The number of district nurses has declined alarmingly over the last twenty years. District nurses require a year's additional training after nurse qualification. According to the Royal College of Nursing and the Queens Nursing Institute in 2003, there were 12,620 district nurses in England. By 2013, the number had dropped to 6,656. In 2019, it was down to just 4,000 - a reduction of two thirds in 16 years. That left only one district nurse for every 14,000 people, despite the national policy direction of providing more treatment in peoples homes.