Specialist nurses have been presented as a solution to huge variations in the quality of some NHS care by a new Department of Health publication.
The second NHS Atlas of Variation was published today by the DH. It shows large differences between primary care trust areas on 71 indicators of quality and health outcomes. It is intended to highlight where money is being wasted as well as poor care.
The report also suggests how poor performers can improve.
Details seen by Nursing Times show a number of key improvements require more use of specialist nurses.
One is the measure of how much longer people with diabetes stay in hospital than others with similar conditions and age. The percentage by which they stay longer varies from 7.8 to 36.9% between PCTs.
The Atlas says studies have shown that “the introduction of dedicated inpatient diabetes teams can reduce the length of stay for people with diabetes”.
It says: “In these local studies, diabetes specialist nurses provided diabetes training and awareness raising for non-diabetes clinical staff; protocols for the management of patients with diabetes; specific input into the management of patients; experiencing problems with their diabetes management.”
Another indicator is the emergency admission rate for children with epilepsy, where there is a 4.3-fold variation. The Atlas says it in part reflects variation in management of seizure control and of acute seizures.
Among its recommendations are that commissioners consider putting “specialist nurses in the epilepsy service, whose roles could include coordination of care pathway, family support, population education, and liaison with primary care and education services”.
Another indicator is the rate of Parkinson’s disease drug items prescribed in an area, on which there is a 3.5-fold variation. The Atlas says in some areas there may be overprescribing but in others there is likely to be “under-diagnosis and under-treatment”.
It says specialist nurses can help “review prescribing volumes and costs… to ensure that they meet the needs of the local population”. It says: “Parkinson’s nurses help people come to terms with a diagnosis and to manage their medication, and make appropriate referrals to other health and social care professionals.”
The Atlas also highlights the importance of community nurses, and particularly specialists, in reducing the number of people who need to attend A&E and are admitted to hospital as emergencies.