Long-term plan target will fail without staffing increases, experts warn

The NHS long-term plan, published in January 2019, set out two key pledges for community services, aimed at reducing pressure on acute services – to offer a two-hour crisis response service and for reablement care to be offered within two days of referral.

Every health system has now been asked to offer the crisis response service by April 2022, while no specific timeline has yet been set out for the reablement pledge.

But experts have warned that trying to offer the crisis service in isolation will fail to meaningfully reduce hospital admissions, and that neither target can consistently be met with the current staffing levels.

There are staffing shortages in many key roles within community services, such as district nurses, whose numbers have fallen by 40 per cent since 2010.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “We are currently gathering data from directors of nursing in our networks and the early indications are that 1,500 district nurses are needed to be trained each year rather than the 500 that are currently funded by [Health Education England].”

This estimate was based on staffing reviews by 21 community providers, almost a quarter of the total in England.

Ms Oldham added the shortages must be addressed if the crisis response service is to become “an established element of the district nursing service in every community”.

Martin Vernon, former NHS England national clinical director for older people, said the long-term plan had put the two ambitions together to ensure those in crisis could be supported in the community through their recovery.

He added: “Concentrating on crisis responses in isolation, especially for adults with complex care needs, is unlikely to achieve the objectives of avoiding unwarranted acute hospital admission or expediting timely discharge.

“For crisis responses to have meaningful impact, these additional services must also now be fully funded, adequately staffed and planned for in all systems.”

NHS Providers has also described “a clear interdependency between urgent community response services and rehabilitation and reablement services”.

Liz Fenton, deputy chief nurse at Health Education England, said: “HEE listened to concerns that were raised about district nursing numbers, which is why we invested £18.5m to support those nurses who want to pursue their specialist practitioner qualifications.”

NHS England said in a statement: “The NHS is on track to deliver the NHS long-term plan commitment of a two-day standard over the next three years and has brought forward its commitment for the two-hour standard so all patients in England receive the right community care at home, by April 2022.”

It said capacity in community health services is being supported through uplifts in system baseline funding.