District nursing services provide care for patients and support for family members in the community, with common treatments including wound management, diabetes management, leg and pressure ulcer treatment and end of life care. Services cover every village, town and city in the country, and operate most (if not all) hours of the day for 365 days a year. If the government is to succeed where previous administrations have failed in shifting more care into the community, district nursing services will have to be a linchpin.
However, between 2009 and 2024 the number of staff recorded in NHS district nurse roles – represented by the solid purple line on the chart – fell by 43%, from 7,643 to 4,322. Put another way, for every five district nurses in 2009, there are now just three. In comparison, over that period the number of adult nurses in hospitals has increased by that same level (43%).
Some of the decrease around 2011 may be attributed to a policy-led shift to provide more community services through voluntary and independent sector providers, so district nurses no longer appeared within NHS data. But this does not explain the longer-term trend, and there are further reasons to be concerned. Firstly, when factoring in the increasing and ageing population, the trend is worse still: we estimate that staffing levels relative to need – presented by the dashed lines – have fallen by over half (55%). That’s comparable to losing around 4,200 full-time equivalent district nurses.
Secondly, over one in four (27%) of these staff recorded as “district nurses” are employed at a lower pay grade than qualified district nurses are typically expected to start (Agenda for Change band 6) as shown in the chart by the solid green line. At a time of increasing population need, the NHS would ideally have more senior nurses (at band 6 and above) given they are generally required for visiting more complex patients. The 3,171 district nurses that were at band 6 or above as of September 2024 represent just one in 117 of the total NHS nursing workforce at that time. Relative to population need, their numbers have fallen too.
The NHS’s failure to invest in the district nursing workforce has significant implications for patients and the wider NHS. Previous research has suggested that capacity and workload issues within district nursing services particularly impact psychological care and support, assessments, and continence care – with this care increasingly being performed unsatisfactorily, not being done, or falling on already overstretched services elsewhere. With various NHS and workforce strategies nearing publication, we will soon see whether the government is willing to commit to redressing the falling district nurse numbers.
Look out for our broader report on district nursing which will be published later this year.
Suggested citation
Palmer W (2025) "The lamentable decline of district nurses in the NHS in England". Chart of the week, Nuffield Trust.