Personalised Care Programme
What does the Personalised Care Programme aim to do?
We believe that all residents in north east London living with cancer should have access to high quality care that is personalised to their individual needs. This is from the moment a cancer is diagnosed, all the way through to end of treatment and follow-up.
We work with our cancer clinical leaders, managers, patients and carers to create a ‘whole system’ model to improving quality of life though initiatives such as access to prehabilitation that optimised treatment and increasing access to psychosocial and psycho-oncology support. We ensure that at any time along their pathway, patients can discuss what matters to them.
Our aim is simple – to improve patient outcomes and experience whilst reducing variation for all people affected by cancer. Patients, carers and their families, remain at the very heart of all we do.
National priorities
We have a national mandate to ensure the following personalised care interventions are available for all cancer patients, and data is submitted to COSD for: Personalised Care and Support Planning (PCSP) based on Holistic Needs Assessment (HNA) and End of Treatment Summary (EOTS).
Once through treatment, we are to ensure all patients are offered a fully operational and sustainable PSFU pathways for all suitable patients in breast, prostate, colorectal and endometrial cancer. These pathways are to be underpinned by a remote monitoring system to track patients through follow-up.
Local priorities
The physical impact of cancer has a huge impact on our patients before, during and after treatment. We identified a gap in the provision of exercise-based services. Through a collaboration of service provider, we have set up prehabilitation services across North East London that has shown great results in optimising patients to be ready for cancer treatment, reducing length of stays in hospital and improving the consequences of treatment.
We are investing in our Psychosocial Development Plan to increase the psycho-oncology level 3/4 workforce across the system. This will enable all Clinical Nurse Specialists across north east London to have access to Level 2 supervision groups and increase the clinical capacity within the existing psycho-oncology services to account for anticipated increased psycho-oncology referrals and current inequities in access across tumour pathways.
How do we work?
The Personalised Care Programme focusses on the patient journey right from diagnosis through to treatment and follow-up support.
Find out more about our team and how we work to achieves both national and local priorities.
Key achievements
Prehab services set up
Prehabilitation services are available to all patients across north east London. 260 patients have received prehabilitative interventions and a number of patients have ultimately become fit for treatment with improvements in cardiorespiratory fitness levels.
Cancer Clinical Nurse Awareness Day
On 29 June 2023, North East London hosted a special cancer clinical nurse specialist conference, to recognise the great work of our cancer CNS staff and all they do to support patients with cancer.
Input from our patient and carer group
Our patient and carer group – Patient and Carer Voice in Cancer (PCVC) – has been working hard to make sure that the patient and carer voice is head across all our cancer projects.
You can read about a small selection of some of the things they have been working on to support all residents and patients across north east London.
Remote Monitoring System for patients
All three trusts have procured, upgraded and installed the required Somerset Remote Monitoring System. Barts Health has operationalised RMS and has gone live for colorectal and prostate patients. Barking, Havering and Redbridge University Trust, and Homerton Healthcare have also gone live with breast, prostate and colorectal.
Personalised Care projects
Our team is working on a wide-range of innovative projects which are helping us to deliver against both national and local priorities, which will lead to better cancer services for patients.
