Challenge: redundancy or cut to team size

This step is all about getting the evidence together. Think of it as putting all the right pieces of paper in your portfolio. How you use them to make your case is covered in step B.

Spell out the likely results of a reduction in service in terms of what it might mean for patients – what will happen to them and where will they go if your current service is unavailable? 

Spell out what this will mean for your employer, the risk assessment completed at step 3 should help you here.

If you are unsure of what to do at this stage, contact your supporting national patient organisation. We can look at the evidence you have and help pull the words together to describe what happens if your service is cut or disappears.

1. Describe the threat and its drivers

   Why is redundancy being offered or threatened? Is it voluntary or compulsory redundancy?

2. Describe your service in 500 words or less

   Click the link for a generic description which you can amend to fit your particular specialist nursing service

3. Describe the risk

   Click the link for a sample risk assessment which you can amend to fit your particular circumstances

4. Describe the consequences

   Looking at the service description and risk assessment, write down the consequences of having a reduced or non-existent condition-specific service eg
   • reduced number of clinics
   • reduced telephone support
   • cuts to home visits
   • does this put pressure on other neurology services?
   • are patients in the service more likely to:
     • fall
     • contract UTIs
     • fail to comply with medication
     • be at higher risk of serious adverse incidents eg SUDEP (sudden unexplained death in epilepsy) etc
   • pressure on waiting times for neurology outpatients
   • higher risk of admissions/bounceback
   • very delayed discharge
   • increased mortality etc

5. Summarise the arguments

   List what you have found in point 4 in up to 10 key bullet points, eg Include any direct financial consequences you know will result, eg: increase in emergency admissions/readmissions, loss of income from nurse-led clinics etc
   • reduction in staff = reduction in specialisation
   • greater pressure on neurology registrars and consultant neurologists
   • potentially greater waiting times for patients, risk of breaching 18 week referral to treatment targets
   • potential for more emergency admissions and readmissions
   • increase in delayed discharge
   • risk of higher mortality etc

6. Craft an executive summary

   In 200 words or less, create an upfront statement about the likely effect on your service of the bullet points found in point 5, for example

   "We recommend retaining the role of MS specialist nurse in its current form. Making the MS specialist nurse role redundant will have an adverse impact on safe, high quality patient care, creating longer waiting lists for neurologists and for out patient appointments, risking breaches of the 18 week referral to treatment target. It will increase the risk of emergency admissions by 20% and raise the risk of emergency readmissions within 28 days by 50%. Without an MS specialist nurse service, all annual reviews and monitoring will have to be undertaken by neurologists, whose caseload will prevent them from offering annual reviews in clinic. Therefore all symptom management and medication reviews will pass to primary care where there is no specialist knowledge. This may create an increase in complications such as avoidable UTIs and falls, leading to a rise in avoidable admissions. Since the specialist nurse will no longer be able to offer support to inpatients, many of whom have limited mobility and may present with pressure ulcers – requiring intensive nursing and therapy input - a risk of increased readmissions within 28 days and significantly delayed discharges, as well as poorer medication adherence is anticipated."

Cut and paste all the answers from section A into a coherent document.

Check whether your management requires a particular format for the document, in which case you will have to follow that.

In all other cases, write a business case as follows:

1. executive summary – cut and paste from section 6 above
2. describe the situation – cut and paste from section 1 above. Exclude drivers if these are known but unhelpful, eg a personality conflict with management
3. list your key arguments in bullet points – cut and paste from section 5 above
4. describe your service– cut and paste section 2 above
5. describe the risks – cut and paste section 3 above
6. describe the consequences– cut and paste section 4 above

Ask your supporting charity to read the final document. Sometimes a fresh pair of eyes can spot things you've missed that can help support your case.

Ensure you know who should receive this, eg local management, senior management, commissioners etc. Discuss with your national patient organisation if you are unsure.

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