Banbury end-of-life patient 'still not receiving adequate district nursing care' - questions remain over district nursing cover

On December 5, the Banbury Guardian raised the issue of an elderly man whose deteriorating condition required twice weekly visits to re-dress his ulcerated legs. However he was not receiving the required visits and district nurses told the man’s advocates there was a staffing problem.

Oxford Health NHS Foundation Trust (OH) told the Banbury Guardian they were satisfied they had sufficient staff, but the increase in demand for home nursing meant they could not always respond as quickly as they would like.

Since then the advocate (who we are not naming to protect the identity of the patient) said his legs continue to worsen and he is in so much pain he is now being given morphine.

Correction: An article published by the Banbury Guardian on our website on December 5 - ' Lack of district nurses has left 'end of life' Banbury patient with serious medical issues' - stated that Banbury Cross Health Centre was responsible for the district nurses in the area. This was incorrect and we would like to apologise to Banbury Health Centre for the mistake and for any upset caused.

"Clearly his wounds need dressing more frequently than once a week for the less bad leg and twice a week for the worst leg. One of the district nurses (DN) even took photos of his wounds and said she would show them to her manager as it was obvious they needed to be dressed more frequently,” she said in a letter to the OH Trust.

“I would like to understand for what clinical reasons the DN team decided (his) dressings needed changing less frequently as I can only assume this is down to staffing reasons rather than his clinical needs, given the state his legs are currently in.

"This is not on, he is very unwell and has limited time, so to be neglected so appallingly is disgusting.”

She said the patient’s legs indicated they were becoming infected.

"This is not acceptable as the last time this happened due to missed district nurse visits, he had to be admitted to hospital for a week and given intravenous antibiotics. He has serious heart failure. Allowing his leg ulcers to become infected could lead to sepsis and due to his serious heart failure, his consultant has said he is not suitable for amputation should his ulcers deteriorate.

“What I would like to understand is what steps are being taken to address the staff shortages in the district nurse team which lead to missed visits. I fully understand that they are doing the best they can with the staff they have, but unfortunately, this is not enough to keep (this patient) safe and well.

"There will be so many more vulnerable people who are dependent on DNs who aren’t getting the number of visits they should do but don’t have the means to complain or someone like me to fight their corner,” the advocate told the Banbury Guardian.

"One DN representative told my sister and the patient’s wife they didn’t have sufficient staff and to take it up with the trust, as something might change if enough people complain.”

The Patient Advice and Liaison officer for the Oxford Health Trust told the advocate: “We are aware of the concerns raised.

“(The patient) has been visited at home today and I have just received some feedback from the visiting nurse. Following his stay in respite the frequency of visits was reassessed and reduced as clinical indicated.

"This has been discussed and explained again today by the visiting nurse and an agreement has been reached for twice weekly visits (left leg to be dressed weekly and right leg to be dressed twice weekly). The visiting nurse today reported that leg care was undertaken at her visit and the patient, and his wife, felt reassured following her visit.

“Sadly, we are at times unable see all the patients requiring our input on a set day and we would like to offer our sincere apologies for this.”

Oxford Health issued the following statement to the Banbury Guardian on December 12: “Oxford Health is aware of the increased pressure our district nursing teams are experiencing this winter. The Oxfordshire service is well-staffed and delivering its planned capacity, providing high quality care to many thousands of patients across the county every month.

"People’s need for district nursing support has increased significantly at both a local and national level, however, meaning that it is not possible for us to respond as quickly as we would like to all the home visit requests we receive each day.

"We recognise the impact it has on patients, carers and families when our nurses have to prioritise the visit requests they receive and are working with colleagues in the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care Board, the commissioning body for NHS services in Oxfordshire, to develop a plan to meet more of this growing need.

"We welcome feedback on how we might improve our communications with patients about their care, but respecting the confidentiality of our patients means we cannot comment publicly on specific cases.”

On December 19 a spokesperson said: “We… always work collaboratively with colleagues in primary care to ensure patients receive the care they need. We also work directly with families who have concerns to explain the level and frequency of care they might receive, based on each individual patient’s specific clinical needs. Regarding district nursing we have nothing to add to our statement of last week.”

The trust refused to answer specific questions about staffing with the Banbury Guardian – numbers of staff, numbers of patients currently being cared for and how many staff are off on sick leave and how OH could demonstrate that it has enough district nurses. The Royal College of Nursing said the number of district nurses had fallen by almost 50 per cent between 2009 – 2020. However new treatment pathways demand more people are treated at home rather than in hospital.