District nursing cuts leave patients "at risk".

England’s district nursing service is at "breaking point" as unmanageable workloads have left patients at risk, a report suggests.

The King's Fund review found there had been a big drop in nurse numbers, causing delays and fewer visits.

The review described a service where staff had been left "broken and exhausted" by the pressures they were under in caring for the frail and vulnerable.

District nursing plays a key role in caring for the elderly, those with disabilities and long-term illnesses, by providing support in their own homes. As well as district nurses, the service includes community matrons and other nurses.

The King's Fund identified official figures showing that district nurse numbers had fallen by 28 per cent in the past five years to just fewer than 6,000, while the wider community nurse workforce had shrunk by eight per cent to 36,600.

The fund acknowledged some of this was down to services being contracted out to the private and voluntary sectors, whose nurses are not counted in the official figures, but said that this would not account for the entire drop.

Researchers spoke to nurses and patients during their review as well as analysing official data. They were told that the service was being "propped up" by agency staff as managers struggled to fill vacancies.

Staff complained they were being left exhausted and stressed by the extra hours they were required to do. This meant they were not always able to spend the desired time with patients, due to delays and the frequency of visits being cut.

The King’s Fund policy researcher, Anna Charles, said: "For years, health service leaders have talked about the importance of providing more care in the community, but this objective cannot be achieved when district nursing is at breaking point.

"It is even more troubling that this is happening 'behind closed doors' in people's homes, creating a real danger that serious failures in care could go undetected because they are invisible."

But NHS England said attempts were being made to attract nurses back into the community and training places for district nurses were increasing.