District nurses fear service fragmentation.

The question of district nursing services being "outsourced" by district health boards (DHBs) was high on the agenda of the district nurses' section national committee meeting in May. Capital and Coast DHB are already making moves to do precisely that (see report p30).

Informal feedback to our discussion paper The Future of District Nursing in New Zealand--Where Do We Fit? has indicated some people have not understood the paper and think district nurses (DNs) currently employed by DHBs are not willing to make any changes. In fact, the recommendations from the paper were that both DHBs and other providers should continue where the current model is "demonstrating the ability to effectively and efficiently achieve service delivery goals in partnership with all health providers ... that there may be opportunity for change ... and that district nurses should be included in discussions and decision making over any changes".

However, we are concerned that transferring district nursing from hospital community services to primary health organisations (PHOs) could fragment the service, reducing DHBs' ability to work collaboratively to bridge the gap between hospital services and primary care. Eighty-one percent of those DNs who responded to our survey earlier this year felt they should be employed by DHBs, eight percent by PHOs, and the remainder were divided between other non-government groups. I believe the flexibility to work with art GPs in a community, white stilt retaining strong links with acute and specialist hospital services, would be restricted if district nursing is restructured to fit with PHOs and the private sector. But the most important point is that DNs should be included in discussions and decision making with the Ministry of Health, DHBs and PHOs over any changes to DN service configuration. We want collaboration, not integration, and to achieve this we need a nursing leadership structure, resources and an infrastructure focused on best nursing practice in the community and best outcomes for patients.

Although many MPs have responded by letter to their copy of the discussion paper and the DN committee has had a meeting with Opposition Hearth spokesperson Tony Ryall, to date no director of nursing or DHB member or any other provider of district nursing services has contacted the section directly.

While we have had some information via the media, the committee also needs to hear from DNs about what is happening in their areas--either via the regional network or by contacting one of the committee. The section is the national voice of DNs but we need to hear what is happening! You can contact me on email [e-mail] or phone [phone].

Report by chair of the district nurses' section national committee Christine Cumming