They are the unsung backbone of the NHS – going in to people’s homes to perform everything from wound dressings to support at the end of life. However, what once was a vibrant district nursing workforce has been reduced to nil over the last decade.

They are exhausted from the constant increase in caseloads, limited resources, and complex health care needs.

As a result, they’re leaving in droves – at a time when we need them more than ever. Today’s record-breaking 5.7 million are still waiting for surgery or treatment in hospitals. Their conditions continue to deteriorate.

The number of people dying at home is up by one third since before the pandemic, and those who do make it into hospital for care are discharged faster than ever to free up beds, long before they’ve made a full recovery.

The number of district nurses working in the community has been slashed over recent years

Recent years have seen a decrease in the number of nurses who work as district nurses within communities.

Ministers have tabled some ambitious ideas to address the vital need for at-home care, including a wave of new community health hubs, or more video appointments. But none are a quick fix, nor are they proven to solve the problem

Ministers are proposing ambitious solutions to the urgent need for at home care. This includes a new wave of health hubs in communities and more video consultations. None of these ideas are quick or permanent solutions.

Ministers are proposing ambitious solutions to the urgent need for at-home healthcare. This includes a new wave of community health hubs and more video consultations. None of these ideas are quick fixes and have not been proven to be effective. Experts say that a greater number of district nurses can help ease these problems and address the growing crisis in community health care. It might not be as easy as it seems.

It’s well-known that GP services are buckling in the present climate, but local district nursing teams are also now under near-intolerable pressure.

Before Covid, the situation was dire. In England, there has been a decline in the number of nurses working as district nurses since 2009 when they were more than 7,000. Now it is just over 4,000. District nursing charity the Queen’s Nursing Institute warned that most of these nurses were being forced to delay treating patients on a daily basis because they simply didn’t have time to see them.

The Royal College of Nursing’s analysis found that there was only one GP per 14,000 inhabitants of England. This compares to one GP per 1,600.

This is what it means for patients. To date, few widescale studies have been carried out, but organisations such as the Royal College of Nursing and QNI – along with district nurses themselves – say it may well have led to chronic conditions worsening, or complications being missed.

The number of district nurses is decreasing means there are less staff and less care for the patients. When patients’ conditions worsen, they are sometimes admitted to the hospital without warning.

A study that has not been published yet suggests that there is a connection between the decrease in nursing staff in districts and an increase of hospital admissions.

Professor Alison Leary, a healthcare expert at London South Bank University who carries out research for the QNI, describes district nurses as ‘the air traffic control of healthcare’. Cut their numbers, she says, and ‘you might expect more plane crashes or not being able to take off at all’.

One study, not yet published, is understood to have found a link between the decline in district nursing numbers and an increase in avoidable hospital admissions

Unpublished research has shown a correlation between declining numbers of district nurses and an increase in hospital admissions.

She adds: ‘It is a risk to all of us. We’re more likely to need nursing care in our lives than any other kind of care. In terms of safety, it is essential this care is co-ordinated, with different specialists speaking to one another about patients’ individual needs. That’s what district nurses do. There is a lot to support the idea that specialist nursing can help prevent hospital admissions.

‘Now, if you need a district nurse, you might not get one. Increasingly, the chances of you being able to get care at home, or have a good death there, are diminishing because the services are just not there.’

The most experienced and respected nurses in the field, district nurses, have been around for a long time. They are based either in GP practices or community healthcare Trusts, but spend the majority of their working day in patients’ homes.

There are many tasks they perform, such as tending catheters or prescribing medication, and administering insulin to diabetics. They provide crucial end-of life care for patients and their families, as well as monitoring chronic conditions and delivering chemotherapy.

However, their roles are also multi-faceted. The role of the nurse is to build long-lasting relationships with both patients and families. This allows them spot potential complications like sepsis and gangrene and new or evolving health problems. They also assess whether or not living arrangements and family coping strategies are suitable. They can flag worrying signs of a potentially dangerous problem that may have otherwise gone unnoticed – such as if a patient isn’t eating – and liaise with GPs, pharmacies, physiotherapists and occupational therapists.

Veteran district nurses have told The Mail on Sunday – on condition of anonymity – how ‘privileged’ they feel doing such work.

‘It’s the best job in the world,’ one said. ‘There’s so much joy in it. You really get to know patients and it’s so rewarding being able to help them the way we can.

