Overview Early Presentation of Cancer „Early Presentation of Cancer Symptoms‟ is a Symptoms Programme community-led programme working across Topic: deprived communities in North East Cancer Lincolnshire. It uses local knowledge and Organisation: communities to encourage people to present North East Lincolnshire Care Trust Plus earlier with suspected symptoms of bowel, Location: prostate and gynaecological cancers, with the North East Lincolnshire (Yorkshire and aim of reducing cancer mortality rates. Humber) Dates: Combining social marketing, community Pilot 2007 to 2008; Now mainstreamed and involvement and rapid improvement ongoing methodologies, the programme developed and Budget: worked with community teams of local people to £107,000 for original pilot (2007 to 2008) gather insight across networks and establish Website: connections, acting as a „passport‟ into www.nelctp.nhs.uk/services/cancer- communities. collaborative Contact: Key results: Julie Grimmer (Project Manager) Email: 50 per cent increase in the number of bowel Julie.grimmer@nhs.net cancers referred into services through two- Telephone: week waits; 67 per cent increase in prostate 01472 232 261 cancer referrals; 28 per cent increase in gynaecological cancer referrals 15 per cent (in 2007/08) increase in people feeling confident in identifying cancer symptoms, with a further 13.9 per cent increase in 2009/10 11 per cent increase (in 2007/08) in reported willingness to act on symptoms, with a further 11.6 per cent increase in 2009/10 ShowCase │ Early presentation of cancer symptoms 1
provided a starting point for developing a new approach with a more explicit focus on: Social marketing, specifically on behavioural goals Two-way learning to develop the framework, Cancer affects one in three people across their rather than more rigid paradigms lives, but it affects certain parts of our An „Experts on the Ground‟ event, to provide communities more than others. For a variety of direction, generate involvement and focus on reasons, communities that face inequalities local needs present later with suspected cancer symptoms. Services find it harder to engage these In 2007, NEL Care Trust Plus (NELCTP) used communities and a range of patient and Neighbourhood Renewal Funding to engage practitioner delays result in higher mortality and not-for-profit organisation Unique Improvements more complex care needs. to design and implement a social marketing programme aimed at increasing early presentation of cancer symptoms amongst hard- to-reach populations. The funding was initially for 15 months, which allowed for 3 months planning and set-up, followed by a 1-year pilot programme. However due to delays in appointing key staff, the programme timescale ended up being a year. NELCTP and Unique Improvements set out a project plan based around four-month slots, followed by learning workshops: The first four-month slot was allocated for Across North East Lincolnshire (NEL), life scoping, development, stakeholder expectancy in priority neighbourhood areas is engagement and construction of an on average seven years less than in other evaluation plan. This would be followed by neighbourhoods. Locally, whilst cancer mortality the first learning workshop to up-skill is reducing overall, there is a widening gap in volunteers in social marketing outcomes between the most affluent and the The second four-month slot was dedicated to most disadvantaged communities. rolling out the work on the ground. Ideas would be tested and partnerships formed As well as inequalities across cancer tumours, before interventions were implemented. there are local inequalities across civic Again, this would be followed by a learning engagement indicators. Influences from the workshop broader policy contexts pointed towards The third and final four-month slot was generating complementary solutions that devoted to using data and local knowledge engaged services and communities in common to further drive improvements, as well as action on cancer, and social and human capital. beginning to pull together the evaluation, publicising successes and working to embed Community-led social marketing the work in local strategies and activities to NEL already had experience of the Healthy ensure sustainability. This would be followed Communities Collaborative (HCC) and this ShowCase │ Early presentation of cancer symptoms 2
by a final learning workshop and Considerable research was undertaken, including: dissemination of results and lessons learned 1. Review of evidence and good practice It was decided at the start that the programme An extensive review of previous programmes and would use „Community Change Teams‟ made best practice from the UK was conducted to learn up of local people to engage with people and what had and had not worked before. increase cancer symptom awareness. These teams would be supported by health Desk research was also conducted to establish professionals who would draw on local networks existing local data and intervention measures to to recruit individuals. drive the programme forward. A steering group was set up to oversee the work 2. Stakeholder input and guide development. This group included: The expertise of local service deliverers was crucial as it was accepted that the local knowledge of cancer workers was more up-to- A public health nurse date and relevant than generic service data. To A health trainer manager explore these sources and engage stakeholders, Specialist health promotion representatives an 'Experts on the Ground Event' was held in A director of service improvement March 2007, before commencement of the A representative from the cancer network programme. It brought together 100 local service Clinical nurse specialities from each tumour providers, staff and community members to site identify priorities, understand local needs, share Community volunteers learning, interrogate local networks and allow programme planners to prioritise areas of work. “The terms of reference for the steering group The programme invited local experts from a was very much around supporting the variety of tumour sites. community teams to take the work forward, and if any barriers presented themselves Through discussions with key stakeholders and organisationally, for them to help to offer a assessment of public health data, four tumour solution, but also very much to promote and sites were chosen to focus on: champion the work, so that all facets of the organisation knew what was going on” (Julie 1. Bowel Grimmer, Project Manager) 2. Ovarian and cervical 3. Oral 4. Prostate Based on feedback from the stakeholder event, and the Neighbourhood Renewal Priority areas, the steering group and programme planners identified four target areas for the programme, which had low screening rates and strong The programme team believed that the indicators of health inequalities: consumer is the most important participant within the change process. It therefore aimed to Immingham use local knowledge, combined with the Cleethorpes professional evidence base, to plan locally- Hainton, Heneage and Park appropriate interventions, based on real West Marsh audience understanding. ShowCase │ Early presentation of cancer symptoms 3
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