Despite a difficult year for cancer services, cancer survival rates are improving in the UK, and it is vital that all parts of the system continue to provide innovative solutions to help maintain this trend and enable more people to survive the disease. The NHS supports more than 360,000 people diagnosed with cancer each year and provides several medical interventions to treat the 200 different types of cancer that exist.
However, the availability of pioneering new cancer therapies has inevitably put additional pressure on already overstretched NHS cancer services. There are concerns about the NHS’ ability to deliver more innovative forms of care at a time when it is already under pressure, particularly as a result of the COVID-19 pandemic. Despite these challenges, one team wanted to give people living with terminal cancer more time to be with their loved ones, and less time spent in a hospital.
The Beatson West of Scotland Cancer Centre (the Beatson) in Glasgow is one of the largest specialist cancer units in the UK. The team there noticed that patients attending the hospital for same day, outpatient treatment were spending too long waiting for their chemotherapy, something that was only going to increase with the introduction of new treatments.
When attending day-case chemotherapy appointments, people with Soft Tissue Sarcoma (STS) reported that they spent between 8-12 hours in hospital, and treatment was consistently administered later than their planned appointment time. As people living with a terminal cancer, they did not want to spend a whole day in hospital waiting for treatment.
The Beatson identified the need to improve the efficiency of their chemotherapy clinic to protect patients’ access to new forms of treatment and sought to reduce the unnecessary hours that patients spent waiting in hospital for day case treatment.
Delays were caused by both an increased number of clinic visits per patient and a higher number of treatments administered in the chemotherapy day unit. Additionally, there was greater demand on hospital pharmacies in terms of both checking prescriptions and making up the drug in the aseptic pharmacy. This is common throughout the NHS and also applies to other therapy areas, including dermatology and rheumatology.
As a large centre offering cancer services, the Beatson had the patient numbers needed to evaluate the scale of this problem and measure the results of any interventions. To investigate how they might reduce waiting times and improve the patient experience, the Beatson entered into a Joint Working Agreement with pharmaceutical company Lilly. For more than five decades, Lilly has been dedicated to delivering innovative solutions that improve the care of people living with cancer. Lilly and the NHS team walked through the clinic flow and mapped out the patient journey. Supported by data provided by the Trust and patient diaries, the main areas of delay were identified, and a new process was developed to overcome these issues.
“This work has gained more importance in the light of the Covid pandemic, as important priority for all organisations particularly those in healthcare is to minimise waits, delays and contact with other individuals to reduce the potential risk of in hospital transmission of coronavirus”
The main aim of the project was to reduce unnecessary time in hospital, however a person’s own experiences of visiting the service and receiving treatment was also critical, so the team collected feedback through a detailed questionnaire. A further measure of success was the ability of the Band 7 clinical nurse specialist (CNS) to carry out the role in line with a specifically developed clinic Standard Operating Procedure (SOP), without requiring additional support from clinicians. For 12 months, patients with STS utilised the new CNS service when attending for systemic anticancer therapy (SACT).
Despite the impact of the COVID-19 pandemic in March 2020, the team ensured the project stayed on course and were able to deliver promising results. They saw a reduction in time patients spent in hospital, from an average of 8 hours 31 minutes to 3 hours 57 minutes – a drop of more than half (53.6%). Beyond the numbers, this gave people with a terminal diagnosis half of their day back and reduced time spent in an environment dealing with coronavirus.
Dr Jeff White, Medical Oncologist said “This work has gained more importance in the light of the COVID-19 pandemic, as important priority for all organisations particularly those in healthcare is to minimise waits, delays and contact with other individuals to reduce the potential risk of in hospital transmission of coronavirus.”
This project highlights how the NHS and pharmaceutical industry can share skills and resources to improve cancer services and enhance patient care. The importance of this is clear, particularly at a time when patients may not want to be sitting in a hospital all day, and the NHS needs to work as efficiently as possible.
From process mapping to the development of data collection plans, these principles can be applied and used within any clinical pathway and are not limited to chemotherapy services. This approach to improving clinic efficiency could be beneficial in reducing strain on the system, particularly at a time when the NHS tries to care for the backlog of patients caused by the pandemic.
What happened next
Since the roll out of the nurse-led service, patients reported being extremely satisfied with their cancer services under the new model. The average score from a patient satisfaction questionnaire was 4.6 out of 5, meaning patients were satisfied with all aspects from booking appointments to provision of care and follow-up post treatment. The CNS only required clinical support in line with the SOP, for example when discussing scan results. This demonstrates the success of the nurse-led service and also the need for the service to be run by a CNS no less than a band 7. This information was used to compile a business case to successfully secure future funding for the position. Patients also stated that they preferred seeing the same caregiver on each visit, and that they had no objections to this being a nurse, though would like a doctor to explain results to them and review their scans, something which has been factored into the new care model.
Stephanie Harvey is Project Manager and Quality Improvement Consultant at Eli Lilly and Company.
Acknowledgements: The core clinical project team from The BWOSCC for leading and implementing the project are Dr Jeff White, Dr Ioanna Nixon & Miriam Brady. Clinical support from Dr Jordan Kelly. Quality Improvement support from Nadia Eley (Lilly UK). The senior management team at The BWOSCC are Maureen Grant (Lead Nurse), Melanie McColgan (General Manager) and Dr Azmat Sadozye (Clinical Director). The wider project team are Gillian Barmark (Clinical Pharmacist) and Catriona Graham (Sarcoma CNS).