Quality in cancer nursing

1. Quality in cancer nursing • National drivers and issues specific to cancer care • Advanced nursing practice • What is truly specialist? • What can be delegated? • Outputs from listening exercise with service users and colorectal and head & neck CNS teams

2. Context Global recession The financial climate next year and beyond will be very different to the one that many Trust’s have faced over recent years NHS growth money comes to an end and GP consortia may look to make savings on their acute contracts Quality and performance targets will tighten with greater emphasis on measuring and reporting of quality targets related to safety, effectiveness and patient experience

3. Background NCAT steering group formed 2009 to address issues specific to nursing in the implementation of Cancer Reform Strategy One of the main work streams was to examine inequities in access to specialist nurse support Census of CNSs in English Cancer Networks Nationally transferable roles with Macmillan and skills for health

4. Cancer care Greater treatment options - improved survival but adds complexity Increasing cancer survivorship issues Changing care settings Variations in patients’ experience of care still exist and some groups in society have disproportionately poorer outcomes Need for transparency in reporting of clinical outcomes

5. What we know so far Variation in access both by tumour type and geographically Definite link with reported quality of care and provision of CNS support No caseload guidance Ever growing demands on expert interventions

6. One to one support to cancer patients • To ensure personalised holistic assessment and care planning which takes account of needs associated with the individual, the disease and the treatment. • To undertake a major role in coordination and continuity of care through supporting patients to navigate the system, to signpost to other sources of support and ensure that patients can re-enter the system if required. • To ensure that patients and their carers get information, advice and support about diagnosis, treatment, aftercare, palliative and end of life care services. • To enable supported self-management, where appropriate. • To identify emerging problems around communication between patients and the healthcare system, symptom control and side-effects of treatment, signposting to appropriate lifestyle interventions. • To take a leading role in the provision of care and support, for example by providing specialist clinics as appropriate to the patients needs.

7. RCN 2010 Nationally agreed elements of advanced practice Clinical/direct care practice Leadership and collaborative practice Improving quality and developing practice Developing self and others

8. Improving quality and experience of care • Managing complex, individual and changing information and support needs of patients and carers • Supporting patients in choices around treatment and care • Enhancing recovery and delivering care flexibly and closer to home • Facilitating set up of support groups Increasing productivity and efficiency • Intervening to manage treatment side effects and/or symptom control, preventing unplanned admissions • Providing nurse-led services that free up consultant resource • Empowering patients to selfmanage their condition Reinforcing safety • Delivering safe, nurse-led services • Using vigilance of symptoms and drug toxicity to trigger rescue work • Identifying and taking action to reduce risks • Facilitating rapid re-entry into acute services, if appropriate Impact of key CNS-led activities

9. We can’t do it all! Which aspects of patient support require an advanced practitioner? At what points on the patient pathway? What can be delegated? To whom?

10. We all agree… Map out the interventions of a CNS in patient pathway Explore the options……. What is truly specialist? What can we delegate? What doesn’t need doing at all? How can we make the change? The task...................

11. Specialist level • Breaking bad news • Managing complex admissions • Risk assessment of high risk families • Nurse led clinics • Taking consent/promoting patient choice • Survivorship clinics • Averting inappropriate hospital admissions • Supporting complex patients at home

12. Specialist level • Dealing with oncological emergencies • Reducing LOS by managing complex discharges • Non-medical prescribing • Psychological assessment and support • Devising end of treatment care plans • Genetic screening advice/assessment

13. Support worker level • Liaising with MDT trackers • Non-clinical telephone advice • Co-ordinating and organising tests • Co-ordinating admission dates • Data collection • Communicating results via fax to GP’s • Emotional support

14. Support worker level • Chasing results • Triage phone calls from other HCP • Supplies management • Onward referral to District Nursing Teams • Assisting with benefits advice • Signposting to sources of support • Lifestyle advice • Ensuring patient has relevant contact details and knows when/how to use them