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Nursing staff shortages and winter pressures on the NHS are becoming somewhat familiar terminology across the UK in recent years. This December, while we are focussing on the invaluable role of a Clinical Nurse Specialist (CNS), we have identified how the burden upon the NHS may be impacting on CNS numbers, and hence, leukaemia patient care.
In April 2015, it was estimated that there were 26,700 nursing vacancies across the UK, meaning staff levels were much lower than the recommended safe staffing levels. Each year, this pressure upon staff only intensifies, as the winter comes around and increases susceptibility to illness and rates of infection. The winter pressure on the NHS is a consequence of demand for NHS services being greater than the availability of GP time, hospital staff and bed space.
In our latest report, ‘My CNS Matters’, we identified that in around 1 in 4 trusts the CNSs were required to fulfil normal nursing duties during the times of increased pressure. Some trusts specifically mentioned during winter. The idea of this is to increase the nursing workforce available on wards and ease the pressure.
On the surface this appears to be good practice, however, the knock-on effects of CNSs being unavailable for their normal duties could actually cause greater pressure. This is because a CNS is responsible for the ongoing management of cancer patients. Through their own clinics and telephone appointments with patients, CNSs can continually review a patient. This enables them to determine if patients require appointments or not, spot possible complications and take action to manage them before a patient requires hospital admittance.
The nature of a blood cancer, causing reduced immunity, means that patients are more susceptible to infections during the winter and the complications can be much greater than for someone who is fit and well. Therefore, having a CNS available to call during this time can be invaluable for a patient. One small example could be a patient’s GP wanting to prescribe an antibiotic for treatment of an infection, but is unaware whether the patient can have this. The CNS is a key contact for providing this information.
You could, consequently, argue that CNS provision is even more vital during the winter periods for blood cancer patients. Patients will need greater support and if the CNS is busy on the wards there is less available time for this. This is likely to translate into patients attending their GPs or even attending A&E and requiring hospitalisation when this could be avoidable.
So effectively, reducing the CNS workforce to alleviate the burden upon the ward staff could be causing increased pressure upon the NHS in other areas. Not to mention the reduced support available for patients during a difficult time of year.
This is why in our latest report we recommended that there needs to be an increase in nursing workforce across the UK to improve CNS access and support for leukaemia patients all year round. This rhetoric is also echoed in the latest report by the All Party Parliamentary Group on Cancer, who has noted that to achieve goals outlined in the 2015-2020 Cancer Strategy (including 100% access to a CNS or key worker) the workforce shortages need to be addressed and resolved.
Read about CNS numbers and the NHS burden in our latest report here.