Optimising the use of resources within the district nursing service: a case study

Abstract

Recent statements from the U.K. government indicate that future provision of services within the National Health Service will involve the transition of care from hospitals into the community. District nurses play an important role in caring for housebound patients while alleviating some pressure on other primary care services. An increase in the number and complexity of patients’ needs treated within the community, coupled with the predicted decline in the number of district nurses poses a potential supply and demand problem. Working closely with a district nursing service in Wales, the optimal size and skill mix of district nursing teams to meet patient demand is investigated. A two-stage model is developed that uses Monte Carlo simulation to generate patient demand and Linear Programming to find an optimal team composition that meets this patient demand at minimum cost. Results suggest significant cost savings if district nursing teams are restructured using this approach.

Keywords:

• district nursing
• healthcare
• Monte Carlo simulation
• workforce modelling
• optimisation

Acknowledgements

The authors would like to thank Cardiff and Vale University Health Board for providing data, as well as their time and advice throughout the project. In particular, we would like to thank Sue Morgan, Primary, Community and Intermediate Care Divisional Manager, and Kay Jeynes, Vale Locality Lead Nurse, for sharing their invaluable knowledge and understanding of the district nursing service in Cardiff.