Darzi report finds ‘underinvestment’ in community nursing
Promises by successive governments to move care out of hospitals have failed due to lack of investment in community nurses, a much-anticipated report into the state of the NHS has found.
Lord Ara Darzi published his Independent Investigation of the National Health Service in England today, which has placed a spotlight on the shortages of community nurses.
“This suggests that we may have too few resources in the community compared to other health systems”
Darzi report
Lord Darzi, a leading surgeon and former Labour health minister, concluded in his 142-page report that the NHS was in a “critical condition”.
The review was commissioned by the government and the findings will be used to inform a 10-year plan to reform the NHS.
One of the main takeaways from the report was that the NHS budget was “not being spent where it should be” and that too much was being spent on hospitals compared to community services.
The report noted that there had been a growth in hospital staff numbers between 2009 and 2023, including a 35% increase in adult nurses and 75% growth in children’s nurses.
However, it warned that there had not been this same growth outside of hospital settings, noting that previous governments had “underinvested in the community”.
Over the same period, the number of nurses working in the community fell by 5%, while the number of health visitors dropped by almost 20% between 2019 and 2023.
The report found that community services were significant “outliers” compared to neighbouring counties.
It warned that the UK had “far fewer nurses working outside of hospital compared to other countries”.
“This therefore suggests that we may have too few resources in the community compared to other health systems,” said the report.
Analysis suggested that the UK could be as much as 86.7% below the Organisation for Economic Co-operation and Development (OECD) average in the numbers of nurses and midwives working outside of hospital (see below).
Graph featured in the Darzi review
The new Labour government pledged in its election manifesto to increase the number of community nurses and health visitors, as well as move care from hospitals into the community.
Lord Darzi noted that governments had been making this pledge since at least 2006 but in practice “the reverse has happened”.
A new analysis, published today by the Royal College of Nursing (RCN), has shown that the community and public health nurse workforce is on track to halve in size compared to two decades ago.
The college’s analysis found that district nurse numbers had declined by 45% between 2009 and 2024.
Over the same period, health visitor and school nurse numbers dropped by 32% and 21% respectively across the NHS in England, the data showed.
The RCN has projected that these nurse numbers will decline further without interventions from the government.
It has predicted that the number of district nurses will be down 61% by the end of parliament in 2029, compared to 2009.
Meanwhile, it said health visitor and school nurse numbers would fall by 44% and 42% respectively in the same period.
In its evidence to Lord Darzi’s report, the college had highlighted the concerning trends in these areas of nursing, warning that it was impacting care and delaying discharge from hospital into the community.
As such, the RCN has called on the government to “invest in the nursing profession” by introducing a loan forgiveness scheme for nurses and to reintroduce state-funded degrees to boost recruitment.
RCN general secretary and chief executive, Professor Nicola Ranger, said: “We made clear in our evidence to Lord Darzi that district nurses, health visitors and school nurses are crucial to supporting people of all ages to stay healthy and independent, providing advice and interventions to prevent conditions worsening.
Nicola Ranger
“They couldn’t be more important to the government’s correct plan to move care into the community.
“The prime minister’s mission to repair a broken NHS is the right one, but that will not happen with ambitions for reform alone.
“Urgent investment in the nursing workforce, all of whom play a key role in prevention and reducing health inequalities, couldn’t be more necessary.”
Responding to the report, health and social care secretary Wes Streeting said: “I asked Lord Darzi to tell hard truths about the state of the NHS.
“He has produced an honest, expert, comprehensive report on the appalling state our health service is in.
“Today’s findings will inform our 10-year plan to radically reform the NHS and get patients treated on time again.”
