Transforming Cancer After Treatment (TCAT) in Scotland

The Transforming Care After Treatment (TCAT) programme was set up by the Scottish Government, Macmillan Cancer Support, the NHS and local authorities to improve cancer care and support across Scotland.

The programme aims to:

  • Reshape the cancer care system to allow it to better support the growing numbers of people with cancer now and in the future
  • Support and encourage the development of integrated health and social care, built around the needs of people with cancer
  • Give people with cancer back control, providing information and support when needed
  • Promote and provide strong evidence for personalised medical follow-up care
  • Promote and provide strong evidence for Macmillan’s Recovery Package

Watch Edinburgh man Alan share his story about how much person-centred care and being listened to mattered to him and his wife when she was diagnosed with incurable cancer, and why he supports the TCAT programme.

Why is change needed?

TCAT was set up in response to research showing that many people weren’t getting the right support to deal with the emotional, financial, practical and physical problems caused by cancer.

Research from 2015 in Scotland showed that 76% of those who’ve had a cancer diagnosis in the previous 10- years – an estimated 100,000 people - had practical or personal care needs.  Despite this, the Scottish Cancer Patient Experience Survey found that, among those who needed it, only 54% got enough care and support from health and social care professionals during treatment. The situation was worse after treatment, with only 45% of people saying they got enough care and support.

The survey also found that just over half of people (52%) wanted information on financial help and benefits from hospital staff, but only half of them (51%) received it. This is despite research from 2013 showing that 80% of people in Scotland who have cancer are £420 a month worse off after diagnosis.

The Scottish Cancer Patient Experience Survey also found that only 22% of people diagnosed with cancer were given a written care plan, despite the survey showing that those who had a care plan were more positive about their experience.

These findings, combined with research showing that the number of people living with cancer was expected to rise from 220,000 in 2015 to 360,000 by 2030, meant the need to find more effective and efficient ways to support people with cancer was clear.

How is TCAT addressing these problems?

The TCAT programme is made up of 25 projects that are testing and spreading new models of person-centred care throughout the NHS and local authorities. Although the exact set up of the projects vary to allow them to meet the needs of the local area, each delivers at least one aspect of Macmillan’s Recovery Package, which was designed to make sure people with cancer get the care and support they want.

A number of the projects are also giving people personalised medical follow-up care. This approach means that after treatment ends, people can see their cancer teams very quickly if they need to, for example if they or their cancer team are concerned about the cancer returning. This is instead of the traditional one-size-fits-all approach where everyone is called back to hospital at pre-set times, regardless of whether they or their cancer team think the appointment is necessary. Watch consultant surgeon Keith Ogston and former breast cancer patient Marion talk about the benefits of this approach, or read Keith’s blog.

The voice of people with cancer and carers have been vital throughout the development and evaluation of the programme and the individual projects and came together as the Cancer Experience Panel (CEP). Read about their work on the Macmillan Scotland blog.

Transforming Care After Treatment (TCAT)

Watch how the TCAT programme in Scotland ensures the increasing number of people living with cancer get all the support they need to cope with life after treatment.

Transforming Care After Treatment (TCAT)

Watch how the TCAT programme in Scotland ensures the increasing number of people living with cancer get all the support they need to cope with life after treatment.

What is the Recovery Package?

Made up of four key elements, the Recovery Package aims to make sure everyone with cancer gets all the support they need for as long as they need it.  It includes:

  • the Holistic Needs Assessment (HNA) and care plan. The HNA is used to find out about the emotional, practical, financial and physical needs of someone with cancer. The care plan sets out how the person will get the support they need. Watch Glasgow woman Laura talk about how being asked about what mattered to her helped her cope after she was diagnosed with cancer for the second time.
  • Cancer care review. This is a discussion between the person with cancer and their GP or practice nurse that takes place within six months of a cancer diagnosis. It’s a chance for the person with cancer to talk about the kind of support they need.
  • Treatment summary. This is a summary of the illness, treatment and side effects. It also outlines signs of recurrence to look out for. It should be given to the person with cancer and their GP and be can shared with other health and social care services with the permission of the person with cancer.
  • Health and Wellbeing events. These are events in local areas where health and social care services and charities come together so people with cancer can find all the support they need in one place.


