Community nursing time per palliative patient fell by two-thirds over a decade even as referrals rose, national data show

A secondary analysis combined a national community and district nursing dataset for England (2013–2024) with regional service-activity data Audit/Data. Referrals rose from around 4,000 to around 6,000 per 100,000 weighted population over the decade, while the number of unique service users stayed flat — meaning the same or a similar-sized group of patients is generating substantially more referral activity. Median time on caseload fell from over 150 days to around 50 days. Palliative and end-of-life care consistently accounted for 9.6% of all community nursing clinical time even as total nursing hours declined nationally, with a disproportionate share of that care delivered out-of-hours.

The paper does not report a regional breakdown fine enough to establish whether any single area’s community nursing pressure tracks above or below this national trend.

Advance care planning and anticipatory prescribing — both of which depend on sustained, non-crisis nurse contact — become structurally harder to sustain if community nursing time per patient keeps falling while referral volume rises nationally. Where that access is not protected, patients who would prefer to die at home are more likely to default to crisis-driven hospital admission when out-of-hours support is thin.