Rehabilitation Strategy

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1 Delivering the Supportive and Palliative Care Improving Outcomes Guidance (IOG) across the East Midlands Priority 8 Rehabilitation Services Rehabilitation Strategy East Midlands Cancer Network 2010

2 Document History Document Location This document is only valid on the day it was printed. The source of the document will be found at this location Revision History Date of this revision: August 2011 Date of next revision: August 2012 Revision date Previous revision date Summary of Changes First issue Changes marked Approvals This document requires the following approval. Name Title Date of Issue Leah Furner Macmillan AHP Lead. Chair EMCN Cancer November Rehabilitation Group 2011 Dr Chris Kenny Director of Public Health, NHS November Nottinghamshire County. Chair EMCN 2011 Board EMCN Cancer Rehabilitation Group members November 2011 Version V1 V1 V1 Distribution This document has been distributed to: Group Name Location Date of Issue Version Primary Care Trust East Midlands 01/11/ Acute Trust East Midlands 01/11/ General Practitioners East Midlands 01/11/ Lead Cancer Nurses East Midlands 01/11/ Allied Health Professional Leads East Midlands 01/11/ Voluntary Sector East Midlands 01/11/ Hospices East Midlands 01/11/ EMCN NSSG Boards East Midlands 01/11/ Lead Nurses in Community East Midlands 01/11/ Long Term Conditions Managers East Midlands 01/11/ Social Services East Midlands 01/11/ This list is not exhaustive as further dissemination will take place by the above groups

3 Contents 1. Introduction Cancer Rehabilitation National Work The Strategy The Implementation Plan Key Deliverables Summary References

4 Foreword This strategy outlines the East Midlands Cancer Network (EMCN) approach to the development of equitable and accessible patient focused rehabilitation services throughout East Midlands. It aims to provide a framework to ensure that all patients have their cancer rehabilitation needs assessed throughout their cancer journey, including living with and beyond cancer, and that appropriate cancer rehabilitation programmes are provided to meet their needs. It encompasses the development of the cancer rehabilitation workforce, in terms of numbers and skill level underpinned by the provision of appropriate education and training programmes to meet these needs, with services that are delivered in the most suitable location for the patient. This strategy has been written by Rachel Atkinson, Leah Furner and Rita Hopkin, Macmillan Allied Health Professional Leads, East Midlands Cancer Network in collaboration with members of the East Midlands Cancer Network Rehabilitation Executive Group. 4

5 The EMCN Rehabilitation Strategy aims to ensure that patients within the East Midlands have their rehabilitation needs assessed and addressed throughout their cancer journey, including living with and beyond cancer, and are able to access rehabilitation services when and where they need them. It aims to set out how the Rehabilitation workforce needs to be developed in terms of numbers and skill level, with relevant and accessible education and training programmes in place. 1. Introduction 1.1 Context Cancer and its treatment can have a major impact on a patient s ability to carry on with their usual daily activities and therefore the capacity for patients to care for themselves and to remain independent. Cancer rehabilitation attempts to maximise patients ability to function, promote their independence and help them to adapt to their condition. It offers a major route to improving their quality of life, no matter how long or short the timescale. It aims to maximise dignity and reduce the extent to which cancer interferes with an individual s physical, psychosocial and economic functioning (NICE 2004). Allied Health Professionals (AHPs) have a major role in cancer rehabilitation, which can be preventative, restorative, supportive and palliative. It is recognised that patients may have rehabilitation needs throughout their care pathway, including living with and beyond cancer, and that their needs should be assessed at key points on the pathway (National Cancer Peer Review Programme 2008). In this context rehabilitation will apply only to the services offered by the four AHPs Physiotherapy, Occupational Therapy (OT), Speech and Language Therapy (SLT) and Dietetics; but in addition, if a lymphoedema service is offered by personnel outside the above AHP groups, (usually by specially trained nurses) this separate service will also be included National Cancer Peer Review Programme (2008). The EMCN Rehabilitation Group has been set up to establish a network wide Cancer Rehabilitation Strategy to address the recommendations in the NICE Guidance on Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Manual for Cancer Services: Rehabilitation Measures (2008). The EMCN is responsible for cancer services to the East Midlands population covered by the three geographical areas of Derby-Burton, Leicestershire, Northamptonshire & Rutland, and Lincolnshire & Nottinghamshire. 1.2 Policy Drivers Cancer Reform Strategy (2007) World Class Commissioning (2007) National Cancer Survivorship Initiative Vision (2010) 5

