staff (a net reduction of 3.29 WTE), these recommendations have been considered alongside professional judgement, quality indicators and local operational factors.

The CNSST recommends a workforce skill mix of 75% Registered Nurses. The current District Nursing skill mix is 65.19%, indicating that future workforce planning should continue to strengthen registered nursing capacity. However, the review group concluded that the recommended reduction in unregistered staff is not appropriate at this time, as it would increase operational risk within a service supporting a high proportion of patients requiring routine interventions across a large, predominantly rural geographical area, where travel time and productivity have a significant impact on workforce demand.

This position is supported by CNSST benchmarking data, which demonstrates that Category 1 (routine, non-complex) patients account for 39.3% of the Trust's community caseload compared with the national benchmark of 19.3%, reinforcing the continued requirement for a balanced registered and unregistered workforce.

Despite workforce pressures during the review period, including the deferral of some patient visits, triangulation with quality and workforce indicators provides assurance that patient care has remained safe and effective. Clinical quality measures remained positive, with consistently strong audit (captured via Tendable) performance, low levels of reported harm, positive clinical outcomes and no formal complaints attributable to staffing levels.

Following a workforce review held on 22nd of May 2026 with the Executive Director of Nursing, Midwifery and AHPs, Matron, Locality Managers and District Nursing teams, it was agreed that no establishment changes would be made at this time due to the wider Community Services Review taking place this year. The triangulated review demonstrates that the current funded nursing establishments across all community nursing services remain evidence-based, appropriate to patient acuity, dependency and service demand, and continue to support the delivery of safe, effective and high-quality patient care.

It was agreed that Knaresborough and Ripon teams would be supported to skill mix unregistered workforce hours into Registered Nurse hours when vacancies arise, as required. An Equality Impact Assessment (EQIA) will be submitted to support this proposal.

To strengthen the reliability and validity of future CNSST data, all waiting lists will be incorporated into the District Nursing daily caseload. This will ensure that any deferred care is accurately captured across all teams.

While the service review is ongoing, work is underway to improve service delivery. This includes the development of self-care initiatives, deferred care, care undone reporting and improvements to roster governance. In addition, the Matron is sourcing a pool car for