Cynulliad Cenedlaethol Cymru	National Assembly for Wales
Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon	Health, Social Care and Sport Committee
Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal	Inquiry into Community and District Nursing services
HSCS(5) CDN11
Ymateb gan Macmillan Cancer Support	Evidence from Macmillan Cancer Support

Thank you for this opportunity to feed into the inquiry process. A sustainable, well skilled district nursing service is aligned to Macmillan’s aims for improving the outcomes of people with cancer. While Macmillan Cancer Support does not directly fund district nursing services - in the way that we adopt and invest in clinical nurse specialists, we fully support the concept that care should be delivered where it is wanted and most appropriate; that generally means outside acute settings. We know that district nurses are critical to delivering care in this way. We wish to provide the committee with some general observations and analysis from our experiences of working in partnership with health and social care in Wales.

Macmillan is committed to supporting our stakeholders, including the National Assembly for Wales, NHS Wales, Health Boards, Velindre NHS Trust, Welsh Government and other third sector organisations to improve care for people living with cancer across Wales.

More than 19,000 people are diagnosed with cancer every year in Wales (WCISU, 2017[1]), a 10% rise over the past decade. There are now over 130,000 people living with and beyond cancer (4.5% of the population) and this number is expected to rise to 250,000 by 2030 (8% of the population).

The health and care workforce plays a critically important role delivering a quality experience to people living with cancer. Annually, Macmillan invests in the order of £5m on services in Wales to improve cancer care and supports the development of more than 340 Macmillan professionals.

The practice nurse and community workforce will grow in prominence and importance to the delivery of Macmillan’s new strategy for people living with cancer Right There With You. In Wales there are already a number of pilots running to support practice nurses to undertake Holistic Needs Assessments and Cancer Care Reviews (predominantly a GP role). The Macmillan Cancer Quality Toolkit for primary care for Wales is due to roll out in May 2019 and will promote the extended role that practice nurses can undertake to care, support and signpost people diagnosed with cancer throughout the clinical pathway. Information concerning the toolkit will be rolled out to the Macmillan Framework for Cancer in Primary Care Programme webpages in due course. Information concerning our work with primary care in Wales can be accessed in this way[2].

The Welsh Government’s strategy, A Healthier Wales, aspires to care for people closer to home. This is commendable but historic under-investment in primary and community care presents a significant challenge. The strategy needs a workforce that is available and able to care for people in their local communities, yet Wales faces a general workforce shortfall in GPs and nurses[3].

Staff numbers need to increase, and a different skill mix is required to deliver seamless high quality care to the people of Wales. To ensure this workforce can deliver the best possible seamless healthcare strategic workforce planning and recruitment that reflects the complex interplay between skill mix, specialist training and targeted investment is required. We look forward to engaging with Health Education and Improvement Wales (HEIW) to discuss and shape this work.

We note that in England “A five-year framework for GP contract reform to implement The NHS Long Term Plan” was recently published which commits to increasing nurses and doctors as part of the GP Contract:

“Increasing the number of nurses and doctors working in General Practice will be boosted by increased funding for the core GP practice contract, which rises by £978 million a year by 2023/24 as a result of investments under this agreement”[4]

Feedback from professionals within Macmillan raised the following points which the committee may wish to consider for the purposes of this inquiry:

· Whether to extend the scope of the inquiry to include GP practice nurses? This part of the workforce is growing in number and expertise and are crucial in delivering care ‘closer to home’. Through their various clinics they will support the of delivery of ‘A Healthier Wales’.

· Will this work link with/inform the safe nurse staffing levels legislation in Wales?

The community and district nursing workforce is crucial and have specific professional needs to be supported to work in their specialist area. However, we suggest that any review of district nursing is not done in isolation, the wider primary and community workforce is integral to the delivery of holistic high quality joined up healthcare for the people of Wales.

Should you have any comments or questions relating to this letter, please do not hesitate to get in touch.

Policy & Public Affairs Officer (Wales)

[1] Average cancer incidence (All malignancies excluding NMSC) in 2014 to 2015. Welsh Cancer

Intelligence and Surveillance Unit, (2017) Incidence Extract http://www.wcisu.wales.nhs.uk/cancer-incidence-in-wales-1

[4] NHS England.(2019) “A five-year framework for GP contract reform to implement The NHS Long Term Plan”.pg9 https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf