Cancer Rehabilitation
– Raising the Bar
L&SCCN May 2011
Introduction
• The challenges of cancer rehabilitation
• The vision
• National Cancer Rehabilitation Advisory
Board
– Care pathways
– Workforce model
– Education, training and workforce
development
– New work
Is there a need for change?
• 2 million living with and beyond cancer in UK
– 1.6 m completed therapy
– Prevalence increases by 3.2% p.a.
– 4 million in 20 years
• 20 million (1:3) people are living with a long term
condition
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“Today, talking about cancer is no
longer taboo and, thanks to
brilliant research and amazing
clinical advances, we are likely
to know more people living with
cancer than dying from it”
Professor Steve Field, Chair
RCGP (HSJ)
The Challenges of Cancer
Rehabilitation
• Rehabilitation is not understood by many people
especially in relation to cancer – patients,
commissioners, GPs, other AHPs
• Rehabilitation isn’t an integral part of cancer strategies
• Cancer care pathways do not often explicitly reflect
cancer rehabilitation as part of the process
• There is currently not a strong evidence base for the
effectiveness of rehabilitation interventions
• Patients with complex treatments will require support
from local teams. How do we train generalists?
• Specialist rehabilitation v generalist rehabilitation?
• Lack of robust data
........where is your evidence?
The vision
• An indication of the workforce needed to provide a
service for patients with cancer
• Rehabilitation integrated into Improving Outcomes
Guidance
• A description of what cancer rehabilitation has to
offer and at what stage
• Clarification and coordination of the evidence base
– What’s is proven? What are the gaps?
• A comprehensive ‘whole pathway’
A better patient experience
2006 - Where is your evidence?
Evidence review
Workshops
Care Pathways
Commissioning Guidance
Workforce Model
National Cancer Rehabilitation
Advisory Board
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•
•
•
Work commenced 2007
Representation from across UK
Primary aim was to provide workforce data
Published:
– Review of Evidence for cancer and palliative
care rehabilitation
– Care Pathways – 9 cancer site/10 symptom
– Commissioning Guidelines
– Workforce model
NCRAB work streams
•
•
•
•
•
Application of Care Pathways
Engagement and ownership
Synergies of working
Research
Workforce, education, training and
competencies
• Commissioning
Patient focussed:
patient version, language,
access to information, whole
process of care, patient
information
Quality and effectiveness:
evidence into practice,
continuous improvement,
outcomes, integrated care
across organisations,
multidisciplinary, reduce
duplication
Care Pathway
Conclusion
Business information:
service cost, workforce, tariff
information, strategic planning,
resource utilisation, training, inbuilt benefits realisation
Clinical Governance:
Identify risks, clear process,
evidence based, decision
support, validation, monitoring
Workforce, Education,Training &
Competency
• Actual specialist numbers v model
indicative numbers
• Current IOG descriptors
• Fit with academic and competency
frameworks, national occupational
standards etc
• Future developments & link with delivering
the NHS workforce
National Cancer Incidence
Cancer Incidence by Tumour Site
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
Brain
Breast
Colorectal
Gynaecology
HeadNeck
Lung
UpperGIHBP
UpperGIOG
1
Office for National Stats April 10 Statistical
Bulletin 2008/09 Data
Urology
Workforce Model Indicative
National Requirement
FTE by professional group, showing break down by
pathway stages
Pa l & EoL
2500
Survi vors hi p
Tre a tme nt
2000
FTE
Di a gnos i s
Pre Di a gnos i s
1500
1000
500
0
Di et
Lymph
OT
Phys i o
SaLT
Indicative v commissioned
workforce
AHPs
AHP
Commissions
2010
Qualified
AHPs 2010
Head
WTE
count
Indicative
Cancer
workforce
Physiotherapy 1527
22029
18610
1928
Occupational
Therapy
17777
15142
1408
Speech & LT’s 779
7643
6143
168
Dietitians
4112
3523
867
1512
336
Workforce Tool Indicative Total Numbers All
Levels v Actual Specialist Numbers (2009)
2500
1928
2000
1408
1500
WTE
Predicted
Specialist
1000
867
500
297
296
840
296
230
168
148
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oe
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m
Ly
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s
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ie
P
hy
si
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0
5 Objectives for Developing the NHS Workforce
Developing NHS Workforce NCRAB objectives
5 Objectives
Security of supply- people
with the right skills, right
time, right place
Indicative workforce
Gap analysis professional & speciality
Responsive to patient and
changing service needs
Team based approach to oncology rehab with
blurred professional boundaries
Flexible High Quality
Education and Care that
supports safe, high quality
care and greater flexibility
Education awards and competency framework for
HE. Consistency of supply and workforce mobility
Value for Money
Team approach/skill mix effective workforce
utilisation. Potential for care provision outside
acute setting
Widening participation
Career progression, Career Framework levels
3&4. ie. Calderdale Framework Access to HE for
non trad groups?
• How secure is your service?
• Is your service adaptable to changing
needs?
• Do you provide value for money?
• How can you prove it?
New work 2011-2012
• Three new care pathways – sarcoma,
haematology & skin
• Patient version of care pathways
• New clinical version care pathways
• Cost-effectiveness study
• Metrics & sound bites
Success
• Rehabilitation is an integral part
of the cancer strategy
• Staff are delivering evidence
based practice
• More practice is evidenced
• More focus on early
rehabilitation intervention
• Staff are appropriately trained
and posts sustainable
• Patient care is transferred well
between acute and community
Further Information
www.ncat.nhs.uk/living with and beyond
cancer/rehabilitation
Site specific and symptom pathways
Commissioning Guidance
Evidence Review
NCRAB Strategic Plan
Service Mapping
Workforce model
email: jackie.turnpenney@ncat.nhs.uk