Evidence submitted by Breakthrough Breast
Cancer (WP 99)
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, specifically with specialist breast care nurses,
to ensure breast cancer patients receive the highest level of
care.
1.3 Breakthrough welcomes this inquiry into
workforce needs and planning for health services. 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 currently the most
common female cancer in England. Data published by the Office
of National Statistics confirms increasing incidences in breast
cancer diagnosis, rising from 34,319 in 2002 to 36,509 in 2003
and a further increase to 36,939 in 2004. Increasing incidences
are accompanied by increased referral rates to breast units. Between
2002-03 and 2005-06 urgent referrals for breast diagnosis increased
by 29% (from 104,823 to 135,919 referrals). [24]
2.2 With an aging 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
staffed with adequate levels and appropriately 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
3.1.1 As the Department of Health does not
record the number of breast care nurses working in the NHS, it
is difficult to quantify the extent and impact of poor workforce
planning and job losses.
3.1.2 Breakthrough is currently working
with the Royal College of Nursing (RCN) and Breast Cancer Care
to carry out a survey of UK breast care nurses to gain a snapshot
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 Health Committee's Inquiry
into NHS Deficits, there is some evidence that specialist breast
care nursing posts are being frozen or left vacant across England
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.
3.1.3 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.
3.1.4 Breakthrough is concerned that the
introduction of Payment by Results may mean that activities promoting
patient care may suffer as income-generating activities are prioritised.
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 patient care.
3.1.5 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
3.2.1 Increased referrals to breast units
has led to discussions of how to make more effective use of consultant
and specialist breast care nursing time. The current financial
situation is also requiring breast units to think more creatively
about existing resources and meeting Government targets, as well
as plans for "Going Further on Cancer Waits" as part
of the Cancer Reform Strategy.
3.2.2 In October 2003, Breakthrough launched
the "Left in the Dark" campaign calling for all people
with breast problems to be seen by a specialist within two weeks
following a referral by a GP. The campaign highlighted the fact
that every year, 10,000 women subsequently diagnosed with breast
cancer in England are given a routine referral and were waiting
up to 17 weeks for an appointment with a specialist.
3.2.3 With the support of a clinical advisory
group, Breakthrough developed an Advanced Nurse Practitioner role,
where nurses and other healthcare professionals such as radiographers
could be trained to perform advanced tasks in breast clinics to
assess, diagnosis and follow-up patients with breast disease.
[25]In
2005 the Prime Minister and the then Secretary of State for Health
committed the Government to implementing a two-week wait for all
by 2008.This post could be used to help breast units in meeting
existing targets and in implementing this two-week commitment.
3.2.4 Support for the Advanced Nurse Practitioner
role has been received from clinicians and the Department of Health.
A Breast Working Group, established by the Department of Health,
is working with Skills for Health to confirm the competencies
for a Breast Assessment Practitioner, similar to Breakthrough's
Advanced Nurse Practitioner role. While the role and competencies
required have received support, the Department of Health has confirmed
there is no additional funding to support the development of training
courses or additional funding for Primary Care Trusts to support
clinicians to undertake the training.
3.2.5 It is vital that the necessary infrastructure
is in place to support the development of competencies for the
Breast Assessment Practitioner role. Training courses must be
developed, and time and resources made available for this training,
for staff who may take on this role. Furthermore, it is difficult
to see new targets, such as the two-week wait, being met and reforms
made to the working practices of staff in breast units if no priority
is given to workforce planning for the future.
3.2.6 Breast cancer treatment has the potential
to change greatly over the next 10 years with better technologies,
such as less invasive and more targeted treatments, delivered
in different ways by different 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 Department of Health should support
workplace innovation and changing workplace practices, ensuring
resources are available to trusts and frontline staff to implement
the Department of Health's Breast Working Group's Breast Assessment
Practitioner role.
4.2 All those involved in the National Health
Service including the Department of Health, Primary Care 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 Department of Health should ensure
that Primary Care 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 "bank staff nurses"
restrict ability to attend training.
4.4 The Department of Health should ensure
that short term financial situations do not impact upon the NHS's
ability to retain and recruit skilled and motivated specialist
breast care nurses.
Vicki Nash
Breakthrough Breast Cancer
24 January 2007
24 Cancer Waiting Times Statistics, 2003-06, Department
of Health. *This figure does not include non-urgent breast diagnostic
referrals, which are not collected centrally. Back
25
Towards a Two-Week Wait for All: Reducing Waiting Times for
Breast Cancer Diagnosis, A Role for Advanced Nurse Practitioner,
Breakthrough, 2003. Back
| 
