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The case for retaining MS specialist nurses

The case for retaining MS specialist nursesAs commissioners of health services address a need to ensure the most cost-effective use of soon to be reduced NHS resources it is understandable that specialist posts should be the subject of scrutiny; there are clear advantages if specialist services can be provided to the same standard but at reduced cost. However, attractive though such a proposition may seem at face value, a closer examination of the facts demonstrates that commissioners need to be extremely cautious in their scrutiny.

In the case of MS and other specialist nurses the isolated focus of an accountant's spotlight will miss areas upon which bright light needs to shine because, below the surface and in the shadows, lies hard evidence, not only of significant clinical benefit, but of cost-effective services and a wider ripple effect, which makes retention of specialist nurses an absolute ‘no brainer'.

Setting aside the more obvious considerations, such as that MS specialist nurses ensure compliance with NICE Guidelines on MS and the NSF for Long-term Conditions, there is also the tricky aspect of statutory direction. For several years now MS specialist nurses have ensured effective delivery of the MS Risk Sharing Scheme, which is mandatory for all primary and acute care trusts (this is the scheme that ensures availability on the NHS of disease modifying drug therapies and governs research on cost effectiveness). Effectively, this mandatory requirement means that there can be no choice about continued administration of the scheme, for which there are infrastructure and minimum data set requirements, and a range of specialist protocols that need to be observed: ‘commissioners, in conjunction with their designated specialist centres, should establish suitable arrangements for dealing with and funding continuing treatment'. (HSC 2002/004 – revised 11/06).

Meeting statutory requirements is clearly non-negotiable but there is also compelling financial evidence to support the MS specialist role. The Royal College of Nursing estimates that the NHS could save £180 million by treating multiple sclerosis flare ups at home instead of in hospital and research by the MS Trust and South Bank University suggests that each MS specialist nurse saves the NHS over £64,000 every year due to fewer unexpected hospital admissions and bed days. And, of course, acute trusts attract substantial income from the MS clinics that they run.

Digging deeper unearths more and more evidence of the folly of dispensing with MS specialist nurses. Ultimately, the role's capacity to ensure optimum support for people living with the unpredictable and debilitating condition that is MS has to be the benchmark measure by which services are judged but, from an accountant's perspective too, the evidence points to the economy of specialist provision. Benefits read like a roll call to hard-pressed commissioners to see the simple common sense of it all:

  • reduce GP referrals to acute neurology services, freeing consultant time and increasing potential to meet and improve eighteen-week referral to treatment targets
  • reduce actual appointment time for GPs and neurologists
  • facilitate timely referral to other services and ensure appropriate discharge planning, which:
    • prevents unplanned, emergency admissions/readmissions
    • prevents bed-blocking
    • reduces referrals to acute neurology services
  • increase awareness by other staff of the needs of people with complex disabilities, leading to:
    • fewer inappropriate referrals
    • fewer unplanned and emergency admissions
  • ensure compliance with/adherence to the NICE Guidelines on MS and the NSF for Long-term Conditions
  • ensure delivery of the MS Risk Sharing Scheme, which is mandatory for all primary, and acute care trusts (HSC 2002/004 – revised 11/06)

With talk of the need for change still ringing in our ears from the election campaign, it may be helpful for commissioners of services to reflect on Lord Darzi's review of the NHS in which he cited one of his reasons for change as being ‘the need for more specialized care'. It will represent a grave step backwards for the UK's 100,000 people with MS if the accountant's narrow gaze passes over the wider and long term cost benefits of the MS specialist nurse, falling only on the sparkle of short-term gain. There is a growing body of evidence that this is bad for people living with MS and, ultimately, bad for the books.

The case for retaining MS specialist nurses

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