Is the district nursing service in a position to deliver intermediate care? A national survey of district nursing provision

Abstract

The government intends to invest heavily in intermediate care services by the year 2004. The term ‘intermediate care’ de. es precise definition, but is said to include a number of community-based services, including those provided by district nurses. Enhanced district nursing may be one solution to providing care for many elderly patients who are thought to be inappropriately admitted to acute hospitals. The feasibility of this option has yet to be tested, but district nursing enjoys public confidence and is well placed within the primary care framework to ensure continuity of care. This paper describes a national postal survey of district nursing provision within all community trusts in England conducted in 1998 to explore a picture of the structural and organizational factors which impinge on the delivery of intermediate care by district nurses. The Handbook of Community Nursing was used to identify those with designated responsibility for district nursing within trusts. A response rate of 83% (n = 148) was attained. The majority of responding trusts reported a lack of resources to deliver more intensive levels of care. When trusts were ranked according to their performance on six key variables thought to be related to the delivery of intermediate care only two achieved the maximum score. Over half of the trusts scored 3 or less. The findings from this survey indicate a curious neglect of the district nursing service and suggest that considerable investment is needed if district nurses are to deliver an intermediate level of care.