1. 24 hour, 7 day a week District Nursing Service within Herefordshire Linda Marsden, Royal College of Nursing Safety Representative UK Conference 2007

2. Historical care provision Day DN service provided county wide City and only one of the rural areas had an evening service. On call over night – provided county wide by 5 nurses each night No provision for rest period next day if called out. Poor management of lone worker monitoring.

3. Why was change necessary Highlighted in a review of the DN service GPs out of hours now provided by private provider DN service becoming more busy. Palliative Care service specification recommended intermittent visiting day and/or night. Care provision needed to be standardised.

4. History 2 yrs of consultation with DNs Equality of patient service across county. Quality care provision Continuity of care provision. In light of the likely changes with provider services.

5. Reluctance for change Felt unsafe driving to unknown areas when on call On call was too regular – up to twice a week Needed to work day after on call Introduction of late shift – Some DNs had chosen to come into District Nursing because of the more regular hours

6. Why did I take action Aware of nursing redundancies being made throughout the country- some staff facing section 31 arrangements. Felt that nursing is a 24 hour service and should be provided to patients wherever they needed care. Concerned about possible risk of losing complete DN service to private provider, as plans were being made for a private provider to take on 14 hours out of the 24 hours. Would create extra NHS jobs within the service

7. Meet with District Nurses to discuss What would/might happen if they relinquished a proportion of their service. Take account of earlier feedback from DNs Bring together a best option from previous proposals according to the DN feedback. Held a secret ballot.

8. Proposal Evening service – provide our own. Extra resources for teams. (shared out across teams as per resource allocation) A system of Earlies and Lates across larger partner teams.(8am – 10pm)

9. Proposal Only 1 member of “larger" team required per late shift- 8 for the county. Buddy system set up to address lone worker issues. Staff with personal issues which may make this difficult would receive 1 to 1 interviews, to find solutions

10. Proposal Overnight service- provide an on call service ourselves 10pm – 8am 2 on call one north one south (approx 1 in 12 for all = 2% pay wte) Band 6 and 7 only

11. Proposal Taxi service for on call nurses Split according to population (50 % 50%). Mileage included with rurality weighting. Triage Clear referral criteria. Lone worker tracking.

12. Proposal Time off next day – For call out of less than 2 hours report to work for 10.30. Over 2 hours call out report to work at appropriate time e.g. out for 6 hours report to work at 2pm; out for 7 hours report to work at 3pm.

13. A year on Fully implemented. Ongoing reductions in overnight call outs, care now more proactive. Patients now seen late evening rather than when they are in a crisis overnight. No difficulties with recruitment to the DN service. Patient feedback – excellent