period from February to October last year, there was a 12pc fall in the number of district nursing staff.

However Norfolk Community Health and Care (NCH&C), which is in charge of providing community health care in Norfolk, excluding Great Yarmouth, says there has been a 20pc increase in the number of qualified community nurses since 2010 and that staffing is at its highest level for three years.

Anna Morgan, NCH&C’s director of operations, said: “We have actually seen a 20pc increase in the number of our qualified community nurses since 2010, which equates to an additional 41 community nursing posts, the majority of which were within the higher bands, band six and above.

“We now have 266 qualified community nursing staff working for local people right across the county, our highest level in three years.”

NCH&C’s community nursing and therapy service is to allow adults, including older, frail, less mobile and vulnerable patients, to receive interventions either within or close to their own homes, which focus on maintained or improved health, comfort and independence, promoting self care wherever possible.

This can include services such as end-of-life care, management of patients with leg ulcers, long-term conditions, continence problems and post-operative support.

The RCN report also raises concerns over the mix between qualified, or registered nurses, who are band five and above, as compared to unqualified staff working at bands three and four within community nursing teams.

Andrew Stronach, regional communication officer for the RCN Eastern, said: “Those who are unregistered need some element of supervision and access to registered nurses, which is much harder when they are working in the community than it is in a hospital ward.

“Increasingly, patients are having more complex problems as well and we are worried that the mix is moving towards tipping it the wrong way and relying overly on health care assistants.”

The RCN Eastern survey, for which there was 139 responses, showed that three of the 27 who responded in Norfolk said there was not a qualified district nurse in their team, while for Cambridgeshire this was four out of 14, and for Suffolk, three out of 16.

The original skill-mix within community nursing and therapy teams in Norfolk was 60pc qualified staff to 40pc unqualified staff, but it is now 57pc qualified staff and 43pc unqualified.

However, NCH&C says a review found that many of the senior qualified staff were carrying out low level tasks that could easily and safely be undertaken by appropriately trained unqualified staff.

In Norfolk, one nurse told the RCN: “The recruitment of band three and four generic staff, rather than qualified nursing staff, is undervaluing the complexity of quality nursing care delivered in the community.

“The dangerous levels of staffing currently experienced needs to be seriously addressed and incident reports need to be acknowledged. District nursing is currently a very stressful area to work and care delivery is unfortunately compromised.”

Norman Lamb, North Norfolk MP, said the results of the survey reinforce the case for better integration of health and care services.

He added: “I can quite imagine that many of them are under pressure because obviously we have got a particular challenge in Norfolk with a very elderly population and it’s growing rapidly so the pressure keep growing.

“This is a fact that we have got to plan for and seek to address.

“The bottom line is we can’t leave people without proper care and support and apart from that we need to be improving it, while getting people out of hospital and improving preventative care.”

However, even NCH&C acknowledges that the pace of growth in funding in community services is slower than it would like.

In an accompanying report to the committee the trust said: “It is widely agreed that the way forward for the NHS is to invest in community service. These are generally preferred by the patient as they are delivered closer to, or in, in their own homes. In addition to this, community services can offer increased value for money for the tax-payer. Unfortunately, continued growth in the funding of acute hospitals means that the growth of community services is slow.”

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