Downbanding or downgrading a job means changing the pay structure of the role to a lower grade. At the moment, NHS staff are placed on a national pay scale by reference to a UK-wide NHS job evaluation scheme. The scheme ensures that staff doing the same job in different places are paid the same.

Budgetary pressures on employers mean they may downband existing staff as a way to increase the workforce.

You should receive notice of the intention to downband your role. Start planning as soon as you receive notice of the process.

Immediate actions:

  1. contact your union eg RCN, UNISON to alert them to the change in service
  2. 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.
  3. identify anyone else affected
  4. attend every meeting you can
  5. start gathering evidence to support your case
  6. make your case following steps A, B, C and D below, 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.
  • think about making joint submissions eg with other condition-specific neurology nurses
  • ensure your submission stands out. Management will be receiving lots of reports from specialist nurses – what makes yours different?
  • 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

Back to "Practical tools for defending specialist nurse posts under threat" homepage

Analysing the threat: materials to support your response

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. Remember to keep all the elements concise.

1. Describe the threat and its drivers

Why is downbanding being threatened? What is the pay protection period? When will downbanding come into force?

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 less hours in the condition-specific service. For example:

  • no nurse-led 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? E.g.

  • Does this put pressure on other neurology services?
  • Are they 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?

Spell out what this will mean for your employer e.g.

  • pressure on waiting times for neurology outpatients
  • higher risk of admissions/bounceback
  • very delayed discharge
  • increased mortality etc.
  • loss of skilled staff

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 reduced in scope.

5. Summarise the arguments

List what you have found in point 4 in up to 10 key bullet points e.g.

  • 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

Include any direct financial consequences you know will result, e.g. 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 five. For example:

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

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 an external party to read it

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.

Submit your document

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

This project has been developed collaboratively between organisations committed to supporting and developing condition-specific specialist nursing in neurological conditions.

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