Community nursing unable to keep pace with rising palliative care demand, researchers warn

Community nursing services are struggling to keep pace with rising demand for palliative and end-of-life care, according to new research from Hull York Medical School, University of Hull.

The study found referrals to district and community nursing services increased by 50% over the past decade, while the number of people receiving care remained largely unchanged. During the same period, the average length of time patients spent under community nursing care fell by almost two-thirds, highlighting growing pressure on services. 

Funded through the National Institute for Health and Care Research (NIHR) Policy Research Unit (PRU) in Palliative and End of Life Care, the study combined national and local data to provide one of the most comprehensive assessments to date of the role district and community nursing teams play in delivering palliative and end-of-life care. 

Community nursing teams provide a wide range of essential services, including patient assessment and review, symptom management, and delivery of medication. Palliative and end of life care accounts for a growing proportion of workload, with much of this activity taking place outside normal working hours. 

Dr Sophie Pask, PRU Research Fellow at Hull York Medical School who led the research, said: “By combining national and local data, we were able to build a detailed picture of the contribution community nurses make to palliative and end-of-life care. 

“More people are living longer with complex long-term health conditions. The rise in demand for community-based nursing care is in line with our expectations. 

“That we also found no significant increase in the number of patients receiving community-based care and a significant a reduction in ‘time on caseload’ indicates a system under considerable pressure. 

“Patients are being seen for shorter periods before discharge and then often re-referred later. Under pressure, nurses are prioritising end of life care, increasingly responding to crises, often out of hours, rather than offering planned care.” 

Despite the total time spent on all nursing care falling year on year, time allocated to palliative care has remained consistent over the period. 

District and community nurses are increasingly having to fill gaps when patients cannot access other community services, including GP support. 

Professor Fliss Murtagh, Director of the Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull said: “This study adds to a growing body of evidence showing that the way we provide end-of-life care is increasingly out of step with rising need. 

“Our research has shown that good palliative care can improve quality of life and reduce pressure on hospitals, yet too many people still miss out on the support they need, particularly in the final months of life. 

“District and community nurses are central to delivering that care, but these findings suggest they are being asked to do more with no corresponding increase in capacity. 

“The impact of being unable to deliver the standard of care they aspire to can affect workforce wellbeing, recruitment and retention, putting further pressure on a system already under strain. 

“If we are serious about improving access to high-quality end-of-life care and reducing inequalities, we must invest in the community workforce that makes that care possible.” 

The service evaluation analysed national district and community nursing data collected between 2013 and 2024, alongside three years of local data from Birmingham covering 2023 to 2025. 

The research found that referrals to district and community nursing services increased substantially over the study period, while patient numbers remained stable and average time on caseloads declined significantly. Local data showed palliative and end-of-life care accounted for 9.6% of all district and community nursing clinical time, equivalent to around 30 to 32 hours of care per 1,000 population each year. 

Contributions to palliative and end-of-life care by community health nursing services: improving care through national and regional service evaluations (Pask et al.) is published in the Journal of Clinical Nursing.