Evidence submitted by Macmillan Cancer
Support (Def 43)
INTRODUCTION
1.1 Macmillan Cancer Support has invested
approximately £230 million in cancer services over the past
five years in England. Macmillan currently funds or supports 3,349
health and social care posts in England. We operate a "pump-priming"
funding model under which we fund a new post—typically for
three years—on the condition that the NHS "picks up"
long-term funding thereafter.
1.2 We are extremely concerned that some
of our posts are currently under threat as a result of the combined
effects of local financial deficits and NHS financial and structural
reform.
2. MACMILLAN'S
AUDIT OF
POSTS AT
RISK
2.1 Since January 2006 Macmillan has been
conducting a monthly ongoing audit through our Service Development
Teams of all Macmillan posts and services "at risk".
"At risk" is the term we use to identify those posts
where there is a threat of the post being made redundant, being
frozen, not being picked up for long-term funding by the NHS,
not being filled following a vacancy, or being significantly changed.
2.2 Our service teams reported the following
problems on 31 May 2006:
— In order to reduce financial
deficits NHS Trusts are cutting what they see as expensive specialist
cancer services. Posts are being frozen and postholders are facing
redundancy.
— PCTs and hospital trusts are
reneging on written agreements, negatively affecting posts and
services that Macmillan has supported financially.
— PCT managers are reluctant to
sustain funding commitments when their future is uncertain.
— Specialist nurses are being
asked to undertake generalist duties to compensate for the overall
shortage of nurses.
— PCT re-organisation is disrupting
long-established relationships with commissioners.
— Agenda for Change is resulting
in specialist nurse and other posts being downgraded with staff
demoralised and/or moving jobs as a result.
3. WHICH POSTS
ARE AFFECTED?
3.1 The figures from our 31 May 2006 audit
show that:
— 204 Macmillan posts are currently
"at risk". Of these, 24 posts are at risk of redundancy,
a further 33 posts have been frozen, and funding for 14 posts
is at risk due to PCTs reneging on their commitment with Macmillan
to pick-up funding.
— The main reasons for the reported
problems are:
— NHS financial deficits—118
posts (58%);
— Agenda for Change grading disputes/problems—58
posts (28%); and
— PCT structural reforms—30 posts
(15%).
— Four out of five posts at risk
(83%) are Macmillan nursing posts (169 posts). Nurses comprise
73% of all Macmillan postholders.
— Other posts at risk are doctors
(two), allied health professionals (10), information posts (12),
social care posts (nine) and user involvement posts (two).
— In 49% of the posts at risk
(100 posts), a change is currently happening or has happened already.
A change is "very likely" or "likely" to happen
in 25% of posts (50 posts), and "possible" in 27% of
posts (55 posts).
— Nearly four out of five posts
(160) currently "at risk" are in Macmillan's London,
Anglia and South East Region (LASER). The problems are most acute
in North and West London, Kent and West Anglia.
4. WHY DO
MACMILLAN POSTS
MATTER?
4.1 There is always a clear "case of
need" developed and agreed in partnership with NHS clinicians,
patients and carers before any Macmillan post is funded. Macmillan
has invested between £12.1 and £14.1 million (at current
market value) of publicly donated money in the posts currently
"at risk" as a consequence of NHS financial deficits.
4.2 While cost-cutting measures to reduce
specialist cancer care services may help trusts to balance their
books in the short-term, they will also undermine the key Government
policy objectives of delivering the NHS Cancer Plan targets, reducing
health inequalities, improving the patient's experience and quality
of life, and facilitating greater patient involvement and choice.
4.3 There is a substantial body of evidence
that demonstrates the difference that specialist services make
for cancer patients and their families (see appendix for more
detail). Benefits include improved coordination of care, symptom
control, information and emotional support, and a stronger "voice
and choice" for cancer patients.
4.4 More specifically, the NHS in England:
the operating framework for 2006-07 planning guidance sets out
"must-do" targets that all NHS trusts are required to
deliver. These include implementation of the NICE Improving Outcomes
Guidance (IOG). Cutting Macmillan posts will directly compromise
trusts' ability to meet these targets.
4.5 It is too early to assess the full impact
on patient care as Macmillan service teams are still negotiating
with our NHS partners over the future of specialist posts. A number
of threatened posts have been saved as a result of these negotiations.
These saved posts have not been included in the figures.
4.6 However, we remain extremely concerned
that patient care will suffer. The threat to patient care is most
evident where the problem is redundancy, the post being frozen
or loss of pick-up funding. We are being told that specialist
teams are being stretched to capacity to cover the workload as
vacant posts are frozen and the district nursing team depleted.
4.7 The impact of specialist nurses being
asked to work shifts on general wards also has an impact on the
quality of care. In one case a specialist palliative care nurse
has been told to work one shift a week on a ward. This means she
has less time to spend with each palliative care patient and less
time to attend to patients' psychosocial needs. In another case
a lung cancer nurse has reported that patients are being readmitted
to die in hospital rather than their preferred wish to be at home
because of the lack of specialist support in the community.
4.8 By reneging on agreements to fund Macmillan
posts, NHS trusts may also undermine the relationship built over
many years between Macmillan and the public. There is a risk that
public donations to Macmillan may be negatively affected and this
will, in turn, significantly affect our relationship with the
NHS in the future. It is therefore imperative to both the future
of cancer services and the future of our organisation that Macmillan
posts are protected.
5. RECOMMENDATIONS
5.1 We have been in discussions with our
NHS partners at a local level and have expressed our concerns
to both Ministers and senior Department of Health officials. We
would ask that the Committee recommends that NHS trusts should
honour existing funding agreements with Macmillan and pick-up
funding for services we are currently developing.
Duleep Alhiajah
Macmillan Cancer Support
6 June 2006
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