North Wales cancer specialists explore new ways of delivering follow-up care to patients

Clinicians from Betsi Cadwaladr University Health Board have been on a fact-finding mission to Northern Ireland to discover more about an award-winning project to improve cancer services.

The group, including surgeons, radiologists and clinical nurse specialists, travelled to Belfast to hear about Transforming Cancer Follow-Up – a programme funded by Macmillan Cancer Support to redesign the way patients are followed up after treatment.

The programme, which has been rolled out across Northern Ireland’s five Health and Social Care Trusts, challenges the traditional ‘one size fits all’ approach based around routine hospital follow-up.

Instead, patients receive tailored follow-up care, which may mean they no longer need to attend hospital appointments.

The trip was organised by colleagues on BCUHB’s Transforming Cancer Services Together programme, which has been set up to improve cancer services in North Wales and which is also funded by Macmillan.

Andy Owen, Macmillan Project Manager (Breast) on the programme, said: “More people are surviving cancer than ever before, but without a complete transformation of the way people are supported after their treatment ends, there is no way patients will get the aftercare they so desperately need, whether that’s practical help at home, financial advice, or even emotional support.

“This is about helping people make the transition from ‘patient with cancer’ to ‘person getting on with life’ – getting their health and wellbeing back on track, while still having the reassurance of a point of access back into the system if required.”

The Transforming Cancer Follow Up approach, which won both a Macmillan Team Excellence Award and a UK Nursing Standard Award, means every patient is given their own individual care plan post-treatment.

As part of a ‘Recovery Package,’ patients are educated on what to do and who to contact should a problem occur and are also invited to a health and wellbeing event for additional support.

Liz Henderson, former Programme Lead on Transforming Cancer Follow-Up, said: “Partnership working between Macmillan and the Health and Social Care Board, a cohesive programme team and engaged clinical leaders were essential elements in bringing about transformation.

“While the change process was challenging at the time, the innovative approach has now become embedded in business-as-usual.

“In addition to reducing pressure on the system, this more holistic approach takes account of the changing needs of people living with cancer and empowers them towards greater self-management.”

Heather Montverde, Head of Services for Macmillan in Northern Ireland, added: “We were delighted to welcome Andy and the team to share the benefit of our experiences.

“As the cancer landscape changes and demand for services continues to grow, it’s increasingly important to review how we deliver care and where improvements can be made.

Richard Pugh, Head of Services for Macmillan Cancer Support in Wales, added: “True cancer care is not just about adding years to life. It is about helping people to live the fullest life they can in the years they have been given.

“The Transforming Cancer Follow-Up programme recognises that the impact of cancer can reach into every corner of a person’s life, and create a wide range of financial, practical and emotional needs that go far wider than what happens in hospital.”

BCUHB’s Transforming Cancer Services Together programme, which launched in February, has been set up to improve services in North Wales and is looking specifically at breast, lung, colorectal and urological cancers.

There are a large number of redesign programmes underway by Macmillan and its partners but this is the first in Wales to look at a patient’s entire journey; from referral by a GP, to treatment in hospital, to living with and beyond cancer.

The programme will be shaped by the ideas and input of clinicians, partners and most importantly, people affected by cancer.

More information about the programme and how to get involved can be found here.