Summary

In 2012 the clinical and service team developed a three-year chemotherapy strategy with a vision to develop a safe and effective service, delivering treatment closer to the patients’ homes under a single governance arrangement. The goal was to improve patients’ experience and waiting times by developing improved patient pathways. The strategy aimed to deliver 80% of agreed clinically appropriate systemic anticancer therapies closer to patients’ homes by 2014, which required a significant expansion of appropriate facilities across a considerable geographic area.

Challenge

In 2012 a survey of patients receiving treatment identified the following priorities in terms of their cancer treatment: access to the very best available treatment for their cancer; less waiting times on the day of treatment; and the possibility of receiving treatment closer to home but keeping the connection with the Christie. Our agreed approach required system leadership to gain support and buy-in from providers and commissioners across the board – this meant redesigning existing clinical pathways and changing the way we traditionally delivered care.

Objectives

To increase the provision of chemotherapy services closer to home, making flexible and best use of facilities in each locality. To improve patient outcomes by enabling patients to have access to the latest evidence-based treatments and clinical trials. To provide the best possible experience for patients while meeting all chemotherapy performance targets by reducing on the day waits, improving overall satisfaction and providing services within 20 minutes’ travel time of patients’ homes.

Solution

A full postcode analysis took place identifying patients travelling for more than 20 minutes to reach the main Christie site, which indicated which areas we needed to provide services. More nurse-led clinics were developed, with a two-day stop for patients to have a doctor review one day and receive treatment closer to home within 72 hours. The team set up services in two primary care services, a mobile unit travelling to 5 sites a week and expanded the services based at 8 hospital sites closer to patients’ homes, thus reducing on the day waiting and travel times for the patient and providing a more personalised service.

Space in two primary care centres was identified, and agreements, policies and protocols were set up in these facilities creating a new nurse-led treatment delivery service. Agreements were set up to enable patients to have their pre-treatment blood tests locally and access links put in to allow us to view those blood results at the main site. A team of outreach nurses, who could rotate to deliver treatments at all these satellite sites, began working out of the main treatment centre at the Christie. In 2014 a partnership with Wrightington, Wigan and Leigh NHS Foundation Trust was set up to develop and build a new purpose-built cancer unit, with consultants and nurses delivering cancer services for all patients living in this area. This flagship unit was opened in January 2015 with the capacity to deliver over 4,000 treatments a year. We now deliver chemotherapy at 12 different sites across the sector. 

Results

After three years, over 33,000 treatments were delivered closer to home and waiting times reduced from appointment time to actual treatment time. Overall patient experience improved from 2012–2015, with patients quoting reduced waits, less travel and a more personal service as some of the improvements made. Providing a rota of staff from the main treatment unit allowed staff to rotate to work in the outreach units: staff morale and retention has improved. The main site unit used to be open from 8am to 11pm, but since reorganising the service it now closes at 10pm, with plans to close at 9pm. An important part of any service transformation is the ability to demonstrate value for money. We have worked closely with NHSE and local PCTs/CCGs to develop the model and have contained the cost within the current tariff-based system, ensuring commissioners do not contribute additional funding. 

Learnings

Evaluation

Regular audits measure waiting times – the target is to treat 80% of all patients within an hour of their appointment time – and patient experience. For the latter, a small survey takes place on a monthly basis by governors visiting the treatment centre and collecting data from patients regarding their general experience. Patient experience surveys are conducted at all outreach sites, auditing privacy and dignity, environment, views on staff and on their treatment experience. Complaints are monitored and reported on a monthly basis at our divisional quality meeting, where any trends or concerns are discussed.