Our NHS Through The Eyes Of A CNS.

As our Government and healthcare leadership held their breath and put their fingers in their ears, cancer continued to rampage through our country. Covid, covid, covid, was all we have heard for more than 30 months. No real surprise then, that we are now facing the longest waiting lists in the NHS that we have ever seen. More people waiting to be diagnosed, whilst others are dying before being able to receive the treatment they need. I have a very unique position as a patient and advocate. Watching as the system is breaking in front of us, whilst politicians bring out the same soundbites. Most seem too busy, concerned with their own lives and political survival. Sadly I see no genuine compassion for the health of the nation.

This week I’m delighted to share a piece sent to me by an incredible cancer nurse who has become so frustrated with things that she decided to publicise her views through this site. I can’t imagine telling patients daily how long they will have to wait for treatment and knowing they may not even make it. Thank you to all you incredible staff who are doing the best you can under such challenging conditions. Perhaps after reading this you might think also what the staff are going through and share more kindness?

Sajid Javid during a hospital visit.
Sajid Javid during a hospital visit.

“I have been planning to write this blog for a while, but it seems fitting that I actually write it in the weeks after the damming report on Cancer report by the Health Select Committee was released. Also two government consultations related to Cancer recently closed. Mr Javid’s War on Cancer and the consultation to simplify cancer performance targets. But will these consultations and reports actually change anything? I am a cancer nurse who has worked for over 20yrs with cancer pts and the system feels more broken than ever.

Cancer performance nationally is at an all time low, this is related to a variety of factors including increased referrals, backlog in diagnostics. Due to staff shortages, shortage of theatre slots/staff, shortage of chemotherapy staff and reduced screening during the pandemic, as staff were redeployed to deliver covid vaccines. The government says that NHS spending is at an all time high and they are making millions available for diagnostics. This is not a lie but what they are not telling you is that ‘extra money’ for diagnostics/recovery is actually being diverted from the full NHS funding. Effectively this means that NHS organisations will get less money this year from normal funding and will have to bid for the extra funding for diagnostics. Additionally although spending is at an all time high it has in no way kept pace with inflation. Meaning in real terms organisations have to find efficiency savings to keep services running.

There is no more efficiency in my opinion, especially in cancer care. Cancer does get additional yearly funding via cancer alliances but this money is ring-fenced for transformational projects and can’t be used to maintain day to day services. The biggest issue we face is workforce, many CNS’s services grew organically in the late 90’s early 00’s meaning that there is inequality across the country. Even within trusts some CNS’ s will have large caseloads whilst others smaller. As an example, some trusts have employed breast metastatic nurses, whilst the urology teams continue to manage all 5 tumour sites – bladder, kidney, testes, prostate and penile. It is not that these nurses aren’t needed, its the inequity that the equally complex metastatic patients in other tumour sites do not benefit from this expert care.

Breast Cancer CNSs
Breast Cancer CNSs

We know from National Cancer Patient Experience Data (2019) that 11% of patients weren’t given the name of a CNS to contact and of those who were 16% didn’t find it easy to contact them. The CNS is vital to high quality cancer care, being the person who can coordinate care and ensure that the patient and families needs are being met but to diagnose and treat cancer we also need a range of other professionals, I can’t list them all but they include: oncology doctors, histopathologists, radiotherapists, radiographers, chemotherapy trained nurses.

We do not have enough of these and as a country we have been poor on early diagnosis. On average for the 4 years prior to the Covid pandemic 19% of cancers were diagnosed via an emergency admission. This has increased but is thought to be because of lack of access to GP’s and screening – showing the importance of adequately investing in these services. There is a highly skilled workforce in cancer but it has been let down by successive governments that haven’t planned for the workforce. Despite many years of reports from suggesting it. The governments failure to adopt amendment 80 in the new Health and Social Care Bill shows it isn’t committed to this workforce, despite all its consultations and reviews.”

I will continue to challenge the Government and the lethargic health leadership in this country. But when you hear thoughts like this from inside the service is when it can have real impact. And I would like thank the incredible nurse who took the time to share her thoughts with the Community. The entire nation has been let down for many years by failure to plan the future of the NHS. How much more evidence does anybody need to see what is happening here? We need action and no more ten year plans to kick the problems further down the road!

As always please feel free to add your own experiences and opinions in the comments below.

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    • Cheers Deb. It’s so important for the public to understand what is going on. It was a great pleasure to share this piece. Big love as always, Chris

  1. Michelle, Daniel & I have unique roles as the piece states most DGHs do not employ CNSs to cover metastatic urological patients. We work at a large cancer centre & believe our patients are lucky to have access to us. Obviously there are 100’s of patients & 3 of us caring until end of life. Our #KidneyCancer & #BladderCancer patients through fabulous #research have additional treatment lines our #ProstateCancer numerous lines so we are under pressure but we all believe that all metastatic urology patients should have a metastatic #CNS

    • Thx so much for sharing Shiv and for adding your own experiences and opinions. This is so helpful for the many patients who have very limited knowledge of how things work in #Cancer.

  2. How refreshing to read this excellent analysis by a CNS. I was one of the 11% who never had a CNS – although I was constantly promised one, but by the time it was my turn to get an appointment, the CNS had been moved on, and one started all over again. As a patient one had to learn to find out best treatment options by oneself, and then you came across dismissive nurses and doctors saying “you are only a patient” as though we had no brains to work out what was best. We need to have courage to ask for what we know will be best.

    • Hi Verite,

      Thanks so much for sharing your experiences. I was given one but she was so busy, I gave up with her and got on in my own way. Things seem to have changed a lot since then and I know how vital the role of a CNS is in the cancer pathway. I was delighted to share this weeks piece so that everyone can understand how challenging things are for the people working in the #NHS

      It is even more important today to ask for what we know is best.

      My very best to you, Chris

  3. Excellent piece of work. Thanks for sharing. I’m a urology CNS. There are 3 of us in my team. We are fortunate to also have 2 met prostate CNS’s who come under oncology (we’re under surgery). 7 years in post. The workload is ever increasing. Pathway targets are so hard to meet.
    Daily feelings of guilt experienced when you can’t get back to patients in a timely manner and provide the support they need. Fortunately we have good working relationships within our MDT and we all pull together to ensure we can do the best we can for our patients

    • Thanks so much for sharing your own experiences Lorraine and for all that you and your #NHS colleagues are doing during such challenging times.