Making care ‘personal’

Over the years, community nurses and others have aspired to deliver person-centred care, where the wishes of the client and their family are respected and acted upon. However, time pressures together with limited cultural change have sometimes prevented personalised care becoming a reality of practice. Universal Personalised Care (NHS England (NHSE), 2019a) reminds us that, while much progress has been made with more than 200 000 individuals benefitting from a personalised care approach in 2018, mainstreaming personalised care as usual practice across the health and care system will require commitment to shared decision-making with social prescribing, if the 2.5 million people with long-term and complex needs are all to receive personalised care by 2023/24. Reskilling and increasing the community and primary care workforce will be essential prerequisites.

A particular challenge facing district nursing (DN) services has been the fall in the number of nurses holding the District Nurse Specialist Practice qualification (DNSPQ) since 2010, compounded by poor recruitment to community staff nurse roles (Queen's Nursing Institute (QNI) and Royal College of Nursing (RCN), 2019). Indeed, the limited capacity of the DN services may underpin the rise in the number of older people being hospitalised (QNI and RCN, 2019). Further, it is difficult to identify DN services that are well-led and delivering excellent care, because many are part of acute hospital or mental health NHS trusts, although there is evidence that new care models with good integration reduce hospital admissions with GPs, particularly valuing the contribution of DN services if the services were not struggling with insufficient staff to meet demand (QNI and RCN, 2019). Unfortunately, uncertainty around funding for the DNSPQ and the introduction of an apprenticeship programme may mean there will be no new district nurses qualifying in 2021 (QNI and RCN, 2019).