Developing a NI Acute Oncology Service

Round Table Discussions

Liz HendersonAdvisor to Macmillan Cancer Support

Discussion agenda

• Take note of your concerns and claims about AOS in NI

• Identify the key issues/questions that emerge• Briefly explore these• Prioritise what is required

Claims

• What positive statements could you make about current acute oncology arrangements

2 minutes

Concerns

• What concerns do you have about current arrangements for acute oncology

4 minutes

SummaryCLAIMS• Patients are in the system and

being managed• Regional input and improved NS

management in AE’s• Collaboration & education in AE• Nurse led 24hr helpline

standardised with UKONS• Unit/centre patient pathways for

chemo complications• SHSCT AOS • Regional collaboration on MSCC• Funding approved for Oncologists

to support AOS• Offer of funding from Macmillan

for AOS nurses

CONCERNS• Current system inadequate

– no mechanism for CUP – no coordination for MSCC – palliative care pts admitted to assess, instead of

assess to admit – no coordination between departments and

oncology

• Patient safety risk• Patient poor experience • AE already swamped and demand

increasing • Gone as far as we can without

additional resource • Changing context increasing risk of

variation in standards• Lack of clarity around nursing role • Hub and spoke model means

haematologists feel ‘put upon’• Commitment and availability of all

oncologists

Issues emerging

• An issue is a reasonable question raised through better understanding of claims and concerns

Questions

1. What are the essential ingredients of AOS?2. What is stopping us from delivering an

effective AOS across NI?3. What would enable us to deliver an effective

AOS across NI?4. What are the key priorities to be addressed?5. What can be done to address these, and by

whom?

Common elements of all successful models• There are many individual models which can be

successful in a variety of different settings but essential core components include:

• Good leadership• Representation from all interested parties • A good relationship between Medical and Clinical

Oncology • Specialised advanced nurse role required in order

to run a successful service

Brian Haylock, Clatterbridge

What are the essential ingredients?

• AOS team with named lead and core membership

• Assessment• Agreed pathways • Good IT links and flagging

systems • Fast track clinics, • Referral protocols, • 24 hour triage line and on

call consultant service, • Regular morbidity &

mortality meetings and prospective data collection

• Coordination & communication• Cooperation & commitment

• WHAT MODELS?

NI Model (s)?• Regionally commissioned model

with local flexibility– Regional plan, recruitment, policies,

pathways, standards of car e -NI Measures / – Service Specification

• Team approach: AOS Nurses & AO Consultants ( Units 5 day oncologist present)– Hospitals with A&E but no cancer

services – access to AOS nurses as minimum

• Importance of data collection/ management

• IT enabled service / communication mechanism

• Initial focus 5 unit/centre

• Need continuity of care• Buy-in all parties• Involvement all stakeholders• Sustainability and resilience • Leadership present and visible in

hospital• Multidisciplinary – skills mix /

advanced roles nurses• Good communication with

primary consultant• Not 1 size fits all• Need be attractive posts

Questions

1. What are the essential ingredients of AOS to provide a safe and effective service?

2. What is stopping us from delivering an effective AOS across NI?

3. What would enable us to deliver an effective AOS across NI?

4. What are the key priorities to be addressed?5. What can be done to address these, and by

whom?

Questions

1. What are the essential ingredients of AOS to provide a safe and effective service?

2. What is stopping us from delivering an effective AOS across NI?

3. What would enable us to deliver an effective AOS across NI?

4. What are the key priorities to be addressed?5. What can be done to address these, and by

whom?

Questions

1. What are the essential ingredients of AOS?2. What is stopping us from delivering an

effective AOS across NI?3. What would enable us to deliver an effective

AOS across NI?4. What are the key priorities to be addressed?5. What can be done to address these, and by

whom?

Questions

1. What are the essential ingredients of AOS?2. What is stopping us from delivering an

effective AOS across NI?3. What would enable us to deliver an effective

AOS across NI?4. What are the key priorities to be addressed?5. What can be done to address these, and by

whom?