6 NHS Operating Framework (2010/11) Improving Outcomes: A Strategy For Cancer (2011) 1.3 Influencers/Guidance NICE Guidance on Improving Supportive and Palliative Care for Adults with Cancer (2004) Manual for Cancer Services: Rehabilitation Measures (2008) End of Life Care Strategy (2008) Cancer Reform Strategy: Maintaining Momentum, Building for the Future - First Annual Report (2008) Cancer Reform Strategy: Achieving Local Implementation Second Annual Report (2009) National Cancer Action Team Cancer Rehabilitation Workforce Model (2011) 2. Cancer Rehabilitation National Work 2.1 The National Cancer and Palliative Care Rehabilitation Workforce Project In 2007, the Department of Health and the National Cancer Action Team jointly funded the National Cancer and Palliative Care Rehabilitation Workforce Project. The project set out to achieve several objectives and within two years, produced: A baseline mapping toolkit to to assist Cancer Networks to map those staff/posts working in specialist rehabilitation, at Levels 3 & 4, in cancer and palliative care services (NCAT 2009) An evidence base to support rehabilitation in cancer Nine tumour specific, evidence based rehabilitation care pathways Ten symptom specific pathways of care with defined therapy interventions A workforce model and information to support network cancer populations, and published guidance on Supporting and Improving Commissioning of Cancer Rehabilitation Services Further information can be accessed on the following website: 2.2 The National Cancer Rehabilitation Advisory Board (NCRAB) The National Cancer Action Team has set up NCRAB to ensure that by the end of 2011, the following broad objectives are achieved: A number of PCTs will have indicative rehabilitation outcomes specified within cancer commissioning Specific metrics for measuring rehab performance incorporated into the cancer commissioning toolkit There will be a reduction in variation of cancer rehabilitation services up and down the country 6

7 Networks will share approaches on rehabilitation commissioning; and The evidence gap or case or change around cancer rehabilitation will be filled 3. The Strategy 3.1 Strategic Aim To ensure that patients within the EMCN have their rehabilitation needs assessed throughout their cancer journey and receive an active and planned approach to cancer rehabilitation delivered by a suitably trained workforce of Allied Health Professionals and support staff. This workforce will be working in a multi-professional team, within a health, social care and voluntary sectors. This strategy will be implemented on three levels: 1. Personal - listening to people affected by cancer and improving the patient experience in line with the NICE Supportive and Palliative Care IOG. 2. Strategic - building on the East Midlands Cancer Network Supportive and Palliative Care Strategy by promoting the need for integrated cancer rehabilitation services. 3. Collective - improving cancer rehabilitation services locally ensuring that the workforce has the knowledge, skills and competencies required to meet the rehabilitation needs of people affected by cancer. 3.2 Strategic Objectives To agree a Network Lead for Cancer Rehabilitation To establish a Network Cancer Rehabilitation Group with agreed membership and terms of reference To undertake a baseline assessment of cancer rehabilitation services, including workforce and equipment, across the EMCN as a measure of current service provision To agree EMCN cancer site specific rehabilitation pathways in line with national work To develop a cancer rehabilitation service specification To develop a service needs assessment based on differences between the baseline assessment and service specification To develop a service development strategy to demonstrate how the Network will implement the service specification To develop a workforce, training and education strategy to support the service specification To provide a rehabilitation section for each locality's cancer services directory 7

8 4. The Implementation Plan The strategy will be managed and led by the EMCN Macmillan AHP Leads who are responsible for the implementation of a Cancer Rehabilitation Work Programme (Appendix 1) devised and agreed by the EMCN Rehabilitation Group and supported by the Network Nurse Director. 5. Key Deliverables Establish an East Midlands Cancer Rehabilitation Group with membership and terms of reference Establish an infrastructure of local Cancer Rehabilitation implementation groups with membership and terms of reference Review baseline mapping of rehabilitation workforce, including equipment provision, within EMCN Produce a contact directory for AHPs working in cancer across EMCN and within local Cancer Services Directories Ensure AHP representation at Network Site Specific Groups at an EMCN level Develop an East Midlands approach to implementation of site specific rehabilitation pathways Review the rehabilitation section of the East Midlands Holistic Needs Assessment Guidance Develop a Workforce, Education and Training strategy for AHPs working in cancer and palliative care across EMCN 6. Summary The strategy provides a framework to ensure that all patients have their cancer rehabilitation needs assessed, and are provided with an appropriate cancer rehabilitation programme to meet their needs. That the cancer rehabilitation workforce is developed in terms of numbers and skill level supported by education and training programmes to meet these needs and that the services are delivered in the most suitable location for the patient. 8

