While much of the attention in NHS debate focuses on waiting lists, A&E delays, and patients treated in hospital corridors, a quieter but equally dangerous crisis is unfolding in community health services. Understaffing in these services is leading to missed care, growing backlogs, and, in some tragic cases, preventable deaths.
Steph Lawrence, CEO of the Queen’s Institute of Community Nursing, describes this as a “hidden risk”, overlooked in public discourse but no less urgent than the pressures on acute care. The numbers bear this out. The number of district nurses in England has fallen sharply over the last decade, with only three now for every five in 2009. Adjusted for population growth, staffing has dropped by 55 per cent, the equivalent of losing 4,200 nurses.
The impact on care is clear. Research shows that half of community nurses report missing elements of care during their last shift, despite working an average of 10 hours of unpaid overtime each week. These missed tasks are not minor oversights. They can involve delays in wound care, missed medication rounds, or reduced visits to patients with complex needs. Over time, these lapses add up to a significant threat to patient safety.
In some cases, the consequences have been fatal. Coronial inquests have already linked deaths to a shortage of district nurses. One such case was that of Susan Clissold, whose death was partly attributed to understaffing in community nursing. Experts warn that more cases of this kind are likely if staffing levels are not addressed.
Beyond nursing, other community health services are under similar strain. Health visiting, podiatry, and speech and language therapy all face growing backlogs. This is not just a problem for those already receiving care. It also creates a barrier to early intervention, increasing the likelihood that patients will deteriorate and need hospital treatment.
The government’s long-term ambition to move more care out of hospitals and into homes is widely supported by clinicians, patients, and policy experts. It makes sense both for patient experience and for managing NHS resources. But as the Queen’s Institute of Community Nursing points out, the shift cannot be achieved at the expense of safety. Community care requires the right staffing levels, the right skills, and the ability to respond quickly to patients’ needs.
A key part of the solution is better monitoring of missed care. Unlike in hospitals, where staffing levels and incident reporting are closely tracked, community services often lack systematic oversight. This makes it harder to identify where risks are building and to act before harm occurs. Introducing robust reporting systems would help shine a light on where care is falling short and why.
The staffing challenge will not be solved overnight, but it requires urgent attention. Recruitment campaigns, targeted training, and incentives to retain experienced community nurses should be a priority. This should be matched with investment in multidisciplinary teams, so that allied health professionals can work alongside nurses to meet patient needs more effectively.
Community health services are the connective tissue of the NHS. They support people to live independently, manage chronic conditions, and recover from illness without needing a hospital bed. When they are weakened, the whole system suffers. The government’s goal of moving care closer to home will only succeed if community services are strengthened, not hollowed out.
Ignoring the warning signs will carry a high cost, for patients whose care is missed, for families facing avoidable loss, and for a health system that will end up with more people in hospital, not fewer. The “hidden risk” is no longer hidden. The question now is whether ministers will act before more lives are lost.
