Welcome and setting the scene Dr Tony Branson Personalised care and - - PowerPoint PPT Presentation

Welcome and setting the scene

Dr Tony Branson

Personalised care and the NHS Long Term Plan https://www.youtube.co m/watch?v=jkzLP1_Y6Mw &feature=youtu.be

Collaborating to improve cancer care

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Collaborating to improve cancer care

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Personalised Care

• Every patient should have access to personalised care

interventions

• Stratified follow-up after treatment should be rolled out for

breast cancer, and piloted in other tumour types

• New metric should be developed to measure quality of life
• National target - 66% of eligible patients on new pathway by

2020

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SUPPORTED SELF MANAGEMENT PATHWAY

ATTEND BCN CLINIC HOLOSTIC NEEDS ASSESSMENT TREATMENT SUMMARY ACCESS TO CLINICS INFORMATION BOOKLET BOOK ANNUAL SURVEILLANCE MAMMOGRAPHY FOR 5 YEARS

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PATIENT WITH SYMPTOMS/PROBLEMS/ENDOCRINE THERAPY SIDE EFFECTS/LYMPHOEDEMA/WISHES TO DISCUSS RECONSTRUCTION

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CONTACT BCN TRIAGE VIA TELEPHONE PROFORMA REASSURANCE/ADVICE GIVEN OR APPOINTMENT ARRANGE FOR APPROPRIATE CLINIC BCN CLINIC BREAST SURGERY CLINIC ONCOLOGY CLINIC LYMPHOEDEMA SERVICE RECONSTRUCTION SERVICE

Collaborating to improve cancer care

'Why Should the Devil Have All the Good Music'?“

Attr Charles Wesley

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'Take Back Control’

Dominic Cummings

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Patients perspective

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Personalised Care

Michelle Thompson

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Digital Solutions and Considerations

Robin Blythe

Digital Solutions: Remote Monitoring

• a patient app

Robin Blythe

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Remote Monitoring

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Current situation

• NHS Operational and Planning Guidance “ Must Do”
• 3 pathways - Breast, Prostate and Colorectal
• Key stakeholders

– Academic Health Science Network (AHSN) – Health Call (Trust collaboration) – ICS Digital Programme – Trust (Clinical and Digital) and patients

• National collaboration – Cancer Alliances
• Technical specification confirmation.

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Why?

• Ensure patients are supported to live with and beyond cancer
• To improve survival for people by detecting recurrence earlier
• Provide a clinically safe process of remote monitoring with no

demonstrable impact on the lead time to recurrence detection.

• To reduce hospital led follow up
• Support a stratified model of care for low risk cancer patients

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Example Breast Pathway

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Eligibility criteria example - Breast

Patients classified as suitable for patient-led follow up will be identified at the breast MDT. Eligible patients may include:

• Patients whose surgical treatment is complete

– Patients treated for a Ductal Carcinoma In Situ (DCIS) – Patients receiving radiotherapy and/or hormone therapy without chemotherapy Patients who may not be suitable for patient-led follow up are:

• Patients who have received chemotherapy
• Patients on Herceptin
• Metastatic patients
• Patients on primary endocrine therapy
• Patients where there is a concern re compliance
• Patients requiring MRI as surveillance
• Patients still undergoing surgical treatment (e.g. reconstruction)
• Patients where there is clinical concern

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Key points

• 1st phase
• Work in progress
• Patient and clinical requirement
• Trust / patient engagement
• Trust interoperability
• Finance available.

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Potential functionality

Pre Assessment information

Appointment Management (Book/Cancel) Appointment Management (Reminders)

Shared Test Results Patient Treatment Summary Self Care Advice Patient Tracking Secure Messaging to Consultants /Clinicians

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Function Description Pre Assessment information Ability for patients to input into and system to capture pre assessment information online such as Holistic Needs Assessment which can be forwarded to clinician prior to an appointment Appointment Management Surveillance appointments should be available for patients to book or cancel online. This could also be a solution to reminder patients about their appointments Shared Test Results The consultant should be able to see mammogram / colonoscopy test results online, review and where negative forward to the app where the patient can view their test results online. Where the test results are positive the consultant may wish to contact the patient directly prior to making them available on the app Patient Treatment Summary This would include a summary of patients treatment summary at discharge which will include allergies, medications etc.

