Councillors yesterday claimed district nurses would struggle to cope with changes proposed by a Birmingham health trust to improve endof-life care for patients.

Birmingham East and North Primary Care Trust is consulting over its plans to reconfigure its palliative care services in the community, which will end in January.

About 4,300 people die in the PCT's area each year, but a trust survey revealed 75 per cent would rather die at home.

Tony Ruffell, assistant director of commissioning and redesign, told the city council's health overview and scrutiny committee the trust's current provision of palliative care was "fragmented" and "disjointed".

"We are attempting to move the service forward for its patients, because at present we aren't meeting patients' or carers' needs," he said.

"Under this proposal, district nurses are the focal point and would co-ordinate all other care for their patients.

"When patients no longer can benefit from curative care, the district nurse will continue to monitor and co-ordinate their support and care, working closely with GPs and other providers of palliative care."

The PCT's proposal would mean district nurses co-ordinating their patients' care with social services as well as NHS healthcare providers.

The expansion of the existing 'hospice at home' service will also include 36 extra supportive care beds, as well as additional holistic and community based support services.

But the city's health watchdog felt the plans would put further pressures on already hard-pressed community staff.

Coun Catharine Grundy (Lab Kingstanding) said: "District nurses already have to meet particular targets in terms of how long the spend with patients and how many they see.

"They arrive to look at a dressing, redo it if necessary and then leave. In order to do a full assessment they need time and my concern is that it may end up becoming nothing more than a medical 'tick sheet'."

Coun Rev Richard Bashford (Lab, Quinton) added: "What has been suggested appears to be more of a social model, and I am worried that if district nurses are trained in medical care, are they the best possible people to deliver such care?"

Mr Ruffell answered: "We do feel district nurses are the best possible to co-ordinate, and deliver, this care."

The trust's consultation continues until January 11, 2008. For details of the proposals and public meetings are at www.benpct.nhs.uk.