9 7. References Department of Health (2007) Cancer Reform Strategy Department of Health (2008) Cancer Reform Strategy: Maintaining Momentum, Building for the Future First Annual Report Department of Health (2009) Cancer Reform Strategy: Achieving Local Implementation second annual report Department of Health (2008) End of Life Care Strategy providing high quality care for all adults at the end of life Department of Health (2011) Improving outcomes: a strategy for cancer Department of Health, Macmillan and NHS Improvement (2010) National Cancer Survivorship Initiative: Vision Department of Health: Revision to the NHS Operating Framework for NHS in England (2010/11) Department of Health (2007) World Class Commissioning: Vision National Cancer Action Team (2011) Cancer Rehabilitation Workforce Model National Cancer Action Team (2008) Manual for Cancer Services Rehabilitation National Cancer Action Team (2010) National Cancer and Palliative Care Rehabilitation Workforce Project Project overview report National Cancer Action Team (2009) National Cancer Rehabilitation Baseline Mapping Toolkit and Guidance NICE (2004) Improving supportive and palliative care for adults with cancer: The Manual 9

10 Appendix 1 Work Programme Strategic Objective Performance Measure Timescale To agree a Network Lead for Cancer Rehabilitation Coordinated cancer rehabilitation services throughout EMCN Achieved To establish a Network Cancer Rehabilitation Group with agreed membership and terms of reference Robust clinical engagement throughout EMCN Achieved To undertake a baseline assessment of cancer rehabilitation services, including workforce and equipment, across the EMCN as a measure of current service provision Comprehensive Network understanding of the specialist cancer rehabilitation AHP workforce within EMCN Equipment Services mapping to be completed by end 2011 Workforce mapping to be reviewed by end 2012 To agree EMCN cancer site specific rehabilitation pathways in line with national work and to ensure that they are embedded within existing NSSG clinical care pathways All patients within EMCN have their cancer rehabilitation needs recognised and met throughout their pathway Address Haematology, Sarcoma and Skin Rehabilitation Pathway development by end 2012 Complete National Rehabilitation Pathways Scoping Exercise within EMCN by end 2012 To develop a cancer rehabilitation service specification A comprehensive profile of the cancer rehabilitation services and AHP workforce required to deliver the Network agreed cancer site specific rehabilitation pathways across East Midlands Use National Workforce model to obtain indicative workforce requirements for EMCN end 2011 Completion of EMCN Service Specification end 2012 To develop a service needs assessment based on differences between the baseline assessment and service specification Detailed information regarding unmet cancer rehabilitation needs within the EMCN population Completion of EMCN Service Specification 2011/12 Service needs 10

11 Strategic Objective Performance Measure Timescale assessment to be developed 2011/12 To develop a service development strategy to demonstrate how the Network will implement the service specification A clear action plan to address the required provision of AHP services to meet the cancer rehabilitation needs of the EMCN population Completion of EMCN Service Specification developed 2011/2012 Service needs assessment to be developed 2011/12 Service Development Strategy to be developed 2011/12 To develop a workforce, training and education strategy to support the service specification Adequate provision of training and education programmes for AHPs working in cancer and palliative care, and all AHPs working in cancer and palliative care accessing such programmes Rehabilitation section of the education website to be available 2011/12 AHP Training Needs Analysis to be distributed 2011/12 EMCN wide Cancer Rehab Educational Event planned for 2011 To provide a rehabilitation section for each locality's cancer services directory Availability and access to key contacts, and a summary of services offered by AHPs working in cancer and palliative care across EMCN Alternative nameless version to be published and uploaded to the EMCN website by end April 2011 Directory to be reviewed and updated by end

12 unlock better care East Midlands Cancer Network 2010

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