‘The families of patients with terminal illnesses we cared for write to us saying we were “the only light in the darkest times of their lives”. That’s beautiful. But I’m 60 and thinking about retiring – not because I want to, but because I’m not sure I can do it any more.’

Many feel the profession has changed ‘beyond recognition’ over the past few decades.

The nurse in my area has been incredible

Vicky Saynor knows the importance of district nurses better than anyone.

This 45-year-old woman, Hertfordshire from, was diagnosed in the early stages of breast cancer. In 2019, she received six rounds of chemotherapy at home.

Every week, a district nurse visited her to administer the life-saving medicine and clean out the tubes that carried the drug into her bloodstream. One time, the nurse noticed a dangerous infection close to the site where the tube had been inserted. She visited each day to ensure that the problem was quickly addressed.

Her assistance was also needed to deal with the side effects of new combinations of chemotherapy.

Without her, Vicky, who runs cancer charity True Cancer Bodies, knows she would have ended up in hospital – and could have been very seriously ill. ‘I know so many people who were not told this was an option,’ Vicky admits today.

‘Other women have told me they’ve had no option but to go to A&E with problems, where they’re at even greater risk of picking up an infection.

‘They’ve been amazed and envious at the care I’ve had at home. I would not have chosen the other option. She absolutely kept me out of hospital.’

In the 1980s to 1990s patients suffering from complex conditions would stay in hospitals until they were no longer required for clinical care. District nurses were made up mainly from district nurses, with occasional support by a healthcare assistant.

With the help of technology and an effort to avoid hospitalizations, many more patients are being treated at home. Many district nurses say they’ve become a ‘remote hospital’ and the work is now more technical, time-consuming and demanding.

One nurse said: ‘Patients who would have died 30 years ago are now being managed at home with really complex needs. It was rare that I’d treat people in their 80s and 90s. It is now common to treat people with long-term, chronic illnesses.

‘You go to see someone because they’ve fallen over and you realise they’re dealing with 12 other different problems. And because they haven’t been seeing their GP or going in for hospital appointments, they’re a lot sicker than they were before the pandemic.’

While teams can manage 600 patients, they might only have one to two district nurses. To fill the gaps, teams are more likely to have to rely on agency nurses or less-experienced staff nurses. Three quarters (75%) of the teams have vacant positions they aren’t able to fill or cannot afford because of financial problems.

Now, district nurses will also be responsible for being part of an urgent response team that is sent out to patients who call the NHS Helpline 111. These patients – who are in need of emergency care but not sick enough for hospital – must be assessed within two hours.

‘Unlike hospital wards, we can’t close when we’re full, we can’t say no,’ one nurse says. ‘But we can’t guarantee a patient will be seen when they need to be, or that it’ll be a district nurse – we have to delegate. You’ll see someone who can do the task, but might not have our level of expertise to assess a patient’s entire situation.’

This can have serious consequences for patients. A nurse shared the story of how she saw signs of serious sepsis in an elderly patient while providing routine wound care.

She said: ‘Her legs looked fine but she was a bit muddled and couldn’t remember if her son had visited that day, or if she’d eaten breakfast. This was unusual and it was obvious that something was seriously wrong. Someone less experienced, who didn’t know that lady well, wouldn’t necessarily have picked that up.’

Agency staff have alleviated the pressure, but one nurse said: ‘Personally, I’m not happy giving an agency nurse a complex task unless I’ve actually seen them do it.

‘So you give them the least complicated jobs, but that means we’re not there to spot something that can become a bigger, more complex problem later.’

Vicky Saynor, pictured, who has an aggressive form of breast cancer, said the regular visits from her district nurse kept her out of hospital for a long period of time

Vicky Saynor was pictured. Vicky, who has an aggressive type of breast cancer said that her frequent visits from her local nurse kept her out hospital for long periods of time.

Prof Leary added: ‘You can teach anyone to take blood pressure or clean a wound. But I’ve come across cases where less experienced workers were going in and beautifully dressing wounds but the patient becomes very unwell because they didn’t recognise the signs of, say, gangrene.’

District nurses say they ‘routinely’ deal with up to 15 patients a day, in which they have to perform a thorough assessment of health needs as well as the care. Because of time restrictions, this may take 20 minutes. If a patient’s condition has deteriorated, or there are a lot of red flags, it can take far longer, so for subsequent patients this means delays. A survey for the Royal College of Nursing found 79 per cent found time allocated for patients wasn’t enough.

