BAHNON response to the National GIRFT report
BAHNON Response to the GIRFT Report
The British Association of Head and Neck Oncology Nurses (BAHNON) is proud to co-badge the GIRFT report and welcomes the acknowledgement of the critical role played by head and neck cancer nurses. We remain firmly committed to improving patient outcomes, promoting high-quality care and supporting effective service delivery across the entire head and neck cancer pathway. Safeguarding the sustainability, clinical value and professional expertise of the Clinical Nurse Specialist (CNS) role is fundamental to this effort. In this context, BAHNON Council wishes to clarify its position on two specific recommendations within the report.
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- CNS to see every patient at the point of diagnosis
The importance of Clinical Nurse Specialist (CNS) involvement and support following a diagnosis of head and neck cancer is undisputed. However, given the complexity of the patient pathway, Council recognises that the expectation for a CNS to see every patient at the point of diagnosis is not always realistic or achievable.
This standard was included within the 2004 Improving Outcomes Guidance and has already driven widespread and successful implementation, with approximately 93% of organisations achieving full compliance. Importantly, the value of the CNS role lies in its availability and expertise across the entire patient pathway, rather than at a single point of contact.
Cancer Support Workers play a crucial role in enabling this whole-pathway approach and are increasingly integral to the CNS workforce, making a significant contribution to patient care. BAHNON is therefore reassured that, as a guidance document, the GIRFT report allows local services the flexibility to ensure patients are supported by the right professional, with the right skills, at the right time. Ultimately, we continue to endorse the presence and appropriate utilisation of Cancer Support Workers at the point of delivering bad news.
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- Speech and Language Therapists (SLTs) to lead on Surgical Voice Restoration (SVR)
The GIRFT report recommends that Surgical Voice Restoration (SVR) services should be Speech and Language Therapy led. Given that the report also acknowledges a high vacancy rate among SLTs, Council considers it neither realistic nor sustainable for SVR clinics to be led by a single profession.
Current service models across many organisations already reflect a collaborative, multidisciplinary approach, with specialist nurses frequently playing a central role in delivering SVR clinics. These nurses utilise extended and advanced altered airway skills to provide safe, timely and expert care that is critical to service resilience and patient outcomes.
Importantly, the GIRFT report functions as a guidance document and allows flexibility in local service delivery. It does not supersede the Improving Outcomes Guidance, which continues to place Clinical Nurse Specialists (CNSs) at the centre of SVR service delivery. This position is further reinforced in the Royal College of Speech and Language Therapists’ Laryngectomy Guidelines (2023), which explicitly recognise the valuable contribution of CNS extended skills in this clinical context.
BAHNON is therefore clear that sustainable, high-quality SVR services must be underpinned by collaborative working across professional groups. We aim to engage proactively with the Royal College of Speech and Language Therapists in the hope of developing a shared framework that supports safe, effective and sustainable SVR care delivery.
Looking Ahead
We remain committed to advocating for CNS services and are focusing on several key areas to support this work. These include advanced practice roles, greater autonomy and prescribing responsibilities, CNS-led follow-up and enhanced involvement in complex SVR and airway management.
