The Queen's Nursing Institute

The Queen's Nursing Institute works with the public, nurses and decision-makers to make sure that good quality nursing is available at home for everyone when they need it.

Healthcare at home

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QNI very concerned by Which? investigation into home care

A Which? investigation published today, has exposed shocking examples of poor home care of vulnerable people, suggesting a system that is at breaking point. Which? asked 30 older people to keep diaries during one week in January. These diaries showed a distressed older lady left in the dark, unable to see her food or drink, a man's vital diabetic medication forgotten and rushing care workers. Which? is concerned that, as people are living at home with increasingly complex care needs, safety is being jeopardised by poorly managed care. The Survey reported home care managers spoke of tightening margins and the struggle to maintain a quality service, while care workers described bearing the brunt of increased responsibilities and low pay.

Rosemary Cook, Director of community nursing charity The Queen’s Nursing Institute said the findings were ‘very worrying’. She said, ‘The investigation highlights some of the very poor care that some of the most vulnerable elderly people in our society are receiving. The investigation mirrors our own research findings that community nursing services are very stretched, and hence very variable in quality. However, we believe that good quality community nursing services are the key to good health and social care being provided to elderly patients at home.’

‘District nurses used to have a general oversight of health and social care that was provided, and were able to co-ordinate services to ensure that people received the most appropriate care. However, as more people live at home with complex, chronic conditions often for many years, services simply have not kept pace with the new challenges or, the sheer number of people who need care at home’, she added. ‘A ‘Berlin Wall’ now exists between health and social care, so that district nurses no longer have the central position that they used to. This contributes to patients receiving inappropriate care’.

The QNI’s report, ‘Nursing People at Home: the issues, the stories, the actions’, published in November 2011, showed that what patients value most are the attributes of skilled and experienced community nurses: the ability to assess unexpected situations, coordinate services, and answer questions about treatment. The report follows the QNI’s Right Nurse, Right Skills campaign, which received hundreds of stories from the public describing the impact that the dilution of skills in community nursing teams can have on the quality of care. The report highlights several reasons for the loss of skills in the community, including the decline in district nurse training, an increased reliance on less experienced nurses and a growing trend to replace nurses with health care assistants.

Some of the key findings of the QNI’s report echo those of the ‘Which?’ investigation. Patients found it worrying when practitioners were clearly rushed, and did not have time to do a good job before leaving for their next patient. This lack of compassion shown by some has a demoralising effect. The QNI is also very concerned about the dilution of skills in community nursing teams, as qualified district nurses are replaced with unregulated healthcare assistants. A healthcare assistant would not be expected to have the skills or training to co-ordinate social care, to help improve it, or to manage a crisis.

The QNI identified a number of key actions that employers can take to deliver a better service. These include ensuring adequate and specific training for staff, investment in understanding patient requirements better, and being more responsive to their concerns. These recommendations apply whether health or social services are being delivered.

Ms Cook added, ‘If the Which? findings do suggest a system at breaking point, this only adds more urgency to the QNI’s call that we must reinstate the district nurse at the heart of health and social care in the home. The district nurse is the key professional who can lead the improvement of services, which is so clearly needed.’  



Notes to Editors

The Queen’s Nursing Institute is the charity that campaigns for good quality home nursing for everyone, when they need it.

The Nursing People at Home report is available on the QNI’s website at

The Which? investigation is available here:

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