The 75th anniversary of the NHS is an event that we should all celebrate, and also a time for us all to reflect on healthcare in this country – where it has come from and where it is going.
By the time the NHS was established in 1948, the Queen’s Nursing Institute (QNI) – or Queen’s Institute of District Nursing as it was then known – had already been in operation for 60 years.
In many ways the QNI provided the blueprint for community nursing as the profession continued to evolve after 1948. For example, the QNI had already established the need for national standards in community nurse education and practice and was providing the training in every region in the UK, an approach that also took account of regional variations in population need.
“Community nursing is responding to innovations in healthcare technology, population and individual need”
For 20 years after the establishment of the NHS, the QNI continued to set the curriculum standards and accredit regional examination centres for district nurse education, and until 1968 the title of ‘Queen’s Nurse’ was a qualification obtained after passing the exam. After that time, education for district nurses was moved into higher education institutions and the Queen’s Nurse title fell into abeyance until 2007 when it returned in a new form for all nurses working in the community.
In the decades preceding the NHS, there was a huge drive to improve the health of children as it became recognised that this was imperative to lifelong health and wellbeing, and national prosperity. This drive continued to become central to the new NHS and local authority public health departments. Nurses working with their communities became core clinicians in the organisation, management and delivery of public health initiatives for the local populations they served.
Standards for education and practice for new community specialisms that we recognise today began to emerge in order to meet this need – and these specialist fields of community nursing practice often had roots and connections with district nursing – for example general practice nursing, community children’s nursing, community mental health nursing, community learning disability nursing and school nursing.
Nursing in the community has always been creative and innovative – we work with what is available to us in often unpredictable, complex and non-clinical environments in which we are a guest. One consistent theme in community nursing history is the education to support nurses working in these high-risk settings, education which has always responded to the healthcare needs of the day.
Now we see additional specialist fields of nursing evolving to have formal standards and being recognised as an equivalent to the district nurse qualification – including health and justice nursing, inclusion health nursing, adult social care nursing and palliative and end-of-life community nursing.
In the 21st century, community nursing in all its forms is more essential to the nation’s health than ever before. Community nursing is responding to innovations in healthcare technology, population and individual need. Health needs are continuing to evolve and posing challenges to government and society. People are living much longer, but this comes with an increasing challenge to maintain health and wellbeing and prevent and minimise the impact of long-term complex conditions.
Government policy has recognised that more care should be delivered at home, and this is the preference of the majority of people surveyed, but this is dependent on a skilled nursing workforce, the willing support of unpaid carers, and effective use of technology and joined up working. Health education, personalised care and supported self-management is as important as ever and community nurses play an instrumental role in this.
In 2023, the QNI has come full circle and now sets voluntary standards of education and practice to complement those of the Nursing and Midwifery Council, and these QNI standards reflect the advanced level of practice at which the modern-day nurse leader works when taking responsibility for the leadership and management of a nurse-led service in the community.
The QNI also supports nurses working in the NHS and all other community services in many different ways – through our nurse-led innovation programmes, leadership programmes, raising the profile, value and impact of community nurses, developing the evidence base for supporting workforce development and influencing healthcare policy.
Crystal Oldman is chief executive, Queen’s Nursing Institute