Paul Trevatt

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Paul Trevatt Nurse Director North East London
Cancer Network
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The Challenges for Clinical Nurse Specialists

• Paul Trevatt Network Nurse Director North East
  London Cancer Network
• United Kingdom

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The Aim of the Presentation

• This presentation aims to compliment Professor
  Richardsons paper and expand further some of the
  themes identified using a number of regional and
  national audits focusing on the role of the CNS.
  

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The New World

• NHS voted worse than 10 years ago
• Redundancies for 900 NHS staff
• Hewitt warns patients will vote with feet
• Competition wont add quality
• PbR fundamentally flawed says coding chief
• Efficiency saving costed at 2.2bn

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The CNS in the New World

• Certain cancers increasing
• More complex presentations /
  co-morbidity
• Challenges with recruitment and retention
• The focus of care moving from acute to community
  sector
• The role of the voluntary sector regarding nurse
  specialist posts

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North East London Cancer Network CNS Audit
(2004/2005)

• Survey took place to profile the role of cancer
  and palliative care clinical nurse specialists
• The Survey focused on three areas
• Role
• Education and training
• Professional development
• 73 questionnaires returned

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North East London Cancer Network CNS Audit
(2004/2005)

• Variations in Role Title
• Macmillan palliative care nurse
• Macmillan Clinical Nurse Specialist in Palliative
  Care
• Macmillan CNS in Palliative Care
• Senior CNS (Palliative Care)
• Specialist Palliative Care Clinical Nurse
  Specialist (Macmillan)
• Clinical Nurse Specialist in Palliative Medicine

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North East London Cancer Network CNS Audit
(2004/2005)

• Variations in Role Title
• Clinical Nurse Specialist in Urology
• Uro-Oncology Nurse Specialist
• Macmillan Urology Nurse Specialist

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Clinical Nurse Specialist Mapping (2006)

• Mapping carried out by Clair Honnor (Thames
  Valley Cancer Network Nurse Director)
• Most recent Cancer Registration Data
• WTE of CNS 2005/2006 Data
• 73 response rate (25 Cancer Networks)

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Cancer Incidence taken from 25 Cancer Networks
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The numbers of CNS across the Cancer Networks
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Cancer Networks Specialist Workforce Review

• Unpublished research (Honnor Trevatt 2006)
• The workforce review focused on a number of
  areas
• Frozen posts
• Funding for voluntary sector sponsored posts
• Posts that had been cut or were at threat
• Agenda for Change
• Moving Clinical Nurse Specialists onto the wards
  to work as generalists

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Cancer Networks Specialist Workforce Review

• 13 out of 34 networks responded (38) expressing
  concerns
• 62 of those responding has ongoing specialist
  workforce reviews
• 15 of networks expressed concern around pick up
  for specialist posts following investment.
• In this review 4 posts were identified as not
  receiving further funding and were being cut

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Themes from the Three Audits

• There are variations in role titles which may
  confuse patients / carers. This may lead to role
  blurring.
• There are variations in cancer incidence across
  the cancer networks
• There are Inequalities between some cancers in
  terms of provision of Clinical Nurse Specialists
• Urology patients appear poorly served when
  compared with breast and colorectal

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What is the Added Value of the CNS?

• The role of the CNS in the delivery of direct
  care is often overlooked or not recognised.
  Validation of service can demonstrate the
  significant contribution CNS can make to length
  of stay and admission avoidance all issues
  pertinent to our health economy
• Senior Assistant Director of Nursing (2006)

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What is the Added Value of the CNS?

• However, there may be also be some who have
  failed to demonstrate their contribution by
  failing to engage in research or other
  professional activity. Professionals need to be
  able to show what it is they contribute to the
  service in question. Without such evidence it is
  unsurprising that they will face questions when
  the money becomes tight
• Kelly D and Trevatt P (2006)

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What nurses spent their time on
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Areas for Consideration

• Clearer roles and role titles for Clinical Nurse
  Specialists
• There needs to be effective auditing of services
  with regular reports shared within Directorates /
  Directors
• There needs to be effective support (clinical
  supervision / case supervision and role mentoring
  / buddying)
• The voluntary sector needs to consider the future
  of sponsoring specialist posts. There may be
  value in the charities working together to
  develop a cohesive strategy to tackles this

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Final thoughts and reflections

• It is difficult to remain motivated at the
  frenetic rate of change in the NHS. CNS who are
  fit for purpose should be demonstrating clinical
  expertise, developing others through education,
  lecturing, and publishing and be relentless in
  their innovation for quality and service
  development..when they ask are you value for
  money? I think frankly Im a bargain.
• CNS (2006)

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The End

• Thank you for listening
• Are there any questions?
• Paul.trevatt_at_bartsandthelondon.nhs.uk
• 0207-377-7241

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