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A national focus on improving access to clinical nurse specialists

NHS England’s Cally Palmer explains the national drive to reorder the workforce so that clinical nurse specialists working in cancer care can give more support to the patients who need it most.

NHS England’s Cally Palmer explains the national drive to reorder the workforce so that clinical nurse specialists working in cancer care can give more support to the patients who need it most.


Picture: John Houlihan

In 2014, the NHS Five Year Forward View set out a vision to deliver better prevention, swifter diagnosis and improved treatment and care for all cancer patients. In 2015, the Independent Cancer Taskforce published a report setting out how to achieve this vision in England. The report recommended a fundamental shift in how we think about cancer services, placing a much greater emphasis on earlier diagnosis and living with and beyond cancer. It called for a reduction in preventable cancers, improvements in survival rates, and a transformation of patient experience and quality of life.

NHS England’s cancer programme was created to lead this fundamental shift and has made significant progress in the two years since its launch. Further improvements in patient care will be driven via the 19 cancer alliances established across England.

We know that people with cancer value the support provided by a clinical nurse specialist (CNS) in cancer care highly. NHS England is also aware that access to a CNS can be varied because of where you live, your ethnicity or the rarity of your cancer. It is looking to reduce this inequality by increasing the skill mix of nurses to support CNSs and to enable them to concentrate on those with greatest need. This includes developing new roles, such as ‘navigators’,  who understand the complexities of the health services and can help steer patients through the system to find the support that is right for them. 

Support and self-management

Macmillan Survivorship Research Group (MSRG) senior research fellow Jane Winter is a consultant colorectal nurse at University Hospital Southampton NHS Foundation Trust. Dr Winter is delivering a project aimed at potentially redesigning the workforce so that patients who need greater support receive it while those who can ‘self-manage’ are signposted to useful resources while still having access to a CNS. 

'You know intuitively – your skill set tells you – which patients need greater support'

Jane Winter

She explains: ‘I have been a CNS for 20 years and you know intuitively – your skill set tells you – which patients need greater support, but what we have not been able to do until now is structure that in a formal way.’

The ColoREctal Wellbeing (CREW) study, funded by Macmillan Cancer Support and conducted by MSRG, gathered information from 1,000 colorectal cancer patients about life after their illness and has provided important evidence for this self-efficacy approach.


Picture: Tim George

Patient experience

Dr Winter says that identifying at the point of diagnosis those likely to need more support is key to targeting care more effectively, while introducing Agenda for Change Band 4 nurses to support patients who are confident at self-managing will enable CNSs to spend more time with those whose needs are greater. This will integrate with the existing aftercare pathway that Dr Winter introduced for colorectal patients in 2011, where Band 4s are already established.

Understanding an individual’s experience of cancer services, from initial appointment through to treatment and beyond, is fundamental to improving the service. A goal of the national strategy is for patients’ experience of their cancer treatment to be considered as important as the treatment itself.


About the author

Cally Palmer is NHS England’s national cancer director and chief executive of the Royal Marsden NHS Foundation Trust

 

 


References

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