Tuesday 24th June 2014
Mac Voice, the magazine for Macmillan professionals: Summer 2014
Jackie Rowe, Recovery Package Programme Manager, describes what the Recovery Package is and explains its background.
The Recovery Package is a series of key interventions which, when delivered together, can greatly improve outcomes for people living with and beyond cancer.
The video below gives a good introduction to the Recovery Package.
The Recovery Package is central to Macmillan’s objective of achieving its nine outcomes:
Background to the Recovery Package
There are over two million people with cancer in the UK, and this is projected to increase to four million by 2030. Research shows that one in three cancer survivors experience moderate to severe unmet needs at the end of treatment, and for 60% of people, these needs have not improved six months after treatment. These findings are supported by subsequent National Patient Reported Outcome Measures (PROMs), which have found that people with cancer experience persistent long-term problems.
The PROMs survey also identified that if a person has one or more long-term conditions other than cancer, they are likely to have poorer quality of life scores. Even those with no other long-term conditions had poorer quality of life scores when compared to the general population.
Although more people are being diagnosed with cancer in the UK, more people are surviving a cancer diagnosis due to earlier detection and improved treatments. Cancer is moving from a disease where mortality was often the norm to one where more people can expect to live healthy and active lives for many years once their treatment is over. However, this also presents health and care services with the challenge of delivering sustainable healthcare to this group.
The increase in cancer prevalence and the evidence of unmet needs will require a transformation in the way that the NHS cares for people affected by cancer. This will mean moving away from the emphasis on acute and episodic care towards a holistic, personalised approach that is well coordinated and integrated. It also means moving away from using a single disease framework to a multiple disease framework.
The National Cancer Survivorship Initiative (NCSI) was set up in 2008 to address these challenges. Its aim is to: 'ensure that those living with and beyond cancer get the care and support they need to lead as healthy and active a life as possible, for as long as possible.'
The NCSI has developed and tested a number of key interventions, together called the Recovery Package. Its report Living with and beyond cancer: taking action to improve outcomes emphasises the importance of the Recovery Package in achieving better outcomes. It highlights that people will have greater well-being, and their demand for services will be lower, if they get the support that is relevant to their particular needs, and which promotes healthier lifestyles and independence.
Sandra Rowlands, Change Project Manager, Recovery Package, explains the interventions that make up the Recovery Package
The Recovery Package is made up of the following elements:
- A Holistic Needs Assessment (HNA) and care planning at key points of the care pathway.
- A Treatment Summary completed at the end of each acute treatment phase and sent to the patient and GP.
- A Cancer Care Review completed by the GP or practice nurse to discuss the person’s needs. The review should happen within six months of the GP practice being notified that the person has a cancer diagnosis, but this should be the start of an ongoing conversation required across the cancer care pathway.
- An education and support event, such as Health and Wellbeing Clinics, to prepare the person for the transition to supported self-management. The event should include advice on relevant consequences of treatment, recognition of issues and who to contact. They should also provide information and support on work and finance, healthy lifestyle and physical activity.
The Recovery Package also complements the introduction of stratified care pathways. This enables individualised follow-up care either through a supported self-management approach, with rapid access back into the specialist team should this be needed, or continued face-to-face follow up with health care professionals.
Introducing the key elements of the Recovery Package will support:
- A more systematic and proactive approach to cancer care and rehabilitation to aid recovery. This will improve outcomes for cancer survivors, reduce inappropriate use of hospitals and enable people to live a healthy and active life.
- More emphasis on empowering people to manage their own care by giving them the appropriate information and support to do so.
- A shift in focus from a standard 'one size fits all' approach to one where follow-up care is truly patient-centred and where clinical, psychosocial and practical needs are assessed and managed effectively. This proactive approach will help improve patient experience, avoid unnecessary appointments and avoid unplanned admissions. Achieving this balance between quality and cost is a key consideration for both commissioners and providers.
- A more integrated model of care, through a better coordinated approach to shared documentation and improved information-giving between secondary, primary and community care and the person with cancer.
Continue reading this issue of Sharing good practice
Evaluating the Recovery Package
Evidence base for the Recovery Package
Contact Jackie Rowe, Sandra Rowlands or Noeline Young.
1 Macmillan Cancer Support estimates of prevalence at the end of 2012 and 2030 by nation in the UK, estimated using prevalence rates from Maddams J, Utley M and Møller H. Projections of cancer prevalence in the United Kingdom, 2010–2040. British Journal of Cancer. 2012. 107:1195–1202.
2 Armes J, Crowe M et al. Patients’ Supportive care needs beyond the end of cancer treatment: A perspective, Longitudinal survey. Journal of Clinical Oncology. 2009. 27(36):6172–6179
3 Glaser A, Fraser L et al. (2013) Patient Reported Outcomes of cancer survivors in England 1-5 years after diagnosis: a cross sectional survey. BMJ Open. 2013. 3:(4) e002317. Published online April 12 doi: 10.1136/bmjopen-2021-002317
4 National Cancer Survivorship Initiative. Living with and beyond cancer: taking action to improve outcomes. 2013. Department of Health.
5 NHS Improvement. Stratified pathways of care... from concept to innovation. Executive Summary. 2012.
6 NHS Improvement. From Concept to Innovation. 2012.