NHS organisations are going through challenging financial times, in line with government-directed financial and structural reforms. It is acknowledged that cost cutting measures help balance the books in the short term, but there is a danger here that the role of the cancer clinical nurse specialist (CNS) could be seen as a luxury. Any plans to reduce numbers of specialist cancer nurses would, many believe, undermine the key government policy objectives of delivering the NHS Modernisation Agenda. This paper describes how the cancer CNS can help deliver quality clinical care within tight financial limits. It is based on a focus group held with Macmillan Cancer Support CNSs discussing their impact on the delivery of the Modernisation Agency’s 10 High Impact Changes.