Earlier this month, International Nurses Day celebrated the vital role that nurses play in caring for brain tumour patients. Its theme this year – ‘the need for investment in the nursing workforce around the world’ – recognises that cancer nurses are in short supply and are overworked. Essential resources just cannot be provided without them or other support workers. One of these resources is a Holistic Needs Assessment (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 all-round needs of the patient, identifying all areas where support might be required. These support needs could be physical, psychological, or financial, as a few examples. HNAs result in a care plan, setting out the resources needed to best support that patient.
These assessments are usually undertaken by a keyworker or Clinical Nurse Specialist (CNS), making the issue of access to a CNS closely linked with people receiving HNAs. The CNS or nurse signposts the patient to the services that provide the areas of support identified in the care plan.
“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 suggests that most brain tumour patients are not receiving access to services that could improve their quality of life.
In addition, just over one in five of the people who responded to the survey felt they had a care plan resulting from their HNA which was 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.
Understanding and addressing all of the barriers that prevent nurses from offering and providing this necessary form of support may help increase the provision of HNAs to brain tumour patients. One of the barriers is that many of the current cancer workforce are overworked and face 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.
Our survey also showed clear differences in people being provided with an 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 an 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 isn’t 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.
Share your experiences and help create change
By taking part in our Improving Brain Tumour Care surveys and sharing your experiences, you can help us improve treatment and care for everyone affected by a brain tumour.
Improving Brain Tumour Care Surveys