‘Dying without dignity’: alarm at lack of nurses
Hundreds more people are dying at home in Somerset than before the pandemic amid fears that some will end their lives in pain due to a “dire shortage” of district nurses across England.
The Royal College of Nursing (RCN) says the lack of nurses across the country who provide vital care at home means people could be left to die without compassionate care or dignity.
Office for National Statistics (ONS) figures show 2,868 deaths in private homes were registered across Somerset in the 18 months between January 2020 and June this year. That was 37 per cent higher than the average of 2,087 over the previous five years - meaning 781 more people died at home than would have been expected without the pandemic.
Meanwhile, the total number of deaths including those outside people’s homes rose less steeply, by 7 per cent - to 9,971.
It means around three in every 10 deaths (29 per cent) registered over the period happened at home.
District nurses provide much of the health care people get in their homes, and have specialist qualifications. Yet a recent survey by magazine Nursing Standard and endof-life charity Marie Curie found nurses were concerned there were not enough staff to help people to have a good death at home.
It is difficult to calculate the exact number of district nurses that serve local areas from available statistics.
But the latest NHS figures show there were 305 full-time equivalent district nurses across the South West in July. That was down by 53 per cent from 645 in September 2009, when comparable figures were first published - among the steepest declines proportionally of the NHS’S seven English regions.
Across England, there were 236,250 deaths registered in private homes between the start of 2020 and June this year - 58,916 (33 per cent) more than the previous fiveyear average of 177,334.
The figure for deaths in previous years is the average of January to December 2015 to 2019, plus January to June 2015 to 2019 again.
The total number of deaths registered in all places rose by 12 per cent to 852,408. But there were just 4,262 full-time equivalent district nurses in July - down by 44 per cent from 7,643 in September 2009.
Carolyn Doyle, the RCN’S lead for community and end-of-life care, said: “The pandemic has led to more people dying at home.
“The impact of the dire shortage of district nurses could lead to people dying without access to compassionate care, symptom control or dignity which district nurses provide so well.
“We are calling for the Government to come up with a fullyfunded workforce plan as soon as possible and enshrine in law a responsibility for the health secretary to deliver it.”
Julie Pearce, chief nurse and executive director of quality and caring services at Marie Curie, said the rising number of home deaths was “a hidden crisis happening behind closed doors”.
The charity is campaigning for changes to the law that would create a duty to commission palliative care services in every part of England.
A Department of Health and Social Care spokesperson said: “Any death is a tragedy for the family and loved ones that are left behind and our deepest condolences go out to anyone who has been affected by a loss during the pandemic.
“Covid-19, has led to an increase in deaths overall, including in the number of people who died at home.
“We are incredibly grateful to NHS staff, including district and community nurses and volunteers, who have worked tirelessly throughout the pandemic to deliver palliative and end-of-life care to people at the most difficult time of their lives.”
The ONS data shows that, while coronavirus was the overall leading cause of death between January 2020 and June 2021, only a small proportion happened at home directly due to the virus.
Sarah Caul, head of mortality analysis at the ONS, said there were “substantial increases” in people dying from other things such as heart disease, dementia and Alzheimer’s, and various cancers.
She added: “The pandemic therefore appears to have had an indirect effect on private home deaths.
“This could be because of a combination of factors which may include health service disruption, people choosing to stay away from health care settings or terminally ill people staying at home rather than being admitted to other settings for end of life care.