Transcript Making the Changes that Matter LCA Survivorship Forum 1st

Making the Changes that
Matter
LCA Survivorship Forum
1st May 2014
Welcome and Overview of the
afternoon
Survivorship Pathway update:
Progress and Plans
Nicola Glover
Survivorship Project Manager
The London Cancer Alliance West and South
LCA Survivorship Group: The story so far (2013/4)
• Group set up, including three communities of practice
• Engagement
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Provider level
Clinical Fora
With other pathways
Pan-London including with commissioners
• HNA tool
• Treatment summary agreement
• Metrics
The London Cancer Alliance West and South
The story so far (continued)
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Survivorship service mapping
Lymphoedema service mapping
Lymphoedema specialist education mapping
Complementary therapies guidelines developed
Consequence of cancer position statement
Motivational interviewing courses
Skin (urology) HNA screening tool
Fertility pathway
The London Cancer Alliance West and South
What were the metrics?
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METRICS
% of patients that receive HNA at diagnosis
Evidence:
Evidence within the patient records of HNA having been offered
Evidence of actions completed in response to the HNA
Performance Measurement:
Baseline audit when HNA tool launched
Year 1 Q3: Baseline of current practise
Year1 Q4 Shadow metrics submitted TARGET 10%
Year 2 Q1-2: 25%
Year 2 Q3-4: 50%
Year 3: to be set following review of achievement year 2 Q3
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% of patients who have an end of treatment summary
Evidence/quality measures:
Evidence of the necessary paperwork having been completed
Assurance/Performance Measurement:
Yr 2 Q1: baseline of current practice
Yr 2 Q2: shadow data submitted. TARGET 10%
Yr 2 Q3: 20%
Yr 2 Q4: 40%
Yr 3 Q1; to be set following review of achievement year 2, Q4
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% of patients who are offered an end of treatment consultation
Evidence:
Evidence in the patient record of an end of treatment HNA having been offered
Evidence of information on smoking cessation, healthy eating and exercise having been
discussed and given as part of the resulting care plan
Performance Measurement:
Yr 2 Q1: Baseline audit of health promotion information currently being given
Yr 2 Q2: shadow data submitted. TARGET 10%
Yr 2 Q3: 20%
Yr 3 Q1-2: 40%
Yr 3 Q3-4; to be set following review of achievement year 3, Q1
The London Cancer Alliance West and South
And what will they be?
(from NHSE London Commissioning Strategy)
Intervention
2 years
5 years
Recovery package:
HNA & Care plan
Treatment Summary
H&WB events
60% completed
75% completed
100% completed
100% completed
100% completed
Stratified follow up
Fully implemented in Breast, Colorectal, Lung
and Prostate
All pathways
Physical activity
Include intervention in H&WB event
Offered to all as appropriate
Work support
Financial support
VR
Include in HNA & Care plan
Offered to all as appropriate
Evidence of referral pathways from MDT
Evidence of referral pathways from MDT
Evidence of referral pathways from MDT
Full services in place
Develop links with LTC
Work with Integrated Care Champion sites
LW&BC fully integrated into the management
of LTC agenda
Consequences of treatment:
Lymphoedema
Pelvic radiation disease
Sexual function
Cancer as a LTC
The London Cancer Alliance West and South
LCA Survivorship Group: Next steps (2014/5)
• Continue aim of reducing inequality and improving
patient experience
• Refine metrics inline with new commissioning intensions
• On-going work on recovery package
– Solutions to (full) HNA implementation
– Support package for implementation of TS
– Agreed approach to roll-out of HWBE
• Develop pathways for lymphoedema management
• Audit complementary therapy services
• Work towards LCA-wide best information and referral
pathways for exercise, diet and return to work/education
• Research and audit position statement and strategy
The London Cancer Alliance West and South
The clinical board are responsible for the
clinical leadership of the LCA. They are
answerable to the members board
Clinical Board
Chair
The pathway group is responsible for driving
the work of the pathway.
Members must represent:
their work group
Their profession
Their employing organisation
Natalie Doyle
The Chair is responsible for the leadership
and vision of the Survivorship pathway and is
answerable to the clinical board.
She must deliver against the model of care
The set up of the pathway is determined by her
to ensure delivery and output
is optimal
Consequences of Cancer
Treatment affiliated groups
• Pain
• Fertility
• Sexual Dysfunction
• Menopausal symptoms
• Pelvic radiation disease
• Fatigue
• Bone health
The consequences of cancer affiliated groups are tasked with
leading the investigation into current availability of services
for management of consequences of cancer treatment. These
groups are highly like to be constituted from several pathway
groups and project management support should not be
assumed. See page 2 for survivorship membership
Pathway Group
See ToR
Work-streams
• HNA implementation
• Treatment summary
implementation
• Health and Wellbeing events
• Metrics
• Research
• PROMs
Clinical Fora
The work streams are responsible for delivering their
work programme to them. The membership
is based on the perceived
strengths of both the individuals and of the
stream in its entirety. Members can be co-opted from
outside the Survivorship Pathway Group. See page 2 for
membership
Communities of Practice
• Rehabilitation
• Lymphoedema
• Complementary Therapies
The Communities of Practice are constituted from
acknowledged experts in their field from across the
LCA. They are responsible for the delivery of
specific work items from the survivorship work plan
in addition to their own work priorities. They have
their own terms of reference but are accountable to
the survivorship group. Some project management
support is available to them
The clinical fora enables the outputs from the pathway
group in its entirety to be shared more widely.
