Cynulliad Cenedlaethol Cymru	National Assembly for Wales
Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon	Health, Social Care and Sport Committee
Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal	Inquiry into Community and District Nursing services
HSCS(5) CDN12
Ymateb gan Gomisiynydd Pobl Hŷn Cymru	Evidence from Older People’s Commissioner for Wales

Thank you for the opportunity to respond to the Health, Social Care and Sport Committee's consultation regarding community and district nursing services in Wales.

Community and district nursing services play an integral role in supporting an individual's independence and maintaining their health (including the management of long-term conditions and acute illnesses) outside of hospitalⁱ .

There has been a drive in recent years to deliver more, and increasingly complex care to individuals outside of hospital and within the community. Whilst this is welcomed by many older people, who may not wish to unnecessarily stay in hospital or travel to a hospital appointment, it presents challenges and increases the importance of a workforce that is appropriate in size, quality and support.

I am aware, from the casework support provided by my office and through meeting with older people, how highly valued community and district nursing services are by older people.

However, a small number of older people have contacted my office raising the difficulties they have had in contacting their community and district nursing service. For example, individuals have wanted to change/rearrange appointments, raise concerns about their conditions or seek advice on treatments but have been consistently unable to contact their nurse.

By the nature of their roles, I understand that community and district nurses will spend little time in the office - yet the contact number that older people were provided with was an office based answerphone system. This not only caused stress and anxiety, but also creates the risk that these individuals will need to subsequently access unscheduled care services.

An older person relying on these services may be in a particularly vulnerable position, for example with limited mobility or existing care and support needs. Given this vulnerability, and the increasingly complex care that is provided through community and district nursing services, it is important that an effective method of contact and communication between nurses and older people is established across Wales.

A small number of older people have also raised concerns with me about disagreements between themselves and community and district nurse services being removed from them/their loved ones. For example, when the service has proposed that an individual is well or mobile enough to stop receiving community and district nurse services and travel to a GP for routine appointments whereas the individual/ their family has felt that continued input is needed.

These services are an integral and highly valued part of healthcare delivery within our communities, to some of our most vulnerable older people. However, I am concerned that there may be increased pressure placed on community and district nurse services as a growing number of complex health services are moved out of hospitals and into the community.

I am aware that 1000 Lives are undertaking work on establishing the evidence and approach needed to extend the Nurse Staffing Levels (Wales) Act 2016 to district nursing. In addition to this, ongoing monitoring of the quality of these services, patient outcomes, workforce numbers and staff wellbeing is needed to ensure that they're sufficiently resourced and that patients receive high quality care within their home and community as the nature and complexity of this care changes over time.

I hope that these comments are helpful. If I can be of any further assistance, please don't hesitate to contact xxxx, my Health and Care lead, on xxxx, or by emailing xxxx

Helena Herklots

Older People’s Commissioner for Wales