14 COVER STORY
No let-up in pressure on community nurses ‘ drained ’ by end-of-life care in pandemic
Nurses working in the community have filled gaps in end-of-life care provison during the pandemic and now face the prospect of spiralling demand as winter looms
Community nurses have experienced rising levels of stress during the pandemic , and one of the principle reasons for this has been the increased need for end-of-life and palliative care to be provided in the community .
University of Sheffield research published in July revealed 58 % of 500 surveyed community nurses and GPs reported providing more end-of-life care than usual during the first wave of the Covid-19 pandemic . 1 The research suggested other services that would normally be involved in end-of-life care had ‘ withdrawn ’, often leaving community nurses to deal with families ’ questions as well as the patients themselves , leading to a ‘ significant emotional impact ’.
QNI chief executive Dr Crystal Oldman explains the rise in end-of-life care at home was in large part due to people ’ s reluctance to go to hospital because of limitations on visitors and the risk of catching Covid-19 .
Analysis from the Institute for Public Policy Research ( IPPR ) thinktank from May found there was a 35 % rise in deaths at home in England in 2020 . 2
Community services had to adapt rapidly to meet increased need in terms of volume and complexity . However , as Dr Oldman points out , this shift happened against a ‘ backdrop of underinvestment in nursing in the last decade ’, resulting in decreasing numbers of staff being asked to deliver increasing levels of care at a time of huge uncertainty .
The latest NHS Digital data show district nurse numbers plummeted from 6,977 in May to 2011 to 4,261 in May 2021 .
‘ Underinvestment is coming home to roost , says Dr Oldman . ‘ We didn ’ t do the workforce planning we needed ,
References 1 Mitchell S et al . Community end-of-life care during the COVID-19 pandemic . BJGP Open 2021 ; 5 ( 4 ). bit . ly / 3C8Qdy0 2 Thomas C . The state of end-of-life care . London : IPPR , 2021 . bit . ly / 3tAruzy
and more investment is also needed .’
And with winter coming , the situation is likely to get worse . As well as an anticipated rise in Covid cases and a major flu epidemic , terminally ill patients are more susceptible to cold weather , while non-infectious conditions such as asthma can also be exacerbated .
Meanwhile , in care homes , the requirement for all staff to be double vaccinated by 11 November may actually worsen winter pressures . The Outstanding Manager Network , a group sharing good practice in the sector , wrote to Commons health and social care committee chair Jeremy Hunt in August warning that up to a fifth of adult care home staff could be dismissed after the policy comes into force . This would come on top of the existing staffing crisis in care homes , exacerbating the precarious state of the sector and producing a knock-on effect on the demand facing wider community nursing over the winter period .
Dr Oldman concludes : ‘ Some care home staff are choosing to leave because of the threat of mandatory vaccination . That ’ s an additional pressure on care homes in the build-up to winter .’
‘ The country and the world owe a great debt to all nurses ’
David Munday is a nurse , a health visitor and lead professional officer at Unite the union . @ davidamunday
Mr Munday will chair three Nursing in Practice live events this autumn . To book , visit bit . ly / 3EgVtlk
In March 2020 , a few days after the country entered its first national lockdown , I emailed mental health nurse members of Unite the union to thank them for all the efforts they had already made in battling against the emerging global pandemic .
You may remember 2020 had been designated the Year of the Nurse and Midwife long before the term Covid-19 had even been uttered . What a bitter irony that , instead of sharing with the public a celebration of the value of nurses , this value would be seen and felt through our collective labours at a time of unprecedented national and global distress . And what labours they have been ! No matter what your level or sector , the country and world owe a great debt to all nurses .
But will that debt be satisfactorily honoured ? The biggest factor is pay . While there ’ s a differing picture across the UK , I ’ m sure you ’ ll all agree that the 3 % pay rise about to be implemented in England and Wales does not come close to recognising nurses ’ efforts . As p10 of this magazine shows , there is much dissatisfaction with the varying pay , and terms & conditions for nurses in general practice . Politicians may have imagined a weekly clap would fit the bill but it certainly won ’ t pay the bills .
Another area where the system has been found lacking is in support for healthcare professionals . Multiple reports , published both during and before the pandemic , testify to this . Some action has been taken . We ’ ve seen the development of support hubs across England , based on those created after NHS staff responded to terrorist incidents in the UK . NHS England and NHS Improvement have also done work , in which I ’ ve been involved , to address the National Confidential Inquiry into Suicide and Safety in Mental Health report highlighting the worrying levels of female suicide in the nursing professions . More of this work should become apparent this year , and I hope it will make an impact .
As we head towards what could be a very difficult winter , I reflect on the steps I ’ ve taken to support my own mental health and that of the team of people I ’ ve worked with and led at an NHS vaccination centre . At the start and end of every shift , I remind those amazing people that simply by turning up that day we will have saved people ’ s lives . I hope that over the next few months I ’ ll be able to meet and thank more of you in person as I chair three planned face-to-face Nursing In Practice and PULSE Live events . nursinginpractice . com Autumn 2021