Despecialisation is our term to describe when a post or service is threatened with moving from being a condition-specific nursing service to a neurology nurse specialist post that covers a number of conditions.
You should receive some notice of this planned change. Use this time to get prepared, and start planning as soon as you receive notice of the process.
- identify whether this is a genuine threat, and what the key deadlines are
- contact your union eg RCN, UNISON to alert them to the change in service
- contact your supporting organisation/charity eg MS Trust, Parkinson's UK, Epilepsy Action , Epilepsy Society etc. Check whether they are aware of the situation and talk through what support you want now and what you might want in the future
- start gathering evidence to support your case
- make your case following the stepsbelow, remembering these rules first:
Rules for making your case
- prepare brief factual evidence that supports your case including your case load, key responsibilities etc
- avoid personal terms such as I, we, me, us or our and steer clear of emotional statements or responses. Always refer to 'the service'
- paint a realistic picture of the new service. With despecialisation, it's likely that the specialist nursing service for your condition will be reduced; ensure patients and service users are aware of the potential for a reduced service in future, not that you can continue to provide everything as you do now
- remember the 'bigger picture' and the risks for your employer, because it will help shape your response appropriately
- offer an alternative scenario only if this is suitable for the service and the team eg reduced hours in condition specific nursing and some hours offering a general neurology nurse specialist service
- talk to your national patient organisation at all stages of the process
- listen to advice and support
Analysing the threat: materials to support your response
1. Describe the threat and its drivers
Assess where the information you've received about this threat originates? Is it a reliable and credible source? If you are unsure, discuss with your supporting organisation, they are able to ask without fear of recrimination.
Identify the causes of the threat, if it is genuine, eg financial pressures, transfer of service from acute to community, etc
Click the link for a generic description which you can amend to fit your particular specialist nursing service
Click the link for a sample risk assessment which you can amend to fit your particular circumstances
Looking at the service description and risk assessment, write down the consequences of having less hours in the condition-specific service. eg
- reduced number of clinics
- reduced telephone support
- cuts to home visits
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? eg
- Does this put pressure on other neurology services?
- Are they more likely to:
- Contract UTIs
- Fail to comply with medication
- be at higher risk of serious adverse incidents eg SUDEP (sudden unexplained death in epilepsy) etc?
Spell out what this will mean for your employer eg
- pressure on waiting times for neurology outpatients
- higher risk of admissions/bounceback
- very delayed discharge etc
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.
5. Summarise the arguments
List what you have found in point 4 in up to 10 key bullet points eg
- 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
- unmanageable specialist nurse caseload
- overbalancing of service to one subgroup of conditions
- impossible continuing education requirements
Include any direct financial consequences you know will result, eg increase in emergency admissions/readmissions, loss of income from nurse-led clinics 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 eg:
We recommend retaining the role of MS specialist nurse in its current form.
Changing the role of the MS specialist nurse to a neurology specialist nurse will have an adverse impact on safe, high quality patient care, creating longer waiting lists for neurologists and for out patients 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%. The specialist nurse's caseload will rise to 1,200 patients, so the majority cannot be offered annual reviews in clinic including symptom management and medication reviews: this will lead to increased pharmacy costs, and avoidable admissions for patients poorly managed in primary care. The specialist nurse will no longer be able to offer support to inpatients, risking increased readmissions within 28 days and significantly delayed discharges, as well as poorer medication adherence. Additionally, the education requirements of the post-holder will rise in order to ensure safe practice, particularly in prescribing, at a time of rapid change in neurological medications. This has implications for study leave costs as well as for covering clinics.
Creating your response, using materials from analysing the threat
In all other cases, write a business case as follows:
- executive summary – cut and paste from section 6 above
- describe the situation – cut and paste from section 1 above. Exclude drivers if these are known but unhelpful, eg a personality conflict with management
- list your key arguments in bullet points – cut and paste from section 5 above
- describe your service– cut and paste section 2 above
- describe the risks – cut and paste section 3 above
- describe the consequences– cut and paste section 4 above