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All cancer patients 'should have access to specialist nurse'

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Patients should also have access to a clinical nurse specialist or other key worker to help coordinate their care, according to a major report on cancer care in England.

Better nursing support for patients falls under the strategic priorities identified by the Independent Cancer Taskforce to help the NHS achieve world-class cancer outcomes.

The taskforce, chaired by Cancer Research UK chief executive Harpal Kumar, was established by NHS England in January 2015 to develop a five-year strategy for cancer services.

Its report, published today, makes 95 recommendations and highlights six strategic priorities.

“There is a shortage of CNSs and sometimes they are used inefficiently, for example, spending time on administrative tasks”

Independent Cancer Taskforce

It noted that the support of a clinical nurse specialist (CNS) was identified as the “most important contributing factor” to a positive experience of care in the 2014 Cancer Patient Experience Survey.

“They play a crucial role in providing information, enabling communication and in coordinating care,” stated the taskforce’s report titled Achieving world-class cancer outcomes: A strategy for England 2015-20.

The taskforce highlighted promising figures showing that the number of cancer patients having access to a specialist nurse had continued to increase from 84% in 2010 to 89% in 2014.

“However, there is a shortage of CNSs and sometimes they are used inefficiently, for example, spending time on administrative tasks, rather than providing specialist care,” the report warned.

“As well as increasing the number of CNSs, the NHS should explore ways to deliver personalised care that is appropriate to the individual’s level of need,” it said.

“This report has to be more than a set of recommendations on paper. It has to inspire action and lead to meaningful improvements for the lives of people with cancer”

Lynda Thomas

The taskforce highlighted a support worker pilot scheme being undertaken by Macmillan Cancer Support.

It said early evidence from the Macmillan pilot suggested the support worker role could undertake holistic needs assessments and coordinate care from diagnosis through to life after cancer.

“These roles can free up CNSs to concentrate on other activities,” said the report. “Alternative creative approaches are being trialled in East Kent and London, for example cancer patients having access to CNSs through a telephone helpline.”

As a result, the taskforce recommended that NHS providers should be encouraged to ensure “all patients have access to a CNS or other key worker from diagnosis onwards, to guide them through treatment options and ensure they receive appropriate information and support”.

In parallel, NHS England and Health Education England should encourage providers to work with Macmillan Cancer Support and other charities to “develop and evaluate the role of support workers in enabling more patient centred care to be provided”, it stated.

Overall, the taskforce’s report outlined how an extra 30,000 patients each year could survive cancer for 10 years or more by 2020. It comes at a time when both cases and survival rates are increasing.

 

The six strategic priorities recommended by the taskforce:

  • Radical upgrade in prevention and public health: the NHS should work with the government to improve public health, including adopting a new tobacco control strategy and a national action plan on obesity
  • National ambition to achieve earlier diagnosis: by 2020 95% of patients referred for testing by a GP should get results within four weeks, either definitively diagnosing them with cancer or ruling it out
  • Patient experience on a par with clinical effectiveness and safety: patients should have electronic access to all test results and other communications involving further care by 2020. Patients should also have access to a clinical nurse specialist or other key worker to help coordinate their care
  • Transforming support for people living with and beyond cancer: By 2020 every person with cancer should have access to elements of a “Recovery Package” – a comprehensive plan that outlines treatment and post-treatment care. A national quality of life metric should be developed by 2017
  • Investment to deliver a modern high-quality service: plans to replace and upgrade linacs machines after six and 10 years, a permanent and sustainable model for the Cancer Drugs Fund, a nationally-commissioned but regionally-delivered molecular diagnostics service, and plans to address “critical deficits” in the cancer workforce

 

Taskforce chair Dr Kumar said: “We’re better informed than ever about how best to prevent, diagnose and treat the disease, and how to deliver better patient experience and quality of life. What’s needed now is action.

“Three previous cancer strategies did a great job of setting England on the path to a world class cancer service. But we are a long way from where we should be,” he added.

Harpal Kumar

Harpal Kumar

NHS England chief executive Simon Stevens noted that “one in two of us” will get cancer at some point in our lives, but two fifths of cases were judged to be preventable.

“The NHS will be backing this ground-breaking route map for prevention, earlier diagnosis, modern treatments and compassionate care,” he said.

Lynda Thomas, chief executive of the charity Macmillan, which was represented on the taskforce, said the report must “inspire action and lead to meaningful improvements” for patients, especially the increasing numbers of those surviving the disease.

“In particular Macmillan is pushing for a strong commitment to an ambitious programme of support for people living with and beyond cancer, improvements to cancer patient experience in this country, and stronger leadership at a local and national level to drive change,” she said.

Catherine Oakley, president of the UK Oncology Nursing Society, was the only nurse on the 19-member taskforce.

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Readers' comments (1)

  • As a cancer clinical nurse specialist myself I can also stress the importance of cancer patients being supported by a CNS and other AHP's to make the cancer diagnostic, treatment and survival pathway as least difficult as possible. However, posts are being downgraded where a post holder leaves, support workers are being used instead of trained nurses and we are being asked to do many non-cancer related tasks within the hospital. In some places CNS's are expected to work shifts on the wards and made to feel that we are not doing a valid job because we are not giving direct care. We are frequently asked to fill in time and motion studies, (with no feedback incidentally), insinuating that we waste our time. I regularly work in excess of my hours, sometimes 10-15 hours a week extra week in, week out which will be to support patients and carers, do paperwork, write patient information and try to carry out audits and improve care with self directed learning. We have no admin support (neither to most Doctors any more of course), and Macmillan put more and more pressure on the existing workforce with the (absolutely necessary) survivorship and carers support. This is with a year on year increase in new patient referrals where patients and their families require intensive outpatient support, advice on social, emotional, nutrition and symptom control issues before they even get treatment. It is commendable that Macmillan do highlight the long term support needed but the reality is that it is being expected to be provided by the existing workforce. Cancer nurse training is pitiful, where attendance at a course and one assignment allows someone to apply for specialist posts with little or no cancer experience thus diluting the expertise of a CNS. It is through good will and sheer hard work and going the extra mile that CNS's manage to support cancer patients at a basic level.

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