Impact of the programme so far

Many TCAT projects have still to report, but so far the results have been extremely promising, particularly around the use of HNAs and personalised medical follow-up care.

Some key highlights include:

The project within Stobhill Hospital (link to infographic) in NHS Greater Glasgow & Clyde offered people who had finished cancer treatment personalised medical follow-up and HNAs, leading to significant improvements in patient experience. The new model of care for breast cancer patients led to a 44% increase in the number of people giving their overall care after treatment the top score. It also led to a 50% reduction in demand for consultant appointments, freeing up an estimated 600 appointments in a year that could be used to see people with urgent or complex needs. Work is underway to spread this approach. Watch consultant surgeon Keith Ogston and former breast cancer patient Marion talk about the programme, or read Keith’s blog.

The project within NHS Fife offered lung cancer patients who couldn’t undergo treatment, a comprehensive assessment of all their needs, followed by a care plan and coordinated support. This led to better care for patients and reduced the number of unnecessary days they spent in hospital by 32%. Feedback from patients, families and carers about the programme was positive. Work is underway to spread this approach. Read Doctor Jo Bowden’s view on how the project has helped people or watch a video about the project.

The project within NHS Highlands successfully created an online platform and app called 'My Cancer Portal' that people with cancer used to communicate with their cancer care teams. It also allowed them to complete an HNA and access support for the emotional, practical, physical and financial needs it identified. This project now has more TCAT funding to build additional features into the cancer portal and spread its use to other health boards.


What's next?

In 2016, the Scottish Government’s cancer strategy set out a vision for cancer care in Scotland that was person-centred. A vision of bespoke care and support that was based on what the person with cancer wanted and needed. The TCAT programme is showing how this can be delivered in practice within health and social care.

The next phase for the programme is sharing its learning and helping spread the new approaches across Scotland.

Health and social care decision-makers are encouraged to look at the successes and learning from TCAT and use it to embed the person-centred approach to care into everyday practice.

Find about more about all the TCAT projects

Finished projects

Ayrshire Councils - Employability Project

This project was set up improve the support available for people affected by cancer who want to return to work. It worked with people with cancer, and carers, to help them overcome the barriers to work. The project also worked with local businesses to help them understand how best to support employees affected by cancer.

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Fife - Health and Social Care partnership

This project offered people with cancer a Local Area Coordinator (LAC) who met them and talked through the HNA to establish their needs and wants before they jointly agreed a care plan. The LAC helped the person access the support they needed. Patient feedback was very positive. Visit the website for more information.

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NHS Ayrshire & Arran

This project offered people who had finished cancer treatment an HNA followed by support to deal with their wider emotional, financial and practical needs. The project resulted in patients reporting fewer concerns in many areas. It is now being rolled out within the health board. Download a two-page infographic version of their final report [PDF].

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NHS Borders

This project highlighted the need for better care and support for patients in Hawick, and has now been rolled out across NHS Borders. The project found gaps in care after treatment for cancer, with patients often not knowing what to expect, what to look out for or who to contact.

The project met their needs by offering people an HNA and care plan. It also held Health and Wellbeing Events and created a service directory. Download a two-page infographic version of their final report [PDF].

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NHS Fife – Palliative and end of life lung cancer project

The project offered lung cancer patients who were unable to undergo treatment, a comprehensive assessment of all their needs, followed by a care plan and coordinated support. This led to better care for patients and also reduced the number of unnecessary days they spent in hospital. Download a two-page infographic version of their final report [PDF]. Read Doctor Jo Bowden’s view on how the project has helped people or watch a video about the projectVisit the website for more information.

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NHS Fife - Skin cancer

This project offered people with skin cancer personalised medical follow-up, an & care plan and other support. Most people found the new approach helpful in meeting their needs. Visit the website for more information.

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NHS Forth Valley

This project offered men who had finished treatment for prostate cancer, an assessment of their support needs, alongside help dealing with their emotional, financial and practical needs. The results suggested a significant proportion of men attending follow-up appointments in hospital after the end of their treatment could be supported to self-manage. Download a two-page infographic version of their final report [PDF].

