Breakthrough Breast Cancer memorandum to the Health, Wellbeing & Local Government Committee Inquiry into health and social care workforce planning

1. Introduction

1.1 Breakthrough Breast Cancer is the UK’s leading breast cancer charity and is committed to fighting breast cancer through research, campaigning and education. Breakthrough has established the UK’s first dedicated breast cancer research centre, in order to realise our vision: a future free from the fear of breast cancer. Breakthrough campaigns for policies that support breast cancer research and improved services, as well as promoting breast cancer education and awareness amongst the general public, policy makers, health professionals and the media. 1.2 Breakthrough works closely with healthcare professionals, particularly with specialist breast care nurses, to ensure breast cancer patients receive the highest standard of care.1.3 Breakthrough welcomes this inquiry into workforce planning for health and social care. Our memorandum focuses on the need for effective workforce planning and the impact poor planning has on breast cancer care.

2. Identifying future demand - trends in breast cancer diagnosis

2.1 Breast cancer is the most common cancer in the UK.  In 2004, there were 2,381 new cases of breast cancer in Wales (Cancer Research UK). In 2005, there were 676 deaths from breast cancer in Wales (Cancer Research UK).2.2 With an ageing population it is unlikely these figures will decrease. In fact, despite greater (though still limited) knowledge about risk factors and progress in terms of earlier detection, they are likely to increase over the next 10-20 years. It is therefore essential that breast clinics are adequately staffed with qualified clinicians in order to continue to build capacity to deal with the increasing demands on breast care services.

3. Workforce planning

3.1 The impact of poor planning on breast care

3.1 There is no current published information or statistics available on the exact number of breast care nurses working in the NHS in Wales so it is difficult to quantify the extent and impact of poor workforce planning and job losses. 3.2 Earlier this year, Breakthrough worked with the Royal College of Nursing (RCN) and Breast Cancer Care to carry out a survey of UK breast care nurses to gain a picture of the impact NHS deficits may be having on specialist posts and any consequent impact on patient care. It is feared that specialist nurses are sometimes seen as a 'soft target’ and, in a submission by Breakthrough to the House of Commons Health Select Committee’s inquiries into NHS Deficits and Workforce Planning, there is some evidence that specialist breast care nursing posts are being frozen or left vacant due to financial constraints. This places extra pressure on existing staff. Fewer staff in the breast unit, more nurses working unpaid overtime in order to deliver the service, less time to spend with individual patients and low staff morale will inevitably have an impact on patient care and the patient experience.  3.3 Financial and workload constraints also mean that staff are not being given the opportunities to develop their professional skills. In addition to study days being cut, many breast care nurses have had their training budgets cut or have had to take annual leave in order to attend training events, sometimes even financing the training themselves.3.13 Specialist breast care nurses have voiced concerns about a lack of understanding within NHS Trusts about the nature of their role in supporting and caring for patients and there being no tariff placed on this type of activity. Breakthrough believes this reflects an overall lack of emphasis on the importance of the role that specialist nurses undertake in the NHS. 3.14 Breakthrough believes poor workforce planning threatens specialist nursing posts, damages patient care continuity, and potentially limits the quality of breast cancer care.

3.2 Changing roles

3.20 Increased referrals to breast units have led to discussions of how to make more effective use of consultant and specialist breast care nursing time. The current financial situation also requires breast units to think more creatively about existing resources and meeting Government targets.3.21  In England, several breast units are now using Advanced Practitioners, where nurses and other healthcare professionals such as radiographers are trained to perform advanced tasks in breast clinics to assess, diagnose and follow-up patients with breast disease. These posts are being used to help breast units meet existing targets and to implement the Government’s 2005 commitment that in England everyone with breast problems will be seen by a specialist within two weeks following a GP referral, whether the referral is urgent or routine. 3.22 Women have told Breakthrough that whilst waiting for a diagnosis they experience very high levels of anxiety and distress. Early detection, diagnosis and treatment of breast cancer are vital to improving the chance of a successful treatment outcome.3.23 However, in Wales there are no specific targets or plans to reduce waiting times for referrals for people with breast problems. In fact, in a recent letter (22 October 2007) from the Health Minister, Edwina Hart, the Welsh Assembly Government stated: "In Wales, we have two waiting times targets for cancer and these focus on the start of treatment rather than a first outpatient appointment. There are other general waiting times targets for patients who are referred with breast symptoms where cancer is not suspected or diagnosed. This is in line with the Welsh Assembly Government’s commitment to reduce the maximum wait for all patients to 26 weeks from referral to treatment for those patients by December 2009.” 3.24 Furthermore, a woman from Wales recently told Breakthrough that she had to wait 11 weeks to see a specialist following a referral from her GP. These lengthy waits are unacceptable and Breakthrough urges the Health, Wellbeing and Local Government Committee to look into this worrying situation. 3.25 As in England, the use of Advance Nurse Practitioners could help to significantly reduce waiting times for referrals. However, it is vital that the necessary infrastructure is in place to support the development of competencies for this role. Training courses must be developed, and time and resources made available for training for staff who may take on this role. Furthermore, it is difficult to see any reduction in such lengthy waiting times for referral and diagnosis if no priority is given to workforce planning for the future. 3.26 Breast cancer treatment has the potential to significantly advance over the next 10 years with better technologies, such as less invasive and more targeted treatments, delivered in different ways by a range of clinicians. In addition, patients will continue to need someone to support them through their experiences. It is therefore essential that specialist nursing posts are both funded to meet current needs and allowed to develop to meet future challenges, free from short term pressures to balance budgets.

4. Recommendations for action

4.1 The Welsh Assembly Government should support workplace innovation and changing workplace practices, ensuring resources are available to trusts and frontline staff to develop Advanced Nurse Practitioners to help reduce referral waiting times for people with breast problems. 4.2 All those involved in the National Health Service including the Department of Health and Social Care, local Health Boards and NHS Trusts, and NHS managers recognise the role specialist breast care nurses play in patient care and how that care is being affected by deficits and poor workforce planning.4.3 The Welsh Assembly Government should ensure that local Health Boards and NHS Trusts make available annual budgets for staff professional development, ensuring there are no further obstacles, such as cuts to study days and a lack of temporary or agency nurses (often referred to as 'bank staff nurses’) that restrict ability to attend training.4.4 The Welsh Assembly Government should ensure that any short term financial situation does not impact upon the NHS’s ability to retain and recruit skilled and motivated specialist breast care nurses. Vicki Nash
31 October 2007 For further information please contact Vicki Nash, Government & Parliamentary Campaigns Manager at Breakthrough Breast Cancer on 020 7025 2435 or at vickin@breakthrough.org.uk.