‘There’s something special about making a difference’: community nurses step up – a photo essay

Community Nursing can trace its roots back to Florence Nightingale and philanthropist William Rathbone. In Liverpool in 1859, William’s wife was ill and he wanted her to be nursed at home. After she died he asked the nurse who had cared for her, Mary Robinson, to provide the same care for others among the city’s poor. Florence Nightingale saw the impact of this and wanted more people to be able to access this care. It was rolled out into the 18 nursing districts of Liverpool, which is where the term “district nursing” originated.

The Queen’s Nursing Institute is the oldest nursing charity in the world. It was founded in 1887 with a grant from Queen Victoria and has about 2,500 registered nurses who have spent more than five years working in the community. I spent time with four of its nurses, photographing their work around the country.

Meet the Queen’s Nurses

Angelina Blair, a Queen’s Nurse and sister at Rowcroft Hospice at Home in Torquay, Devon, says death has become more taboo.

• Angelina Blair, a Queen’s Nurse and sister at Rowcroft Hospice at Home, on a visit with Kathleen Cartwright in Paignton, Devon, April 2024

“We can’t prepare individuals, we can’t manage symptoms if we’re not open. In the past people saw dead bodies, families saw dead bodies, Auntie Mable was the one that always dealt with the deaths and Auntie Pam was the one who always dealt with the births. That’s how communities were but we don’t have that any more, it’s all hidden away and that’s where it’s changing again.”

As community nursing takes place outside traditional medical settings, it often goes unseen and unheard. However, the future of healthcare looks as if it will involve a return to caring for people in their own homes. It is cost effective and could free up beds in hospitals, therefore plugging the funding shortfall within the NHS and aiding the adult social care crisis.

The NHS has started to introduce virtual wards and with advances in technology it is possible to care for people at home that previously would have had to stay in hospital.

• District nurse using car to access remote patient near Loch Fyne, Argyll, in 1959

Kathleen Cartwright, 92, who is terminally ill, says: “I think it’s out of this world for me to lie here. I’ve had the pain of family members dying with no help and I’m just lost for words by the care and attention that I have. I would sooner be with my family [than in a hospital]. They just give me hope and a lot of love.”

Angelina became interested in working in palliative care after helping her mother to have a dignified death at home. She says: “There’s something very special about making a difference to somebody and the memory that lasts for those individuals that are left behind. My mum died at home, we cared for her at home, because that was her wish. I look back to the experience of a good death and how important that is for your memories, for your future, for your life. I wanted to do something to make sure that I could do that (for other people).”

• Angelina Blair has been a nurse for 35 years. Hospice at Home has 14 beds in the community. It covers an area of 300 sq miles area, which encompasses rural, coastal and urban areas. All the patients on Rowcroft’s Hospice at Home caseload are expected to die within two weeks.

Kim Duckworth is a Queen’s Nurse and senior children’s community nurse within the palliative care team in North Devon. Kim works with children who have complex needs which are life-limiting or life-threatening.

“The type of ventilators that I used to use when I first qualified were very antique and they used to run off the mains. It was like a car battery,” Kim says.

• Alisha-Kelly, 14, has muscular dystrophy and scoliosis. She has been on a non-invasive ventilator for two years which she wears at night. Kim is fitting her with a new ventilator at home.

“Before these ventilators came along a lot of these families needed carers. But now, a lot of these families are more self-sufficient and can have care at home to support their ventilation needs. This young person doesn’t have anyone and she is ventilated at night and they manage that between the family.”

“We work closely with the children’s hospice, putting together symptom management plans, especially towards end of life. Having to do this with a paediatrician in a 10-20 minute clinic slot is pretty difficult.”

• Kim Duckworth on a visit to weigh Tabitha, eight, who has Cardiofaciocutaneous syndrome (CFC), at a school in Barnstable.

• Kim Duckworth with Fletcher who has global development delay which affects all areas of his life.

