1. Holistic Needs Assessment (HNA) & Treatment Summaries
Emma Mitchell, Macmillan HNA Project Manager

2. Holistic Needs Assessment (HNA) & End of Treatment Summary
Emma Mitchell
Macmillan Holistic Needs Assessment Project Manager
Introduce role and background

3. LWBC Programme Why be part of the LWBC programme?
Increase in cancer patients surviving cancer
1.8 million increasing to 3 million: the projected increase in cancer survivors by 2030
47.3% of survivors express a fear of their cancer recurring
Increase in symptoms and concerns not addressed - 40% of prostate cancer survivors report urinary leakage
19% of colorectal cancer patients report difficulty controlling their bowels
Not everyone is living well
people with cancer are 35% more likely to be unemployed
1 in 5 people suffer from loneliness as a result of their cancer
The dramatic increase in people living with cancer is largely due to improvements in survival and detection, and a growing and ageing population, with the number of over-65s living with cancer increasing by almost a quarter (23%) in just five years.
In general most cancer sites are increasing overall survival significantly but not all cancer sites eg Upper GI, brain ca’s

4. LWBC Programme Recovery Package … Treatment Summaries
Holistic Needs Assessment (HNA) and Care Planning
Health and Wellbeing Events
Cancer Care Plan
Why do we need to consider unmet needs of those surviving a diagnosis of cancer?
Focus on surviving cancer – more patients living well and for longer after cancer. In the Oncology setting it’s easy to focus on patients with cancer dying on the wards, receiving pall chemo but many many more patients are surviving and we need to cater for them
The research by Armes et al (2009) identified significant unmet needs at the end of treatment. These findings were supported by the recent PROMs survey, commissioned by the Department of Health, highlighted high levels of anxiety and fear of recurrence and dying one year after diagnosis and that currently only 24% of people were offered a care plan.
2009 – NCSI set up to challenge and change the process to enable people to be better supported at the end of treatment.

5. Three projects all interlinked
Holistic Needs Assessment & Care Plans
Identifies the individual needs of the person affected by cancer – physically, mentally, socially, financially
A Care Plan can then be developed for appropriate referral to countywide support services.
Care Plan is given to the patient to enable self management and sent to GP via Treatment Summary
Treatment Summaries
Compiled by the multidisciplinary team to provide important info for GP’s e.g:-
Treatment toxicities
Info on side effects
Consequences of treatment
Signs and symptoms of recurrence
Any actions to take
Patient and GP receive a copy and a copy kept in secondary care
HNA results will form part of the decision between clinician and patient of whether they are suitable for the self management
Risk Stratification for self management pathway
Enables people who are willing and able to undertake self-management to do so in a safe and supported manner
Removal of routine follow-up appointments from the pathway. Routine surveillance is still completed at set intervals. However, these do not require the individual to automatically see a hospital doctor or nurse to receive their results.
We need to support people with cancer to return to as good a quality of life as possible after active treatment has ended, or support them to achieve their personal goals if they will be living with either primary or secondary cancer for some time.
Treatment Summaries provide crucial information to the patient about how to self manage their condition
It is also an important communication tool from secondary to primary care about the patients treatment and any ongoing support needed

6. HNA and Care & Support Plans
The Recovery Package
Risk Stratification
HNA and Care & Support Plans
Use this slide to discuss the elements of the Recovery Package and describe them briefly:
The recovery package consists of 4 key elements:
Holistic Needs Assessment
Treatment Summary to patient AND a GP / Cancer Care Review by GPs
An education event such as Health and Wellbeing event that includes physical activity and lifestyle information
Short description of the different elements of RP:
- Holistic needs assessment (HNA) - identifies the individual needs of the person affected by cancer and contributes to a consultation. The consultation can then be focused on the needs identified, a care plan can be developed and an appropriate referral can be made to services. The patient receives a copy of the care plan to enable self management; further copies are stored in the medical records and can be sent to the GP. - Treatment summary - is developed by the multidisciplinary team to inform the patient and the GP of the care and treatment received.  The patient receives a copy to share with other family members and health care providers. Further copies are stored in the medical records and inform emergency/unplanned admissions.  - Cancer care review - is carried out by the GP practice within six months following a diagnosis of cancer and gives the patient information to enable self management. - Health and Wellbeing Clinics - are education events to give the person affected by cancer the holistic information they need to enable rehabilitation and self management.
Referral to Take Control within Macmillan Next Steps Cancer Rehab team

7. What is the Treatment Summary
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Diagnosis:
Staging:
Date Patient Informed of Diagnosis:
Summary of Treatment and relevant dates:
Treatment Aim:
Required GP actions requested
Hospital Ongoing Management Plan:
Possible side effects of treatment:
Contacts for queries:
Other service referrals made (e.g. MNS Take Control, Dietician, Clinical Psychologist):
Alert symptoms that require referral back to hospital specialist team:
Future management plan
Summary of information given to the patient about their cancer and future progress:
Additional information (including issues to relating to lifestyle and support needs including patient and family concerns)
What is the Treatment Summary
The treatment summary includes information on possible treatment toxicities and /or consequences of treatment, signs and symptoms that require referral back to a specialist team, an ongoing management plan, and a summary of information given to the individual about their cancer and future progress and any required GP actions to support the patient. Copies are sent to the GP and provided to the patient when they are discharged.
General Practitioners and primary care professionals
The patient, to enable greater understanding and clarity of their condition and provide a summary to share with others of their choice
Secondary care clinicians
All sections of the TS should be completed and a copy given to the patient and sent the GP promptly at the end of primary treatment for cancer.
TS updates should also be generated at key points e.g. following recurrence, further treatment or a transition to end of life care.
The GP should enter the details onto their data base and use the information to inform the Cancer Care Review.1
What type of Treatment Summary will be used?
When will the Treatment Summary be completed in the patient pathway?
Who will completed the Treatment Summary
Where will the Treatment Summary be sent?
Completing Clinician: Signature: Date:

