Cynulliad Cenedlaethol Cymru	National Assembly for Wales
Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon	Health, Social Care and Sport Committee
Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal	Inquiry into Community and District Nursing services
HSCS(5) CDN16
Ymateb gan Bwrdd Cyngor Iechyd Cymuned	Evidence from Board of Community Health Councils

CHCs are the independent watch-dog of NHS services within Wales and we seek to encourage and enable members of the public to be actively involved in decisions affecting the design, development and delivery of healthcare for their families and local communities.

CHCs seek to work with the NHS and inspection and regulatory bodies to provide the crucial link between those who plan and deliver the National Health Service in Wales, those who inspect and regulate it, and those who use it.

CHCs maintain a continuous dialogue with the public through a wide range of community networks, direct contact with patients, families and carers through enquiries, our Complaints Advocacy Service, visiting activities and through public and Patient surveys. Each of the 7 CHCs in Wales represents the “Patient voice” within their respective geographical areas.

CHCs routinely monitor the performance of NHS services in their area as well as respond to service developments and changes.

District & community nursing is an integral and vital part of primary care provision and cannot be looked at in isolation from other parts of the primary care multi-disciplinary team.

The Kings Fund Report “Reimagining Community Services”^{^[1]} takes a holistic look at these issues. The report contains practical and useful suggestions for new ways of working and involving patients in their own care through co-production.

Local Health Boards across Wales are struggling with the difficulty of recruiting GPs and skilled nurses. CHCs receive proposals to develop or change primary care services increasingly regularly, including proposals to close branch surgeries or limit the numbers of registered patients in a practice. The implications for primary care are significant.

It is timely that the Health, Social Care & Sport Committee is reviewing the District Nursing service and considering its future contribution to the delivery of healthcare in community settings.

The consultation paper highlights the shortfall in knowledge in relation to the real contribution of district nurses and their teams to the NHS in Wales. In the overview to the consultation brief, the term an “invisible” service is used; if the best use of the service is to be made in the future then health boards need to develop a much clear focus and understanding of the role and contribution of these services within local health systems.

Qualified district nurses are skilled professionals functioning at a high level in the community setting and together with their team members they have always worked with a range of professionals and agencies both within primary care and secondary services as well as the voluntary sector.

With the increasing range of professionals (such as advanced paramedics, physiotherapists) now working in the community and primary care settings, district nursing teams will need to adapt their working activities to ensure that they work effectively with these new services and use their individual skills to the best advantage for patients and their families.

In the last paragraph of the overview document, comment is made on the lack of information around the work of children’s nurses in the community. We think there is real benefit in the inquiry focusing on this aspect of community nursing as increasingly paediatric care is being provided in community settings.

The Queen’s Nursing Institute (QNI) District Nurse Education Reports contain useful information on enrolment for the District Nurse qualification. In recent years enrolment levels across the UK has been steadily falling. The QNI warns that, given the numbers who retire from the service annually, “this will represent a major challenge to current and future recruitment efforts to district nursing teams”.

The most recent QNI report notes that 40 of the 44 universities in the

UK approved by the Nursing and Midwifery Council (NMC) to offer the District Nurse Specialist Practice Qualification (DNSPQ) had “major concerns about future funding and viability of district nurse programmes”.

So while there is a drive to move care into the community, there is a clear risk of fewer district nurses. This is particularly concerning at a time when NHS Wales has an ambition of having care closer to home, rather than in hospital settings. It will be extremely difficult to achieve this unless there are sufficient qualified nurses to manage it.

CHC’s are hearing of many innovative schemes to deal with the current GP recruitment crisis through the introduction of multidisciplinary teams. These often include specialist district and community nurses who may be just as scarce a resource as GPs in the very near future.

This is not a problem that can be solved by any individual LHB and we want to see the NHS in Wales and the Welsh Government continuing to look at new ways of increasing the numbers of nurses in training and at ways of making a career in nursing more accessible to young people.

Monitoring Community Nursing Services

Traditionally the CHC movement has focused primarily on visits to hospitals (Community and District General Hospitals), health centres and primary care and it is important that such visits remain a key aspect of CHC work.

However, a substantial and increasing amount of care is provided by community health services. CHCs are responding to this shift by continuing to look at the best ways of hearing directly from people about their views and experiences of NHS services delivered in the community.

CHC’s in some parts of Wales have carried out surveys in their local communities to hear from people about their experience of the District Nursing Service. It is clear from the responses that this service is highly valued and respected by patients and carers overall.

Contact details

Alyson Thomas

Board of Community Health Councils in Wales

33 / 35 Cathedral Road

Cardiff

CF11 9HB