Tuesday 16th December 2014
Mac Voice, the magazine for Macmillan professionals: Winter 2014
Jackie Rowe describes the background behind developing an electronic tool for Holistic Needs Assessment (eHNA)
Background to developing the eHNA
There are currently two million people  in the UK living with and beyond cancer. This number is likely to double to four million by 2030 , reflecting an increasing incidence of cancer and better survival rates. The story about cancer is changing, and we need to recognise its long-term impact on people's lives, plan better services and develop more personalised care closer to home. The current system of follow up is not meeting people's needs, and will not cope if the number of people living with cancer increases at this rate.
The 2014 National Cancer Patient Experience Survey for England identified that only 22% of people with cancer received an assessment of their needs and a written care plan.  Feelings of isolation and loneliness are experienced by many people  and having an effective assessment and care plan helps to ensure that individual needs are identified and met. Macmillan and its partner organisations have a vision that everyone living with cancer should have a tailored care plan  which addresses their emotional, physical, spiritual, social and practical needs. To do this, we must make sure we are assessing people's needs throughout their cancer journey. Among clinical nurse specialists (CNSs), 90% believe a structured Holistic Needs Assessment (HNA) and care plan contributes to person-centred care, with almost identical proportions (89%) saying these measures address people's needs that would otherwise remain unknown. 
HNA and care planning can greatly improve the coordination of care and outcomes for people living with and beyond cancer. The assessment is not an end in itself; it is a means of ensuring that in the first place, a person's needs are identified so that care planning can provide a structured process to address those needs. 
The key components of HNA and care planning are:
- Self assessment using a structured HNA tool, delivered at key transition points of the care pathway.
- A conversation between the person with cancer and the clinician, to discuss the needs identified in the assessment and develop a plan of care.
- A simple care plan/action plan that is co-created by, and owned by, the person living with cancer.
- Referral or signposting to appropriate information or support services.
Introducing these components will support:
- A more systematic and proactive approach to aiding recovery, improving outcomes for people living with or beyond cancer and enabling them to live as near a normal life as possible.
- More emphasis on empowering people to manage their own care, by giving them the appropriate information and support.
- A shift in focus from a pathway that is essentially 'one size fits all' to a service that identifies people's individual needs, and which does this using an assessment process that proactively addresses those needs. This avoids unnecessary follow up appointments and unplanned admissions.
- A more integrated model of care through a better coordinated approach to shared documentation.
- Improved information-giving between secondary, primary and community care, and the person living with cancer.
Working with clinicians and people living with cancer, we are now testing a prototype of a new electronic Holistic Needs Assessment tool (eHNA) across the UK. During 2014, we have expanded the number of sites and hope to engage up to 65 sites by the end of the year.
Macmillan's approach to eHNA
Macmillan's electronic approach to assessment is simple but effective. It starts with people filling in a questionnaire about their concerns on a touch screen computer (a tablet).
The information is then sent to a secure care-planning website, where the issues affecting the person are ranked in order of priority. Using these results, health professionals develop the care plan with the person, and also review data to identify trends and local service development needs.
This innovative approach to care planning is user-friendly and makes it easier to give people personalised support. For health professionals, it immediately shows them what's concerning the person in front of them, as they will have an electronic record of their questionnaire and care plan. For people with cancer, it joins up their care, meaning they are not repeating themselves to different professionals at different times.
Macmillan is testing and evaluating the eHNA to record the quality of individual outcomes and the person-reported experience, and to calculate the cost of delivery.
This work links to three of Macmillan's Nine Outcomes, which are the things that people affected by cancer have told Macmillan matter most to them. The overall aim of the eHNA tool, as outlined above, supports the outcomes relating to:
- I understand, so I make good decisions.
- I get the treatment and care which are best for my cancer, and my life.
- I know what I can do to help myself and who else can help me.
1 Macmillan Cancer Support. Two Million Reasons. 2008. London.
2 Maddams J et al. Projections of cancer prevalence in the UK 2010 to 2040. British Journal of Cancer. 2012. 107: 1195-1202.
3 NHS England. National Cancer Patient Experience Survey 2014 National Report. September 2014.
4 Macmillan Cancer Support. Facing the fight alone. 2013. London.
5 Department of Health. Living with and beyond cancer: Taking action to improve outcomes. 2013. London.
6 Ipsos Mori. Evaluation of eHNA baseline report. 2013.
7 National Cancer Action Team. Holistic Needs Assessment for people with cancer: a practical guide for health care professionals. 2011. London.