Analysis

Plan for seven-day services receives mixed reception

Creating more seven-day services in the NHS in England has been one of the central themes of the new government. Prime minister David Cameron signalled his intention to expand provision at weekends in his first major speech following the election, and the aim was later included in the Queen’s Speech.

Creating more seven-day services in the NHS in England has been one of the central themes of the new government. Prime minister David Cameron signalled his intention to expand provision at weekends in his first major speech following the election, and the aim was later included in the Queen’s Speech.

Since then, health secretary Jeremy Hunt has outlined how the vision could be achieved. In the middle of June he announced a ‘new deal’ for general practice, unveiling how he plans to recruit 5,000 extra GPs and is committed to boosting support staff, including practice nurses, by another 5,000.

But the RCN has warned that the push for seven-day services could be undermined because of the loss of senior roles such as specialist nursing posts, ward sisters and matrons.

'We must invest'

Research published at the start of the RCN’s annual conference last month showed that the number of such posts – bands seven to nine – had dropped by 2,295 in the past five years to just over 64,000 full-time equivalent posts. This led the college’s general secretary Peter Carter to warn that the cuts would put the seven-day plans at risk. ‘We must invest in getting the right skill mix, the right pay, terms and conditions, and the right training to ensure that we can recruit and retain the staff we need,’ he said.

‘There is, of course, scope to do more seven-day working. But the big question is: how are you going to resource it?’

As yet there has been little detail about the vision for seven-day services beyond general practice and urgent care, so the implications for cancer care are unclear. The Department of Health says it is working with NHS England to explore how greater access to hospital services – including for cancer – could be developed.

Complex problems

Macmillan Cancer Support joint chief medical officer Jane Maher says change is needed: ‘We’ve known for a long time that patients report worse experience of NHS care at weekends and out of hours. When people with cancer have complex problems involving different professionals they are particularly vulnerable, because access to the services and specialist support they need may not always be available out of hours.

‘But just announcing that all NHS staff will now work seven days a week seems too simplistic. People with cancer have individual needs and there won’t be a one-size-fits-all solution. Getting the right workforce and working practices in place will be critical to helping people with cancer get access to all the services they need when they need it.

‘We know this will be challenging at a time when the NHS is under huge financial pressure. We’d like to see leaders in the NHS set out a more strategic approach to building the future cancer workforce across the entire care pathway.’

High on the agenda

But UK Oncology Nursing Society board member Emma Sweeney says this is already beginning to happen and seven-day services are ‘high on the agenda of trusts’.

She adds: ‘Scoping is under way to understand what is required – staff, appropriate skill mix and resources. In the long term it will have a positive impact on patient flow, capacity and experience. However, this cannot be implemented and be sustainable without identifying the impact it has on covering the work during the week.’

And Ms Sweeney agrees with the RCN that the role of the specialist nurse will be crucial: ‘Succession planning for specialist nurses is undoubtedly important – how we nurture and support junior staff to progress into this role is of equal importance.’

Senior posts suffer

However, there is clear evidence that the squeeze on senior posts highlighted by the RCN has hit cancer care. Research last year by Macmillan Cancer Support found that just 1% of the 3,088 full-time equivalent specialist adult cancer nurses in England had ‘nurse consultant’ in their title.

RCN cancer and breast care nursing forum chair Maria Noblet says that when the government does start to explore seven-day working for cancer it will need to look hard at this issue.

‘What has been happening over the last few years in cancer is a perfect illustration of what the RCN research has shown: specialist nurses are not being replaced,’ she says. ‘That affects the service that can be provided to patients. The cancer nurse specialist post is really important in co-ordinating the care of these individuals.’

Patient outcomes

In fact, this is something the RCN research specifically highlighted. It said senior specialist posts in everything from cancer care to neonatal services helped to ‘deliver good patient outcomes’ as they were able to travel with the patient through the whole pathway and were at the ‘cutting edge’ of nursing innovation.

‘There is, of course, scope to do more seven-day working,’ adds Ms Noblet. ‘But the big question is: how are you going to resource it?’

She welcomes the investment in primary care that has been announced as it should ‘help improve services in the community’ for survivors. But this should just be the start, she says. ‘We have not heard much yet, but I think it is only a matter of time before we start hearing about the need for cancer care to be seven days.

‘However, there is no point watering down services during the week to just move more to the weekend. It needs to be properly resourced – and that doesn’t just mean with nurses. If you are going to have more operating theatres, imaging and diagnostics, you need those staff to be available too or you will just create bottlenecks in the pathway.’

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