Contributions to Palliative and End-of-Life Care by Community Health Nursing Services: Improving Care Through...

To evaluate adult palliative and end-of-life care provision in England by community health nursing services using a national dataset (2013-2024) to report patterns in service provision over time and a regional dataset (2022/23, 2023/24 and 2024/25) to describe palliative and end-of-life care activities.

Secondary analyses of existing national and regional datasets.

We used national data to evaluate the populations served; workforce; referrals; unique service users seen annually; contacts; time on caseload; care delivered/care locations; support to other teams/processes; and deferred care. Regional data was used to examine palliative and end-of-life care activities in the context of all nursing care delivered.

Nationally, referrals to community health nursing services increased steadily from ~4,000 to ~6,000 per 100,000 weighted population between 2013 and 2024, while unique service users remained stable (around 2,600-2,800). Median average time on caseload reduced markedly from over 150 days to around 50 days, despite stable contact frequency (median 23 total contacts per service user) and duration (median 28 min for face-to-face contacts). Regional data showed that palliative and end-of-life care consistently accounted for 9.6% of all community nursing clinical time (30-32 h per 1,000 population annually) across 3 years, even as total care hours declined. A disproportionate amount of palliative and end-of-life care occurred out-of-hours.

Increasing referrals and shorter time on caseloads indicate a system under pressure. Time spent on palliative and end-of-life care by community health nursing teams has remained stable over time, despite growing population need. Workforce capacity, skill mix and out-of-hours provision need to align to support high-quality, person-centred care in the community.

This evidence informs better planning to ensure sufficient provision and workforce in community health nursing.

Patients, family carers and public members contributed to interpreting findings and implications for practice.