Contributions to palliative and end-of-life care by community health nursing services: improving care through national and regional service evaluations

Aim(s)To describe adult palliative and end-of-life care provision by community health nursing services using a: O_LINational dataset (2013-2024) to report patterns in service provision over time. C_LIO_LIRegional dataset (2022/23, 2023/24 and 2024/25) to describe palliative and end-of-life care activities. C_LI DesignSecondary analyses of existing national and regional datasets. MethodsWe used national data to describe 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. ResultsNationally, 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 26 minutes 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 hours per 1,000 population annually) across three years, even as total care hours declined. A disproportionate amount of palliative and end-of-life care occurred out-of-hours. ConclusionIncreasing 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. Implications for the profession and/or patient careThis evidence informs better planning to ensure sufficient provision and workforce in community health nursing. Patient and public contributionPatients, family carers and public members contributed to interpreting findings and implications for practice. What does this paper contribute to the wider global clinical community?O_LIProvides combined national and regional data to describe the scale and nature of palliative and end-of-life care delivered by community health nursing services over time. C_LIO_LIFindings give a detailed picture of how community health nursing services are under pressure because of increasing referrals and being required to deliver a greater breadth of tasks. C_LIO_LIModels of community health nursing are changing with shorter care episodes and significant palliative and end-of-life care workload (with distinctive challenges out-of-hours). C_LI