8. What is a HNA?
Tool to assess the patient holistically as a whole person.
Scoring system to identify patient’s concerns (needs)
Physical
Practical
Social / Family
Emotional
Spiritual
Lifestyles
Support / Care Plan
support / information / referral or signposting
Information booklet ,
Triplicate Assessment Pack for assessment and care planning
Signposting – we’re good at using Maggies but there are other VERY GOOD similar units out there such as Great Oaks, Longfield who provide similar services. Support for carers, complimentary therapies. Other organisations eg GL1, walking groups,
Signposting directory – signposting for each concern, available electronically through a share drive + paper format

9. Patients identified improvements in: They felt helped, listened to
Relationship with clinicians
Identifying issues Understanding
Enabling thinking Feeling of wellbeing
Releasing anxiety Gaining perspective
They felt helped, listened to
and 97 % Cared for
Patients told us that the process of assessment and care planning –
Helped me – 91%
Made me feel listened to – 96%
Answered all my questions – 97%

10. Emma Mitchell Identify concerns for each sub group eg…
The vision is that all patients will have an assessment of needs at 2 key points in their care pathway, at or near diagnosis at the end of treatment and if health or social needs change.
The process for assessment should be structured - Information giving, self assessment, conversation, care plan, signpost and share with relevant members of the MDT.
The self assessment enables the patient to identify their own needs and enables a focussed discussion. Enables self management
The care plan should then address the needs raised by the assessment and signpost people to the right services either in the hospital or community.
You need to be able to measure the level of concern to enable to monitor the concern / resolution of the problem.
Emma Mitchell

11. eHNA
Touch screen tablet to do the HNA - partly pre- populated care plan
Alleviates practical problems of carbon copied HNA
Patients like using them
Increased completion rate of HNA’s and conversion rate to Care Plans
Improved communication - Joined up seamless care
Data collection – steer future services
Move towards paperless working
Completion on tablet pc.
Early evaluation shows acceptable to patients and staff. Efficient, enables more care plans to be created.
Produces useful data, gaps in services, inform commissioning.
Data can also be used for annual reports and Peer Review.

12. Can drill down to the data - matching age, gender, diagnosis, pathway stage and concern raised. Giving a much more informed picture of peoples needs.
Demographic page double check patient details – Governance – and ensure right details for EPR
Personal information not stored, just data.
The concerns identified are automatically brought through to a partially pre-populated care plan in order of priority according to the score. Continue and individualise in free text. Can be an aide memoire of signposting for the patient
Can saved (owned by patient) for cross reference of next HNA,
Print off ultimate care plan for patient, copy of HNA and care plan sent to G.P
Data can be used for developing reports, Peer Review, developing and commisioning services and informing re the need of patient for information and health and wellbeing clinics.

13. Emma Mitchell
Macmillan HNA Project Manager

14. A Patient’s Story
Paul Illott

15. INTRODUCTION – A FAMILY HISTORY
Name: Paul Ilott; Age: 61; Married 41 years to Sheila (65), two sons, 38 and 36.
1963: Lost my grandmother, mum’s side, stomach cancer
1970: Lost my grandfather, dad’s side, lung cancer
1984: My wife had cervical cancer – surgery - now clear.
1991: Mother-in-law, ovarian cancer then secondary lung, died 1991.
2002: Lost my father to lung cancer.
2009: I had thyroid cancer 2009, two surgeries and radioactive iodine treatment, clear since.
2012: Lost my mother from carcinoid tumour on the liver, 10 weeks after diagnosis.
2015: Lost my father-in-law, unknown primary but secondary on the liver
2016: Brother-in-law has cancer of soft palate. Radiotherapy/Chemo; waiting scan results

16. Nov 2015: weight 100kg

17. Aug 2016: weight 82.5kg

18. Clare Lait’s Exercise classes

19. Question Time

20. Cancer Patient Reference Group (PRG)
Jenny Hepworth, Chair , Cancer PRG

21. It's your chance to really make a difference…
…this was my way of giving something back by ensuring others benefit from improved services
…I joined to make a difference
…to take an active role in helping others with cancer

22. Sum up and Close More questions? Information Stands: Macmillan
Practice Nurses, helping the transition of caring for patients with cancer from secondary care (hospital-based) to primary care (the GP surgery)
Advanced Care Planning
Informal networking time
Suggested dates for future meetings 2017: 28 July and 27 October
Information Stands
Macmillan
End of Life Coordination
Practice Nurse Facilitation
Maggie Pugh is a practice nurse facilitator working for Gloucestershire CCG. She is one of a team of five facilitators whose role is support General Practice nurses in primary care. Each facilitator covers a different area of Gloucester.
General practice Nurses look after many aspects of their patients’ health: long-term conditions such as asthma, diabetes, family planning, immunisations and travel health, wound-care etc. It is essential for safe patient care that Practice Nurses are competent at their work, so the role of the facilitators is to support practice nurses to remain competent and to help develop standards to ensure safe patient care.
Facilitators:
• Identify clinical and educational needs;
• Support the sharing of good practice;
• Develop a consistent standard for practice nursing
• Support local development of primary care as a career pathway for student nurses.
• Help the transition of caring for patients with cancer from secondary care (hospital-based) to primary care (the GP surgery)
Please come and have a chat if you would like to find out more or have any comments to make.