I’ve never been one for keeping a reflective diary but when composing a new blog I always take some time to look back at those I’ve written before. In Sept 2018 I wrote a blog titled ‘What’s next?’ and I believe that blog is just as relevant today as it was then.
Within ‘What’s Next?’ I talked about the role of AHPs in cancer rehabilitation, the inspiring people I’ve come across in my roles, and the need for a collective and sustained effort to embed rehabilitation in cancer pathways. All of which echoes with the themes of #AHPsDay i.e. to celebrate and inspire, to raise the profile of the individual allied health professions, to demonstrate achievement and impact, and to support integrated working.
Transforming Care After Treatment
As 2018 drew to a close, so too did a programme called ‘Transforming Care After Treatment’ (TCAT). TCAT was a 5-year partnership between the Scottish Government, Macmillan Cancer Support, NHSScotland, local authorities, the regional cancer networks, and people affected by cancer. Its aim was to support those diagnosed with cancer to live as well as possible for as long as possible. The programme funded a number of tests and demonstrated models which should be considered by Health Boards, Health and Social Care Partnerships and third-sector organisations, now and in the future.
The AHP contribution
One project delivered under TCAT focused on palliative and end of life care, and dietitians and occupational therapists were integral to the project’s success. Not only were cost efficiencies demonstrated (through fewer admissions, fewer unnecessary tests and a better understanding of individual needs), but more importantly, quality of life improved and more people died in their preferred place of care. AHPs played a crucial role in these outcomes, and their resourcefulness and resultant ‘Teach, Advise, Assist’ model meant significant value was obtained from very little investment in AHP services. Despite this, ongoing funding has remains challenging and that threatens the long-term outcomes and future of the work.
Another project was the ‘Cancer Related Cognitive Changes’ project which was developed and tested by clinical psychologists. This successful project is now being delivered collaboratively by psychologists and occupational therapists across Scotland in Maggie’s centres, hospices and NHS Health Boards, improving access and maximising outcomes for those experiencing memory and concentration problems as a result of cancer and its treatment. The effect of this issue on people affected by cancer cannot be underestimated and I would urge readers to take a few minutes to watch the following short video to see just how much impact a project such as this can have on individuals and their loved one.
Demonstration of need and future focus
The Holistic Needs Assessment (HNA) was a tool used throughout the TCAT programme by a majority of the 25 project teams (n=19). With over 2,800 HNAs completed during the programme, we now have a better understanding of the issues affecting people with different types of cancer at different points in the cancer pathway. The most frequently reported concern at every point in the cancer pathway was ‘Tired, exhausted or fatigue’. This issue and many of the others commonly reported (see figure 1) are issues successfully addressed by AHPs. As such, I would argue that there is enough evidence for us to begin to re-consider how we collectively organise and resource our cancer teams here in Scotland.
Figure 1: Top 5 Concerns Across the Cancer Pathway from Johnson and Campbell 2018
Transforming Cancer Care
My hope is that Transforming Cancer Care Programme (TCC) will be one vehicle for this change. Announced in August 2019, TCC has three individual strands:
- Building on the learning from TCAT,
- Rolling out Improving the Cancer Journey, and
- Exploring Prehabilitation.
As mentioned in previous blogs written by both myself and my AHP colleagues working in cancer services, Prehabilitation is part of the rehabilitation continuum, and guidance published in July 2019 calls for a multi-modal and tiered approach. The three core strands of prehabilitation are:
- Physical activity and exercise interventions,
- Nutrition, and
- Psychological support.
Given the tiered model advocated (universal, targeted and specialist) there are a large number of services we can pull on to ensure everyone affected by cancer gets the best start in their treatment pathway. However, the guidance and evidence is clear – AHPs are vital for delivery and successful outcomes.
A call to action
Thus, with all of the above in mind my thoughts once again return to my previous blog… However, this time instead of asking ‘What’s Next?’ I’m encouraging my AHP, clinical, and third-sector colleagues, as well as those affected by cancer to demand that AHPs and multi-modal, tiered and across-the-pathway rehabilitation are next.
If you’re inspired by #AHPsDayScot and have a story or experience to share, why not get in touch with me at:
Tell me what you’re working on, what impact your service has had on people affected by cancer, what you need to transform your service, how AHPs have helped you to live well after a diagnosis of cancer, or how your experience could have been better with AHP support.
I look forward to hearing from you!
Debbie Provan is a Registered Dietitian and works as the Regional Lead for Living With & Beyond Cancer with the West of Scotland Cancer Network. She is also a PhD student at the University of Glasgow and works with Macmillan Cancer Support to embed rehabilitation across Scotland.
Johnson L and Campbell K (2018) Transforming Care After Treatment Final Wrap Up Report. Available at: http://www.woscan.scot.nhs.uk/wp-content/uploads/ENU-TCAT-Programme-Evaluation-Wrap-Around-Bulletin-November-2018-TCAT-PB-141218-Paper4b.pdf