National Assembly for Wales Health and Social Services Committee Inquiry examining the progress made in implementing the Cancer Delivery Plan in Wales including:
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3. The RCN is an active member of the Wales Tobacco Control Alliance. The Welsh Government’s Tobacco Control Action Plan, published in 2012, sets a target of reducing smoking prevalence rates to 16% by 2020, from a current prevalence rate that remains stubbornly high at 23%. This is clearly an ambitious target. As giving up smoking is a key step for individuals taking responsibility for their own health, and reducing their risk of developing cancer, it is essential to recognise that the Tobacco Control Action Plan underpins the preventive element of the Cancer Delivery Plan as well as in a number of other Welsh Government plans.
4. At the last meeting of the Wales Tobacco Control Alliance, members were informed of the concerns that ASH Wales has in terms of the leadership, accountability and monitoring structures for both of these plans. The following issues need to be addressed in order to ensure that the targets set out in both plans are achieved:
· Clear leadership
· Buy-in from key delivery partners and stakeholders
· Consistent strategic representation on delivery boards
· A more formal and robust accountability structure
· Assign a key worker to each person with cancer, from the point of diagnosis onwards, to coordinate their care;
The Cancer Patient Experience Survey (CPES) 2013[1] identified that only 66% of patients responding had been given the name and contact details of their key Worker.
7. As highlighted in the report, the most striking finding of the survey relates to the impact of the Clinical Nurse Specialist (CNS). On almost all questions in the survey, patients who have a CNS are significantly more positive than patients who do not have access to a CNS.
“It is clear that the presence of a CNS makes a substantial positive difference to the perceived quality of cancer services seen by patients. On 59 questions in the survey, patients who had a CNS were more likely to be positive about their care and treatment than patients who did not; and the scale of differences on many questions is very substantial. All of these differences are statistically significant.
The most pronounced differences in view between those patients with a CNS and those without one in 2013 were in respect of verbal and written information, involvement, information on financial support, discharge information and post discharge care and emotional support.”
The cost benefits generated by specialist nurses include:
· reduced waiting times,
· avoidance of unnecessary hospital admission/ readmission (through reduced complications,
· post-surgery/enhanced symptom control/ improved patient self-management),
· reduced post-operative hospital stay times,
· the freeing up of consultant appointments for other patients,
· services delivered in the community/at point of need,
· reduced patient treatment drop-out rates,
· the education of health and social care professionals,
· the introduction of innovative service delivery frameworks,
· direct specialist advice given to patients and families.[3]
· more than one third of specialist nurses reported that they had a vacancy freeze in place.
· 47% reported that they were at risk of being downgraded and
· 68% reported having to see more patients.
11. The RCN has recently published ‘More than just a Number[4]’ showing that in England, hidden within wider nursing workforce cuts is a significant loss and devaluation of skills and experience in the NHS with 3,994 fewer full time equivalent (FTE) nursing staff working in senior positions (bands 7 and 8). The staff affected by this includes ward sisters, community matrons, clinical nurse specialists and advanced nurse practitioners. A similar study has not yet been undertaken in Wales but we have evidence from our members that specialist posts have been under threat.
12. The RCN recommends that every patient with cancer should have the right to specialist nursing care, and ask that the Welsh Government undertake an audit of the number and type of cancer specialist nurses in Wales. Specialist nurse posts should also be supported through robust long term funding and time should be given to specialist nurses to ensure that they can fulfill the core elements of their role, namely providing clinical expertise, leadership and education and training.
[1] http://wales.gov.uk/docs/dhss/publications/140117canceren.pdf
[2] Epilepsy Action (2010) Best care: the value of epilepsy specialist nurse. http://www.sudep.org/wp-content/uploads/2010/07/EpilepsySpecialistNurse-Report-2010.pdf
[2] Parkinson’s UK (2011) Parkinson’s nurses- affordable, local, accessible and expert care: a guide for commissioners
in England. http://www.parkinsons.org.uk/PDF/Englandnursereport.pdf
16 Parkinson’s UK (2011) Parkinson’s nurses in Scotland- providing safe, effective and patient-centred care.
http://www.parkinsons.org.uk/PDF/Scotlandnursereport.pdf
[2] Mynors G, Perman S and Morse M (2012) Defining the value of MS specialist nurses. Multiple Sclerosis Trust. http://www.mstrust.org.uk/downloads/defining-the-value-of-ms-specialist-nurses-2012.pdf
[5] Macmillan estimate based on known cancer prevalence (Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202) and expert consensus, see Macmillan Cancer Support (2013) Throwing light on the consequences of cancer and its treatment.