‘It’s a problem for patients,’ a nurse said. ‘You might be going to see someone who’s immunocompromised with swollen legs due to chemotherapy, but they need a lung drained and pressure wound care. You know you shouldn’t rush it, but inside you’re thinking, “I’ve got to get to the next patient.” The danger is something gets missed or overlooked.

‘I originally went into district nursing to be completely present with the patient rather than running around a ward, but the pressure now is to keep moving.

‘Unfortunately, lots of district nurses are burnt out and retiring or leaving.’

A recent survey of nurses found that 46 percent planned to leave the workforce or retire within six years. This will only exacerbate current issues. One study also found that poor working conditions and limited IT support were contributing factors to nurses feeling frustrated, as well as slow laptops and low internet speeds.

The main factor is unpaid overtime. One in ten said they were doing more than ten hours of unpaid overtime a week – while one nurse told The Mail on Sunday they regularly worked nearly double their contracted 37.5 hours.

The average salary for district nurses is between £25,000 and £45,000 a year. ‘You don’t do it for the money,’ one nurse said.

The shortage of nurses in the district is being highlighted by nursing leaders.

QNI chief executive Dr Crystal Oldman explains that part of the problem lies in the way the job is perceived. She said: ‘When I first went into the community, in 1982, it was seen as high status. I’m often asked what’s happened to that view.

‘I think television dramas like Casualty and ER has made hospital nursing seem more exciting and glamorous – and it’s hard to dramatise keeping people at home and out of hospital.’

Health Education England is increasing the number of places for NHS nurses. In the future, more District Nurses will qualify. But Dr Oldman says: ‘They need to be double what they are right now.’

Becoming a district nurse involves a specialist qualification – a further year of training which, crucially, incurs a reduction in pay. Some nurses opt to take on other jobs that provide better compensation and career advancement.

In addition, newly qualified nurses have ‘very different expectations’ of the job compared with older nurses.

One district nurse said: ‘They’re pickier about what they will and won’t do, and they won’t work certain hours.’

Both QNI and the Royal College of Nursing are calling for more investment in district nurses to increase staff satisfaction and support extra work.

Carolyn Doyle, Royal College of Nursing’s lead for community and end-of-life care, says: ‘These nurses make an enormous contribution, which is often invisible – a patient’s front door is their front line. Their impact is immense. We have to invest in that, for patients and for the nurses themselves.’

How can the common cold be used to prevent Covid and what is the best way to get an AZ booster? 

Q: Will a cold prevent me from contracting Covid?

A: University College London’s study suggested that recovering from the common cold may help protect against Covid-19.

Researchers studied the experiences of 58 staff members at hospitals who were treating Covid victims in the initial stages of the pandemic. They never fell ill, and they tested positive for the virus repeatedly.

But it wasn’t that they avoided the virus – instead, their immune systems were better at destroying it before it had a chance to replicate inside the body.

Each volunteer had higher numbers of immune cells, called T-cells. These were capable of eliminating Covid. These T-cells are able to remember prior infections, so that they can avoid them from happening again.

But why were these NHS workers’ immune systems so good at attacking Covid-19, a new virus?

The researchers’ theory is that their T-cells had been triggered by recent exposure to a much less destructive type of coronavirus – a distant cousin of Covid that causes the common cold.

The significance of the research is that scientists may be able to exploit it to develop vaccines that target the internal machinery shared by all types of coronavirus – including Covid.

It could be a way to avoid some common colds by avoiding the possibility of resistant strains.

Q: What is the reason why AstraZeneca/ Oxford vaccines are not given to booster patients?

A:Nearly 11.5 million UK residents have received the third Covid vaccine. A fraction have had the Oxford/AstraZeneca shot, despite it being widely available for their first and second doses.

Instead the Government has sanctioned the use of the Pfizer and Moderna jabs, because there’s evidence that they trigger a stronger immune reaction.

Pfizer data showed it to be approximately 96% effective when used as an infection booster.

Studies have also shown that mixing jabs can be beneficial. Patients may experience greater protection if they take AZ first and then a booster. A patient can be given an AZ booster if they have ever had a reaction with Moderna or Pfizer.