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NHS Greater Glasgow & Clyde, Stobhill Hospital

NHS Highlands – My Cancer Portal

This project created an online platform and app called 'My Cancer Portal' that people with cancer used to communicate with their cancer care teams. It also allowed them to complete an HNA and access support for the emotional, practical, physical and financial needs it identified. This project now has more TCAT funding to build additional features into the cancer portal and spread its use to other health boards.

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NHS Lanarkshire - lung cancer

NHS Lothian - Westerhaven

This project aimed to empower people to optimise their well being after cancer treatment, whether they needed help to return to normal life or support as they entered the palliative phase of their illness. Patients who had completed their cancer treatment - as well as their carers - were offered an HNA and care plan in Wester Hailes Medical Practice. Download a two-page infographic version of their final report [PDF].

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NHS Lothian - Secondary care

This project offered patients with breast, gynaecological, anal, rectal and lung cancer an HNA and care plan, alongside the opportunity to attend a recovery clinic with a cancer nurse. The project saw a drop in the number of concerns reported by patients between their first and second assessment. Positive feedback was received from patients. Download a two-page infographic version of their final report [PDF].

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NHS Tayside

On-going projects

Midlothian Council - Living Well After Treatment Project

NHS Borders & Borders Council - Reablement Project

This project aims to help people affected by cancer to live as independent a life as possible within their own community. It offers people a needs assessment carried out by an occupational therapist to find out how they can be helped to live independently and take control of their lives. Watch the project coordinator Angela talk about the project or watch 96-year-old John talk about how it changed his life.

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Dumfries & Galloway Council: Making Connections

This project aims to better support people with cancer, families and carers by helping them access community support and activities within their local area. It also aims to bring together health and social care to work together to get people the support they need.

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Lanarkshire Councils – Personal budgets

This project offers people who have finished cancer treatment control of a small budget that they can use to fund an activity or make a purchase that will make them feel better. The £250 budget is offered alongside three sessions of support where they talk through how they are feeling and agree on the best way to spend the money.

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NHS Lanarkshire – Cancer reviews in Primary Care: The role of practice nurses

This project involves practice nurses using the HNA and care plan to conduct Cancer Care Reviews. The aim is to empower patients to access the range of local support and self-management options available, while also proving the effectiveness of practice nurses conducting Cancer Care Reviews.

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East Dunbartonshire Council

This project is helping people with cancer who are finishing treatment by giving them an assessment of their needs and then directing them to community support services. The project is also expanding the Older People’s Access Line so that many of those affected by cancer can access further support.

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NHS Greater Glasgow & Clyde: Cognitive rehabilitation and support following cancer treatment

The project is raising awareness among patients and health professionals of some of the side effects cancer patients can experience because of their treatment, including issues with memory and attention. The aim is to make sure people who are experiencing these kinds of problems get the support they need. The project is also running cognitive rehabilitation courses for patients and carers to assist with concentration and memory problems.

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Renfrewshire Health and Social Care Partnership

The project offers people with cancer assessments of their needs and supports them to access community services.

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West Dunbartonshire Health and Social Care Partnership

This project is aiming to make it easier for people affected by cancer in West Dunbartonshire to access the support services they need. It is offering people HNAs and is looking at the current barriers to people accessing support services and how these can be overcome. The project is also encouraging better coordination between different support services across health and social care.

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NHS Tayside: Late Effects of Pelvic Radiotherapy

The project is offering HNAs to people who have received pelvic radiotherapy treatment to make sure they get the support they need within their community. It also aims to raise awareness of the effects and symptoms of this treatment.

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NHS Western Isles

This project offers people an HNA as their treatment comes to an end. They’re then supported to access the services and information they need.

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Scotland-wide - Reintegration After Cancer Treatment (ReACT) for Teenagers and Young Adults

This is a Scotland-wide project that aims to provide better care and support to young people with cancer aged 16-25 and experiencing cancer for the first time. Patients are offered an HNA and care plan and then supported to access the services they need. The aim is to help the young people become as independent as possible, while ensuring they know how to get information and support. The project also aims to raise awareness of the long-term impacts of cancer treatment, particularly on young people, among those working in primary care.

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