A key target in the Government’s health reforms – to have thousands of community nurses treating the most seriously ill patients outside hospital – has been missed, with fewer than half the promised numbers in place.

A pledge made three years ago to have 3,000 experienced nurses in post by March this year has been delayed, with social workers and less qualified staff having to make up the numbers looking after patients with chronic illnesses.

Cost-cutting and a recruitment freeze in the NHS have forced ministers to revise the deadline back one year in order to benefit from record funding increases in 2007-08.

The retreat has emerged as Patricia Hewitt, the Health Secretary, prepares to outline today how £8 billion of extra NHS funding will be spent this financial year. It is the last planned annual increase, and many NHS chiefs are already preparing for a subsequent period of drastic budgeting.

There are more than 17.5 million people living with chronic conditions such as diabetes, arthritis and heart failure. The Department of Health has claimed that cuts to local hospital services could be justified by having experienced senior nurses treating these patients in or close to their homes.

But The Timeshas learnt that unqualified social workers, physiotherapists and less experienced staff are being used to boost the total number of “case managers” who care for the most chronically ill patients outside hospital.

The department’s latest estimate is that there were 1,470 community matrons working in the NHS in December, with an official NHS workforce survey suggesting that fewer than 100 were recruited last year.

The target, set by John Reid, the former Health Secretary, during Labour’s “Big Conversation” in 2004, aimed to respond to patients’ calls for more care nearer to their homes. Ministers claimed that the £500 million community matrons’ policy would soon pay for itself by saving £400 million a year through reduced hospital stays.

But Mrs Hewitt admitted yesterday that community care remained poor in some areas. Treating patients with long-term chronic conditions was the “really big challenge” facing the NHS, she said, but she made no direct admission that the target had been missed. “By March next year, 220,000 of the most needy patients will be getting support and care in their homes from 3,000 community matrons and other case managers,” she added.

Josie Irwin, head of employment relations at the Royal College of Nursing, said that the figures amounted to a “spectacular failure” of a government policy.

Health spend

— NHS funding has leapt from £35 billion when Labour took office to £92 billion in 2007-08

— About 80 per cent is allocated to local services

— The remainder is spent on capital investment or centrally by the Department of Health on training budgets or vaccine stocks

— Pledges for this year include £600 million for new hospitals

— Funding is also promised for sexual health services, cutting waiting times and MRSA infections, managing drug misuse and services to help smokers to quit

Source: Department of Health

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