The Integrated Cancer Care Programme in Halton

1
The Integrated Cancer Care Programme in Halton

• RCN Conference - 20.9.06
• Marion Hopwood Nurse Director, Merseyside and
  Cheshire Cancer Network
• Janet Winstanley District Nurse Team Leader,
  Brookvale Practice, Runcorn

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ICCP Background

• ICCP is part of overall vision for delivering
  high quality, managed care for cancer patients
• Department of Health commissioned UnitedHealth
  Europe to manage ICCP
• ICCP complements other work being undertaken by
  the NHS to enhance the care being given to
  patients with long-term conditions

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ICCP Pilot Sites

• Year One Sites
• Halton
• Haringey
• Poole
• Year Two Sites
• Derbyshire Dales and South Derbyshire PCT
• East Berkshire Locality
• Slough,Bracknell Forest, WAM (Windsor, Ascot,
  Maidenhead)
• Harrow PCT
• Herefordshire Locality
• Portsmouth and South East Hampshire Locality
• Fareham Gosport PCT, East Hampshire PCT,
  Portsmouth City PCT
• Selby York PCT

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Integrated Cancer Care Programme Aims

• To improve quality of care for cancer patients
  through improved coordination of care across the
  care pathway
• Improve the experience of care for cancer
  patients and increase the quality of care
  provision in the community
• To assess and seek to reduce NHS expenditure
  related to unnecessary or prolonged hospital
  admissions and duplication of effort
• Use NHS resources as efficiently and effectively
  as possible
• Help patients receive the right care, at the
  right time, in the right place
• Link with other national and local initiatives
• To improve the satisfaction of staff in all areas
  with the care delivered to cancer patients

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What the patients say .

• Patient feedback via the 2004 National Cancer
  Patient Survey confirm what we need to improve
• Communication
• Waiting times
• Provision of information
• Providing care nearer home
• Organisations working together
• Single point of contact to help patients navigate
  the cancer journey

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New Direction for Community Services for the NHS
and Social Care

• Our Health, Our Care, Our Say
• Easier access to services
• Bringing care to the community
• Better information
• Improving health
• Care for people with ongoing needs
• Help for carers
• Joined up care

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National ICCP Governance

• National ICCP Steering Group
• Chaired by the National Cancer Director, Mike
  Richards
• Key stakeholders for the Department of Health,
  Voluntary Sector (e.g. Macmillan Cancer Relief
  and Marie Curie Cancer Care), a Patient
  Representative, PCTs and Cancer Networks, Primary
  Care, Nursing, Long Term Conditions,
  representatives from UnitedHealth Europe
• ICCP Project Group
• Key programme drivers representing the Department
  of Health, Supportive and Palliative Care, Cancer
  Action Team, Cancer Services Collaborative,
  Cancer Policy, Nursing, Primary Care and
  UnitedHealth Europe

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Local ICCP Governance

• ICCP Steering Group
• 3 working groups
• Nurse competencies
• Pathway
• Data
• Communications Strategy

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Why District Nurses?

• Existing skills and experience in delivering
  palliative care.
• Extensive knowledge and understanding of the
  local community.
• Comprehensive knowledge of referral systems.
• Close working relationships with GPs.

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Why District Nurses?

• Team working covering 7 days a week.
• Decision makers.
• Autonomous practitioners.
• Existing case management skills.

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ICCP Patient Journey

• Patients identified through MDT lists, GP lists,
  DN knowledge.
• Patient contacted by ICCP care co-ordinator or
  district nurse for introduction to the programme.
• Patient has home visit by the ICCP nurse.

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ICCP Patient Journey

• Holistic assessment performed.
• Initial health risk assessment completed and risk
  stratification score calculated.
• Plan of care completed by ICCP nurse with
  patients involvement and agreement.
• Care co-ordinator is part of the care plan.

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ICCP Patient Journey

• Holistic care provided by ICCP nurse.
• Care co-ordinator co-ordinates the patients
  journey.
• Care becomes patient - centred.
• Patient care becomes proactive.
• Patient cared for in the right place, at the
  right time and with the right resources.
• Discharged (minimum of) 6 months after end of
  treatment.

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Role Transformation

• Nurses will gain new clinical skills to enable
  them to focus on the highest risk patients
• To conduct comprehensive physical assessments.
• To collaborate with GPs to diagnose and monitor
  patients.
• To case manage patients with complex needs.

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Everybody wins!

• Improved patient experience through
• A seamless journey for patients.
• Expert local care based in the community
• Extending district nursing skills resulting in
  improved care for all.
• Crisis prevention through proactive case
  management

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Everybody wins (cont!)

• Improved cost effectiveness by
• Making full use of clinical roles
• Making full use of non-clinical role (care
  co-ordinator)
• Reduce Out of Hours incidents
• Appropriate use of specialist colleagues
• Streamlining and reviewing pathway processes
  (e.g. phlebotomy)

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Everybody wins (cont!)

• Hospital admission avoidance
• Improved medicines management
• Reduced unnecessary outpatient appointments,
  follow-ups and DNAs
• Avoidance of unnecessary procedures

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Everybody wins! (cont)

• Enhanced care provision by District Nurses in
  areas of care outside of cancer
• A greater understanding of the full pathway for
  patients
• Illustrates what district nurses can do and
  therefore informs the commissioners
• Increased staff satisfaction
• Enhanced career prospects for District Nurses.
• A chance to focus on District Nursing.