Summary
Many people who have cancer or have survived the disease struggle with the physical and psycho-social consequences of treatment that can be avoided or managed. There is also growing evidence to support the role of healthy lifestyle choices, particularly exercise, in promoting better outcomes and survival rates.
The Newcastle Macmillan-One-to-One Service aims to ensure patients living with and beyond a diagnosis of cancer are supported to live as well as possible following treatment. The Newcastle Service is one of 16 implementation sites nationally and is piloting four new roles to address the concerns of patients who have needs of varying complexity.
Challenge
An increase in cancer survivors places greater pressure on aftercare. Currently cancer follow-up pathways are secondary care-based, but community involvement will be increasingly important.
Many patients have unmet needs, particularly at treatment end, and may struggle with manageable physical or psychological consequences of treatment.
Macmillan Cancer Support (MCS) has been working to address this. The Newcastle-upon-Tyne Hospitals NHS Foundation Trust, with local GP practices, was one of 16 pilot sites for the Macmillan One-to-One Implementation project, aimed at developing a new model of after-care.
This project was an opportunity to ensure patients continued to have access to individualised holistic support and to understand how to live well following treatment.
Objectives
Among the project’s objectives were to identify, assess and meet the needs of patients at the end of treatment, and to develop a model of care to provide effective support. The team also aimed to measure patient experience and quality of care, to develop a risk stratification tool and to identify the workforce and skills to provide effective support to this patient group.
Other objectives were to develop strong working relationships with all relevant partners, establish a directory of services, to explore sustainability and transferability of the service, and develop educational opportunities.
Solution
The team developed a three-level approach to the post-treatment needs of patients (Level 1 supported self management, Level 2, shared care and Level 3, complex care). For patients reaching treatment end, they offered cancer site-specific health and wellbeing events. Relevant professionals including consultant oncologists contribute to the sessions.
Level 2 involved One-to-One consultations for patients with more complex needs. At Level 3, patients with the most complex needs were offered more in-depth support. A six-week Living Well programme was offered to those struggling to self-manage.
The team networked with relevant professionals and began building a directory of services and resources. They engaged with the Macmillan evaluation process in addition to undertaking local audits. They are currently building a business case to obtain ongoing funding.
Results
Learnings
Lessons learnt included the need for extensive pre-planning, engagement with relevant professionals and ongoing promotion.
Project members also found it was necessary to have a strong steering group with stakeholders able to influence peers and commissioners. They learnt that they needed to take every opportunity to promote the service and to listen to service users about their needs.
Other lessons included using the evidence base to structure the service and align it with local needs, and to guide the skillset needed. The team learnt to network widely, liaising with services not traditionally linked to cancer care (for example, Age Concern and mental health services) and to work closely with cancer nurse specialists.
Evaluation
MCS expected the service to prevent admissions. While a few were prevented, the team found that the service is addressing the needs of other patients, including those who had not contacted healthcare services.
The use of nursing staff is able to save professionals six to seven hours a week, allowing them to see patients at other stages. Patients are being signposted to various services, including those not utilised pre-project. The team promotes healthy lifestyles and uptake of exercise on referral is about 70 per cent.
Patient experience and quality of life feedback is very encouraging, both locally and nationally. The team has worked with nurse specialists to deliver health and wellbeing events for four main cancers. These will be extended to other tumour groups.