It provides the LCA clinical community opportunity
to constructively challenge the recommendations of
the Group. Engagement with the forum
is critical to ensuring recommendations and outputs
are integrated into practice
The London Cancer Alliance West and South
Work-stream Membership
HNA roll-out:
Maureen Dowling
Jo Jefford
Michelle Kenyon
Cathy Wilson
Nicola Beech
Ben Hartley
Treatment
summary roll-out
Health and Wellbeing Events
Julie Baker
Kate Shaw
Suzie Stanway
Nic Glover
Nic Glover
Lorraine Barton
Teresa Young
Donal Gallagher
Sonia Pert
Ann Muls
Metrics
Research
PROMs
Julie Baker
Claire Taylor
Theresa Wiseman
Maureen Dowling
Theresa Wiseman
Claire Taylor
Teresa Young
Claire Taylor
Michele Kenyon
Bonnie Green
Janine Mansi
Consequences of Cancer Membership
Pain
Fertility/ Menopausal
Symptoms
Sexual Dysfunction
Pelvic Radiation
Disease
Isabel White
Suzanne Chapman
Will Teh
Alex Taylor
Nick Watkins
Isabel White
Louise Soames
Michelle Bull
Nicola Glover
Fatigue
Bone Health
Janine Mansi
Ann Muls
The London Cancer Alliance West and South
Questions?
Challenges in Changing Services
Sandra Jackson
Head and Neck Clinical Nurse Specialist
Mount Vernon Cancer Centre
The London Cancer Alliance West and South
Focus
• Moving on from Head and neck cancer workshop
• Collaborative Aftercare Protocol
• Local challenges
• Global challenges
• What would help?
The London Cancer Alliance West and South
Early days
We had
• No research proposal
• No project plan
• No business case
• No budget!
But we also had
• Patients with needs
• A dedicated head and neck team
The London Cancer Alliance West and South
What were the needs and drivers?
• Increase in calls from patients at around 3 months post
treatment
• Treatment consequences concerns and anxieties
• Some improvements in physical well being leading to
reduction in OPA
• “Safety net removed”
• NCSI – Changing follow up practice
The London Cancer Alliance West and South
What did we do?
• “Moving on from head and neck Cancer” workshop
commenced in 2005
Important
• Multidisciplinary input
• Relevant to patient and carers
The London Cancer Alliance West and South
Content
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Information
Skills
Normalising peer support
Reflection
Guidance on symptom concerns and alerts
Soft moist textured diet or supplement lunch available
The London Cancer Alliance West and South
Local challenges
• Patient recruitment & commitment
• Unknown expectations
• Creating space in job plans
• Support for evaluation
The London Cancer Alliance West and South
What did we do?
• Developed a Collaborative Aftercare Protocol
• Patients 2 years beyond treatment who fulfil a defined
disease and patient criteria
• Alternating CNS led telephone consultations with clinic
consultation
The London Cancer Alliance West and South
Local Challenges
• Clinicians and AHP’s not involved in development of
protocol were less engaged with new practice.
• Managing differing levels of enthusiasm
• Job plan concerns
• CNS cover for clinic
• Increased workload in clinic
• Securing ongoing funding
The London Cancer Alliance West and South
Survivorship is flourishing!
The London Cancer Alliance West and South
But The Business Case!
The London Cancer Alliance West and South
Barriers to permanent adoption of change
• No national tariff
• No national HRG codes
• Existing tariffs do not reflect level of expertise required
to provide service
The London Cancer Alliance West and South
Difficult Conversations
Quality care
Income
Generation/
Income
Loss
Costs
The London Cancer Alliance West and South
What would help?
• National document outlining consequences of not
providing on-going strategies
• Pass/ fail outcomes which would effect commissioning
of services
• Inform negotiations between providers and
commissioners
• Redirection of money saved on avoidable costs
The London Cancer Alliance West and South
If I knew then what I know now
• Macmillan – Making Change happen study day
• Tim Anstiss – Health Coaching and Motivational
interviewing
• Involvement from the start with the Support Oncology
Research Team in The Lynda Jackson Macmillan Centre
The London Cancer Alliance West and South
Something to share
I just want to say a thank you for the Moving on from Head
and Neck Cancer workshop. I was very sceptical about
attending, not knowing if there would be anything relevant to
me. I am so glad I decided to go.
Every speaker gave me valuable information and some cases
exercises which will benefit me for many months to come and
possibly for life.
I thought over the months of treatment I had learned
everything I need to about recovering from surgery and
therapy but this workshop gave me so much more.
I can’t recommend this workshop highly enough to future
patients.
The London Cancer Alliance West and South
Thank you
Appreciative Inquiry
Dr Tim Anstiss
M.B, M.Ed, D.Occ.Med, M.F.S.E.M
Visiting Research Fellow
Human Development and Health Academic Unit
Faculty of Medicine, University of Southampton
Close
Thank you
See you next time!