Kim says treating children such as Fletcher at home can help them to thrive. “He is very happy and incredibly resilient and is just amazing. So even though he has this condition that affects him in so many ways he is a very happy, very settled little boy. He just thrives,” she says.

According to the Royal College of Nursing and the latest report from the charity, Together for Short Lives, there is a national shortage of children’s community nurses in England.

In Hull, Kirsty Balfour, a Queen’s Nurse and clinical manager in the Modality Partnership, a homeless health team, she explained that a large part of her job involves advocating on behalf of her clients, who are affected by homelessness and are often victims of discrimination within the healthcare system.

“If we are genuinely going to help people and improve the health outcomes of our clients – which is surely what we all set out to do – we have to be non-judgmental and non-discriminatory. So we have to have those difficult conversations and understanding as to where those judgments come from to be able to challenge that,” she says.

• Kirsty Balfour and Anna Darwick, the lead nurse at Pathway, with patient Vicky at her temporary housing in Hull.

• Ribbons to remember people affected by homelessness who they have lost.

Vicky, who broke her legs jumping out of a window after feeling suicidal, says: “It’s been four years [working with Kirsty and Anna]. I was homeless and Anna got me in a hostel and then into a shared house. I’ve been dealing with domestic violence and sexual assault. It isn’t just the jump out the window I’ve had to deal with, it’s been everything else. Just the way that you’re treated by the staff in the hospital, it’s terrible really. I don’t know what I would have done without Anna.”

“I think people are just busy with their own lives, they don’t want to know. You’re judged every step of the way. I remember a nurse taking some bedding off me and I remember saying to her, ‘Have you got kids?’ She was like: ‘Yeah.’ Well, I then said to her, ‘I hope your kids don’t end up like me.’ It was raining and she took the blanket off me because it was a hospital one.” Anna notes: “They were discharging you out to the street. Weren’t they, without a blanket.”

The average life expectancy of someone experiencing homelessness is 46 for men and 42 for women.

Anna Darwick, the lead nurse of the Pathway team, says staff like to pay tribute when a patient dies: “If they’ve got no family then it [the funeral] is paid for by the council. It used to be you have 15 minutes and you could do a quick reading and you could choose a song to play and you used to be able to get an item of clothing or something for them to wear. But they changed it now. We [staff] go if we can and if we can’t, we mark it. We take some flowers.”

• Ken Hearson, a community nurse at Modality Partnership, speaking with patient Lee outside Westbourne House Hostel in Hull.

Community nursing is managing to reach people in spaces outside hospitals and homes.

Fawn Bess-Leith is a Queen’s Nurse and specialist health visitor in perinatal and infant mental health in the London borough of Newham. She co-founded Botanical Brothers, a gardening project created to promote mental health among young fathers.

• Fawn Bess-Leith, a Queen’s Nurse and specialist health visitor, promotes good mental health among young fathers at Botanical Brothers.

• Fawn taking her patient’s blood pressure. She does this before and after the gardening and it significantly drops afterwards. “The benefits of gardening are that it helps improve sleep, lowers blood pressure and reduces the chance of developing obesity, reducing stress and anxiety which makes you feel relaxed – that’s why your sleep is improved. You get to breathe fresh air. There are all these relaxation and emotional benefits behind touching soil with your hands and feet.”

Fawn says: “The idea behind this project is that men generally – especially guys from black, Asian and minority ethnic groups – do not take mental health seriously because of the stigma. As health visitors we get to the home and we concentrate on the mum and the baby. Throughout my career I’ve noticed that sometimes we forget our men. So one of the things I thought of is how can I get men to come together and learn about emotional well being. Destigmatise the whole mental health thing and do something at the same time that will help.”

“It gets you away from the hustle and bustle and the toxic air. You hear the trees, you see the colours of the plants, it just makes you so relaxed and it’s such a tranquil place. It doesn’t have to be one of the gardens in the Chelsea Flower Show, one of those top notch gardens – you come where nature is and you just feel different.”