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Function Description Self Care Advice A knowledge base of advice linked to patient condition & treatment e.g. diet, should be available to read online as well as signposting to agreed volunteer / social groups Patient Tracking Consultants / Nurses should be able to see the progress of a patient within a pathway and a flagging system should be used to ensure the consultant can view when their patient has been seen by another specialist clinician within the hospital. Secure Messaging to Consultants / Clinicians There should be the ability for patients to message medical professionals via a generic inbox which clinicians can access as appropriate as well as the ability for medical professional to email each other.

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The survey says….

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Secure Messaging to Consultants/Clinicians Appointment Management - Book/Cancel Patient Tracking Pre Assessment information Shared Test Results Appointment Management - Reminders Patient Treatment Summary Self Care Advice Yes No

6 Trusts + 1 CCG Breast Colorectal Prostate

Lead Cancer Nurse / Specialist Nurse / Consultant / Breast Physician / Patient group / Screening Practitioner / Macmillan GP Lead / Cancer Manager / Lead Cancer Nurse / Specialist Nurse / Consultant / Breast Physician

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Nationally…

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Appointment Management Secure Messaging to Consultants / Clinicians Patient Treatment Summary Self Care Advice Pre Assessment information Shared Test Results Patient Tracking

Does + Will have Could / Should Other statuses

✓ ✓ ✓  ✓ ✓

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Next steps

• Clinical, digital and patient engagement
• Confirmation of technical spec
• Health Call deployment

– Project planning – Trust roles and responsibilities

• Alliance collaboration

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Personalised Care and the Breast Cancer Pathway Challenges and Opportunities

Clare Doney Personalised Care Clinical Lead NENC

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National Measurables

• All patients offered an

HNA +/- care plan (within 31 days of DTT) recorded on COSD

• Treatment summary
• Cancer Care review
• Opportunity for

health and wellbeing support

• Stratified follow up to

self management for 66% of patients

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Patients

Challenges

• Reassuring patients who may be

anxious about unrelated symptoms

• Navigating IT solutions or

attending events

• Moving away from the emotional

safety net of a regular follow up appointment

• Terminology and understanding

what is expected and by who

Opportunities

• Increased opportunity to have

needs listened to and met

• Receive follow up care closer to

home

• Reduce the anxiety associated with

a secondary care clinic appointment

• Empowered to self manage follow

up

• Clear re-access and signposting for

any concerns

• Increased choice of information

sources

• Co-design services

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Workforce

Challenges

• Reassuring clinicians that safety

netting is robust – relinquishing control

• Perceived additional workload
• Change
• Integration between primary and

secondary care

• Saturated clinics with complex

patients

• Potential impact of re-access
• Resource variation between Trusts
• Equal importance as timed

pathways Opportunities

• Opportunity to set up targeted

clinics for groups of patients - eg side effects of endocrine treatment

• Integration between primary and

secondary care

• Focus on patients with complex

clinical needs

• Innovative team structure

modelling to bridge the community gap

• Embrace the voluntary sector

support available

• Personalised care clinical

champions

• Closer working between trusts

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Systems

Challenges

• Achieving 66% stratified follow up
• Safety netting
• Integrating digital solutions
• COSD data input
• Lines of communication between

primary and secondary care

• Commissioning of services
• Reduced clinical activity in

secondary care

• Capacity and demand planning

across systems

• GDPR

Opportunities

• Digital solutions
• Reduce clinical activity in

secondary care

• Projection planning for the

increased numbers of patients with a cancer diagnosis

• Cross system collaboration –

including the community and voluntary sector

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A new normal…

All patients should be empowered for self management – standard practice Shift away from a medicalised model Personalised care to cover all of a patient’s needs and not just their cancer diagnosis

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Action Planning

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Dr Lorraine Kalra Chair of the Breast Pathway Board

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Lunch