MS Trust Shop Defining the value of MS Specialist Nurses
This report is about the value of multiple sclerosis specialist nurses. It is intended for all members of the MS community, including MS patient organisations, those responsible for managing and commissioning MS services, neurologists and specialist nurses themselves. It assesses the case for the value of MS nursing and outlines the work needed to strengthen this case further.
MS specialist nurses matter greatly to people with MS. The recent audit of MS services, undertaken by the MS Trust and the Royal College of Physicians confirms this, with many comments from people with MS and healthcare colleagues praising the MS specialist nurses and the care they provide. Read more...
The report makes a series of important recommendations for future work, including:
- To describe clearly the different service models currently operating amongst different MS nurses and how these fit with the long term conditions agenda.
- To define clearly what is meant by 'caseload', make explicit the assumptions underpinning the idea of an acceptable caseload, and define what this is, according to service model.
- To share good practice across the MS nursing community in terms of efficient and effective working practices.
- To develop a set of 'SMART', evidence-based quality standards for MS nursing services, against which performance can be measured, together with an effective tool for measuring patients' experiences.
- To up skill MS nurses in evaluating their services through data collection, clinical audit and measuring the patient experience.
- To bring together data on the value of MS specialist nurses to make a robust case to the commissioners of the future.
The MS Trust remains fully committed to the MS Specialist Nurses as well as the other specialist services on which people with MS rely, including therapists, neuropsychologists and specialist neurologists. We know how important these services are to people with MS and we will continue to support, campaign for and generate evidence about the difference they make every day.
Pam Macfarlane, Chief Executive, MS Trust
We have spilt Defining the value of MS Specialist Nurses into short sections, each section can be read below as PDF's.
The MS Trust commissioned Geraldine Mynors and Sarah Perman of Mynors Suppiah Ltd, along with Martin Morse, to undertake a study to assess the evidence of the value of MS specialist nurses. Specifically, this explored:
- The history of the development of the MS role and the range of work they undertake today.
- The number and location of MS nurses and the caseloads they manage.
- The arguments which drive the employment decision, as well as other enablers and the barriers, where these exist.
- How incentives and guidelines operating in the NHS influence the decision.
- Similarities and differences in the roles and economics of MS nurses employed in acute trusts and in the community, and how different funding models affect the decision to employ them
- What evidence is already available or what new data may need to be gathered to complete the case for the value of the MS Nurse role.
In this section, we outline how MS nurses currently work, and changes currently taking place around them which may impact significantly on their roles. We look at:
- The history of the development of the MS nurse in the UK
- MS nurse roles: similarities and differences between nurse roles;
- MS nurse caseloads; and the variable definition of 'caseload';
- Different models of employment; and how these impact on nurse roles;
- Different models of funding; and how these help or hinder MS nursing services.
In this section, we outline the case for the economic value of MS nurses. We present the evidence that we collected in the course of our research, and the conclusions that we have drawn. We set out:
- an overview of the data;
- how MS nurses achieve savings to the health economy;
- evidence of the cost-effectiveness of MS nurses;
- examples from other specialities which employ clinical nurse specialists;
- what savings MS nurses could achieve: our own analysis of the type and level of cost savings that could be realised;
- what MS nurses can do to show their value: how MS nurses could record and analyse data which shows their economic impact; and how MS nurses can improve productivity.
In this section, we consider other ways that MS nurses can measure their performance and show their effectiveness. We describe the basic information that MS nurses need to record in order to do this, and we discuss the role of quality indicators. We cover:
- logging activity: the basic information that MS nurses need to monitor their impact;
- setting standards: why performance indicators are important, some examples of what these might look like for an MS nurse service, and their relationship to the new NHS Outcomes Framework;
- auditing performance: completing the audit cycle by monitoring performance against standards, making service improvements and tracking the results;
- measuring patient experience: methods for finding out what patients really think of the MS service, and how their experience can be improved.
MS nurses have transformed the care of thousands of people with MS. But the NHS is on the brink of a transformation, against the background of economic constraint. The move to clinical commissioning is both a threat and an opportunity for MS nurse specialists. Commissioning groups, and the GPs at the centre of them, may not be familiar with the services MS nurses provide. In the context of the challenges they have to tackle, it may be difficult to bring the topic of MS nursing to their attention. On the other hand, commissioning groups will be considering neurological commissioning with fresh eyes. There may be opportunities to commission new posts to fill gaps in coverage, and to modify existing services to respond more closely to the needs of people living with MS. Both scenarios are entirely feasible. Either way, the next two years will be challenging for MS nurses.