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October 2019

Greater Manchester Cancer. Holistic Needs Assessment Top ten concerns at the end of treatment Lindsey Wilby Macmillan Project Manager – Living with and Beyond Cancer. October 2019. Greater Manchester Cancer. Recap: The NHS Long Term Plan – Personalised Care for Cancer Patients.

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October 2019

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  1. Greater Manchester Cancer Holistic Needs AssessmentTop ten concerns at the end of treatmentLindsey WilbyMacmillan Project Manager – Living with and Beyond Cancer October 2019

  2. Greater Manchester Cancer Recap: The NHS Long Term Plan – Personalised Care for Cancer Patients By 2021, where appropriate, every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support.

  3. Greater Manchester Cancer Holistic Needs Assessment and Care Planning • A HOLISTIC NEEDS ASSESSMENT considers all aspects of a person's needs, including physical, social, psychological and spiritual. • Patient-led • Provides professionals with insight into a person’s coping skills, and enables signposting to support services. • Helps to identify strategies of self-care. • CARE PLANS document any concerns identified and summarise the actions of both the patient and professional. • Shared document – ask patient if they have one? • Equal partnership between patient and professional • Shared with GP (with patient consent)

  4. Greater Manchester Cancer

  5. Greater Manchester Cancer Holistic Needs Assessment – How, Where, Who, When? • Paper • Electronic – preferred • Home • Clinic • Secondary Care or Community • Nurse, AHP • Cancer Care Co-ordinator • Macmillan Cancer Information Centre • Any point in the pathway (but certain target points too)

  6. Greater Manchester Cancer TOP 10 REPORTED CONCERNS WORRY/FEAR /ANXIETY/ UNCERTAINTY ABOUT FUTURE MONEY & FINANCE ISOLATION EATING & APPETITE CHANGES IN WEIGHT MOBILITY HOT FLUSHES /SWEATING OTHERS – PARTNER, CHILDREN, PEOPLE I CARE FOR SLEEP FATIGUE PAIN/ DISCOMFORT Macmillan leaflets for each: https://www.macmillan.org.uk/about-us/health-professionals/programmes-and-services/recovery-package/resources.html, then click “Addressing Concerns Identified from the Concerns Checklist”

  7. Greater Manchester Cancer FACILITATOR or FIXER? GOOD C0-ORDINATOR GOOD COMMUNICATOR GOOD COLLABORATOR

  8. Greater Manchester Cancer Case Study • KIDNEY CANCER – Male, Age Range 40-50 years, Lives alone • HNA (CNS LED) - EMOTIONAL CONCERNS • Cancer Care Support Co-ordinator supporting with actions • Referred to –Macmillan Connections – Befriending & General Support • Signposted to – Wythenshawe Macmillan Information & Support Centre • CO-ORDINATOR ACTION – Source local Kidney Cancer Support Group • OUTCOMES: • Macmillan Connections – Accessing & Benefiting • Kidney Cancer Support Group - at Maggie’s Centre • Co-ordinator attends first meeting with patient • Reassurance, sharing experience – increased confidence • Patient initiates Counselling Referral

  9. Greater Manchester Cancer Case Study • UPPER GI – Male, Age Range 40-50 years, Lives alone • HNA (Cancer Care Co-ordinator) – MONEY / FINANCE & BODY IMAGE CONCERNS • Referred to – Welfare Rights & local Exercise Programme • Signposted to – Wythenshawe Macmillan Information & Support Centre • Later (result of follow-up contact) – Eating problems (broken teeth) – list of local dentists accepting NHS patients • OUTCOMES: • Welfare Rights – Macmillan Support Grant • Exercise Programme – repeated attendance until return to work • Co-ordinator provides details of alternatives) • Dentist – registers & treatment completed; eating improving

  10. Greater Manchester Cancer Personalised Care and Support Planning • CARE PLANS • What matters to patient – captures & records conversation, decisions & actions / outcomes • Support joined up co-ordinated care & support • All copied to GP (with patient consent) • Always include: • Details of local Macmillan Information and Support Centre • Cancer Care Support Co-ordinator and/or CNS contact details • TOP CONCERNS are used to: • Develop Tumour-specific ‘Living With & Beyond Cancer Useful Contacts for Information and Support’ leaflet (included with care plans, Health and Well-being Event invite) • Focus Information Stall attendees at Health & Well-being Event (eg: smoking cessation & alcohol at Head & Neck stall) • …And could ultimately be used to shape and commission support services

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