Clinical nurse specialists have been an integral part of NHSScotland and the wider health, social care and third sector landscape for many years. They make a valued contribution to delivering services and supporting patients and families who require specialist care across hospital and community settings.
The First Minister announced on 7 January 2015 that an additional £2.5 million recurring funding would be made available to NHS boards across Scotland to enhance clinical nurse specialist provision, with £700,000 allocated specifically to support the provision of MND clinical nurse specialists, and enable them to be funded from the public purse.
The additional investment was made available to NHS boards to enable them to:
- employ at least one additional ( WTE) band 6 specialist nurse (0.5 WTE in the island NHS boards) to enhance overall care
- pay all NHS MND clinical nurse specialists from the public purse from 1 April 2015 and double their number by providing the additional investment yearly to NHS boards that employ MND specialist nurses; boards that have links to specialist neurological centres were expected to work collaboratively with the centres in their regions to ensure sustainable national services.
This report summarises how NHS boards have used the additional investment as of May 2017. NHS boards will continue to review and feed back on the impact of the investment.
Clinical nurse specialists
Clinical nurse specialists are defined by the Scottish Executive Nurse Directors group as:
registered nursing professionals who have acquired additional knowledge, skills and experience, together with a professionally and/or academically accredited post-registration qualification (if available) in a clinical specialty. They practice at a minimum of senior practitioner level (Level 6 or above of the NHS Career Framework), will have a high degree of autonomy and responsibility, and may have sole responsibility for a care episode or defined client group.
The traditional clinical nurse specialist role tends to focus on specific conditions. While this may be helpful and appropriate in some areas, the drive to consider the role within teams covering a range of related conditions in centres of excellence, such as those for neurological conditions, is growing, reflecting the reality of many patients' multiple conditions and needs. Like all roles, it needs to be seen in the context of the drive for greater interdisciplinary and multi-agency working and the transformation of roles within teams.
Use of the additional investment
The Chief Nursing Officer ( CNO) asked NHS board executive nurse directors in May 2015 to work with the third sector to review existing specialist nursing provision to identify priorities for further investment and set out how the additional investment had been used locally.
As of May 2017, reports from NHS boards show that specialist nursing capacity had been enhanced through the additional investment by 31.4 WTE. In addition the number of MND nurse specialists had increased by 7.6 WTE, including the appointment of a National Co-ordinator for MND funded by the Scottish Government in collaboration with MND Scotland and the University of Edinburgh. The post-holder is developing a strategic approach to delivering MND services and working with clinical specialist teams in NHS boards to promote the delivery of first-class, evidence-based care for people living with MND in Scotland.
Later this report illustrates how each board has used the additional investment to enhance clinical nurse specialist and MND nurse specialist capacity, and a board-by-board summary is provided in the Annex.
Engagement with the third sector
The third sector plays a significant part in helping to fund and support a range of clinical nurse specialist posts in NHS boards and is a key source of information, support and expertise for service users, families, professionals and services. NHS boards were requested to ensure the sector was engaged throughout the process of prioritising how the additional investment would be deployed.
The Scottish Government's CNO Directorate ( CNOD) commissioned the Health and Social Care Alliance (The ALLIANCE) to facilitate a roundtable event to gather the views of the third sector and people with lived experience of specialist nursing to explore the idea of 'What matters to me'. The event focused on current and future strategic issues, and challenges and opportunities in relation to specialist nursing provision.
The report from the event described how participants spoke of how important it was for them to be heard and listened to as a partner in care within a holistic, compassionate and coordinated service approach. The Scottish Government shares the event participants' aspirations and is already doing much to promote the compassionate, personalised and rights-based approaches they prioritised, with clinical nurse specialists playing a central role.
Engaging with the third sector as a valid and valued part of the care offer, and seeing clinical nurse specialists as a core part of the care team, were identified by participants as means of ensuring people's voices are heard and personalised care becomes the norm. Coordination to help people navigate and access health and social care services was also considered vitally important and was perceived as a central part of the clinical nurse specialist role.
The need for more specialist nursing is frequently identified by individuals and third sector organisations as a solution to the problem of people's needs being unmet. It is recognised that clinical nurse specialists often provide the gateway through which people's voices can be heard, supporting them to understand their condition(s) better and signposting to wider support. The event highlighted that the voices of those with lived experience of specialist nursing - the true experts - need to be heard, and that clinical nurse specialists play a central role in enabling people to live well with their condition(s).