Suffolk health organisations have disputed claims that nearly half the county’s district nursing is carried out by unregistered healthcare assistants amid warnings of a “watering down” of the service’s skill mix.

The Royal College of Nursing’s district nursing statistics for East Anglia highlight an increasing reliance on less qualified staff, citing cost saving challenges as a possible explanation.

The report claims only 55% of the service in Suffolk was run by registered community nurses in 2013, compared with 82% in 2011.

With healthcare assistants making up the remainder, the RCN has expressed concerns that the service is “about cutting costs and not about high quality care”.

The figures, produced from Freedom of Information (FOI) requests, cite Suffolk as undergoing the region’s largest shift from registered to unregistered nursing over the two year period. Cambridgeshire, in contrast, has seen the skills mix grow from 82% to 96%.

Suffolk Community Healthcare, which provides district nursing in the county claims the report is out of line with its own figures and questioned where the data has come from, as it did not respond to the FOI.

Pam Chapel, who is director of nursing therapies and governance, said the SCH does not employ many healthcare assistants “but those we have are essential and do a brilliant job”.

“In our community teams we have three nurses and therapists for every generic worker,” she added.

“Our fantastic community and district nurses are essential and we value them hugely along with everyone in our teams.”

The NHS Ipswich and East Suffolk CCG and NHS West Suffolk CCG, which commissions the services, has also disputed the figures and insisted good quality patient care is a priority for the NHS in Suffolk.

“The clinical commissioning groups work with SCH to ensure their community health teams have the appropriate skill mix,” said, Barbara McLean, chief nursing officer.

North East Essex has also seen a small decline in its skill set from 74% registered nurses in 2013 to 69% in 2011.

A spokesperson for Anglian Community Enterprise (ACE), which provides the service, said: “Healthcare assistants are used to support the work of qualified nurses; they cannot and do not replace them.

“Healthcare assistants have a high level of training and experience and offer a valuable service ensuring that qualified nurses can use their skills where they are really needed.”

A spokeswoman for NE Essex CCG, which commissions the services, said skill sets will change with improvements to local care services.

The spokeswoman cited the Community Rapid Assessment Service at Clacton Hospital as an example, which allows advanced nurse practitioners to look after frail patients in their own homes.