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International Nurses Day: The call for greater Holistic Needs Assessments provision

Earlier this month was International Nurses Day, a day to celebrate the vital role that nurses play for brain tumour patients.

Earlier this month was International Nurses Day, a day to celebrate the vital role that nurses play for brain tumour patients. The theme for International Nurses Day this year is ‘the need for investment in the nursing workforce around the world’. We know cancer nurses are in short supply, being overstretched and overworked and we know there are essential resources that just cannot be provided without them or other support workers, such as Holistic Needs Assessments (HNA). Without access to HNAs, brain tumour patients could be losing out on a vital piece of their all-around care. 

What is a Holistic Needs Assessment (HNA)?

HNAs look at the holistic needs of the patient, identifying all areas where support is required. These support needs could be physical, psychological, or financial, as a few examples. HNAs will result in a care plan, setting out the required support needs of the patient. These assessments are usually undertaken by a Clinical Nurse Specialist (CNS) or other nurses, making the issue of access to a CNS or keyworker closely linked with people receiving HNAs. The CNS or nurse is then able to signpost the patient to the services that provide the identified areas of support.

“We only had one virtual consultation, but in that hour we had such a holistic consultation covering a range of topics, followed up by the CNS referring us to palliative care, accessing physio and occupational health and also referring us for some help with finances.’’

Survey Respondent

All brain tumour patients should be provided with holistic, wrap around care and support.

What does the current provision of HNAs look like?

According to our recent Improving Brain Tumour Care survey, only 40% of respondents were offered a HNA to identify their support needs. This is not good enough, suggesting that many brain tumour patients are not receiving access to services that could improve their quality of life.

Just over 1 in 5 of the people who responded to the survey felt they had a resulting care plan from their HNA which is actually working well. We are concerned that this could suggest that even when some patients are provided with a HNA, they are still not having all of their care needs met. Increasing the provision of HNAs to brain tumour patients could be improved by understanding and addressing all of the barriers that prevent nurses from offering and providing this necessary form of support. This challenge is made even harder as many of the current cancer workforce are overworked and facing pressures on their time.

These statistics should be at 100%; the NHS Long Term Plan states that all patients diagnosed with cancer should have access to a needs assessment and care plan, and the NICE Quality Standard states that all adults diagnosed with a brain tumour should have a named healthcare professional who makes sure that their individual needs are assessed and care plans are put in place.

What is also worrying is that our survey also showed clear differences in people being provided with a HNA across the country, suggesting there is a ‘postcode lottery’ for brain tumour patients. In the lowest performing Cancer Alliance, just 11.8% of respondents were offered a HNA compared with 56.8% in the highest performing Cancer Alliance, a 48 percentage point range. It should not matter where you live, every patient should have access to appropriate services.

Why is not everyone receiving a HNA?

Nurses are working incredibly hard to deliver high-quality support for all patients, despite the pressures created by shortages in the cancer workforce. This was an issue prior to the pandemic; and this has only been exacerbated over the last few years. However, we know that things like availability of staff, demands on nurses’ time, confidence in using HNAs, and the difficulty of communication about needs between health care professionals’ and patients may all be contributing towards a lack of HNA provision for brain tumour patients.

The ability of nurses to offer HNAs depends, in part, on the cancer workforce receiving enough support and funding.  In the 2021 Spending Review, the Government announced funding specifically for the NHS workforce over the coming years. This is incredibly welcome but we now need to see clarity on exactly how that funding will be used to fund the cancer workforce, including nurse specialists.


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