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ESSEX CANCER NETWORK

NETWORK REHABILITATION BOARD

CONSTITUTION Date: June 2011

Review date: June 2012

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Title: Network Rehabilitation/AHP Board Constitution Authors: Members of the Network Rehabilitation/AHP Board Document Owner: Essex Cancer Network Swift House Hedgerows Business Park Chelmsford Essex CM2 5PF

Agreement Cover Sheet

The Rehabilitation/AHP Board Constitution has been agreed by:

Position Macmillan AHP Lead; Chair of Rehabilitation Board

Name Kate Patience

Organisation Essex Cancer Network

Signed

Date Agreed 11th August 2011

Position Chair of Essex Cancer Network Board

Name Sheila Bremner Organisation NHS

Signed

Date Agreed 19th July 2011

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TABLE OF CONTENTS

1. CURRENT AGREED MEMBERSHIP OF THE REHABILITATION BOARD P4

2.THE NETWORK CANCER REHABILITATION LEAD P5

3. ROLE AND FUNCTION OF THE REHABILITATION/AHP BOARD P5

4. TERMS OF REFERENCE P8

5. FREQUENCY OF MEETINGS P9

6. AHP FORUM (EPCAF) P9

7. NETWORK CONFIGURATION (Baseline mapping) P10

8. CANCER REHABILITATION PATHWAYS P20

9. SERVICE DEVELOPMENT (Including rehabilitation Strategy) P21

10. TRAINING & EDUCATION STRATEGY P22

Appendix 1 Role outline: Network Lead AHP P24

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1. MEMBERSHIP OF THE NETWORK REHABILITATION BOARD

Region AHP Group Core member Sector Extended member

Sector

Macmillan AHP Lead Kate Patience

Nurse Director Carol O’Leary

Essex Cancer

Network User Representative Nazira Vizram

Ian Steele

Speech & Language Therapist

Jo Sirkett Acute Hilary Armstrong PCT

Dietician Judy Molyneux Acute Lisa Oakey Acute

Physiotherapist Lisa Curtis Acute Nikki Tuff

Ann Stock

Vol

Vol

Occupational Therapist

Helen Peter Pippa Quinn

Anne Roberts

Vol Vol

Vol

Mid Essex

Lymphoedema Lorna Ellis Vol

Speech & Language

Therapist

Ruth Myers ACE

Dietician Theresa Cole Acute

Physiotherapist Kathryn Smith

Kimberley Rice

Acute

Vol

Amy Eade

Archie Kaul-Mead

Acute

Acute

Occupational

Therapist

Sarah Marsden Acute Joanne Field

Tracey Williams-Macklin

Acute

North

East Essex

Lymphoedema Sara Percival Vol/PCT

Speech & Language Therapist

Laura Dawson Acute

Dietician Anne Berry Acute Rebecca Davies Acute

Physiotherapist Jenny Gates Acute

Occupational

Therapist

Beverley Kemp

Kerry Lockhart

Acute

PCT

Lauren Rule PCT

South East

Essex

Lymphoedema Debbie Sevant PCT

Speech & Language

Therapist

Miriam Mitchell PCT

Dietician -

Physiotherapist Sue Webb Acute Jan Cooil Acute

Occupational Therapist

Natasha York Matt Goddard

Edwina Moore

Acute PCT

PCT

South

West Essex

Lymphoedema Debbie Sevant PCT

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2. THE CANCER REHABILITATION LEAD (Peer Review measure 11-1A-301v) The single named lead for cancer rehabilitation for the network is the Essex Cancer Network Macmillan Allied Health Professional (AHP) Lead Katrina (Kate) Patience, a Chartered Physiotherapist, HPC registration number PH59718 (expiry date March 2012). The Essex Cancer Network (ECN) post of Macmillan AHP Lead was recruited to in June 2010. The post is 0.6 whole time equivalent (wte) and is a 24 month project post initially. As the Cancer Rehabilitation Lead, the Macmillan AHP Lead chairs the Rehabilitation Board. The Chair is also a member of the Palliative and End of Life Care Cross Cutting Group, the Survivorship Group, the Acute Oncology Service group and the Education and Training Forum as part of this role. The outline of the role and the annual work plan is attached as Appendix 1. The work plan for the AHP Lead is agreed by the Nurse Director of the ECN. 3. ROLE AND FUNCTION OF THE REHABILITATION BOARD (Peer Review measure 11-1A-301v) 3.1 Purpose of the Rehabilitation Board The Rehabilitation Board is the executive body and is recognised as the network primary source of opinion on issues relating to cancer rehabilitation and for co-ordination and consistency across the Network on such issues. It agrees the work plan and sets the priorities for Cancer Rehabilitation for the Network. The Rehabilitation Board actively supports the overall aims of the Essex Cancer Network, which are:

• To minimise the incidence of cancer and reduce overall mortality of cancer • To provide high quality patient focused treatment and care at all stages of the

cancer journey

• To provide high quality specialist cancer care within Essex wherever possible

The Rehabilitation Board strives to provide a uniformly high standard of care across the network for patients throughout the cancer journey, and endorses key recommendations from Improving Outcomes for Cancer (2011), The Manual for Cancer Services (2008), the End of Life Care Strategy (2008) and site specific Improving Outcomes Guidance (IOG), e.g. Head & Neck. Chapter 10 of the IOG for Supportive and Palliative Care (2004) gives objectives and recommendations specifically for Rehabilitation, and these are addressed by the Peer Review Rehabilitation Measures. The Rehabilitation Board will also be involved with the strategic objectives of the ECN to reduce length of stay and emergency admissions to hospital by ensuring early intervention in the community for admission avoidance, and ensuring that hospital discharges are timely and effective. There will also be good community links formed for effective rehabilitation in the community after discharge. The Rehabilitation Board will also ensure best clinical practice through links with specialist AHP’s across the Network, through the Essex AHPs in Palliative Care Forum

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(see section 6) and by AHP representation with the Network Site Specific Groups (NSSGs), Cross Cutting Groups and local MDTs. The AHP Lead is also involved with the National Cancer Network AHP Lead Forum, forming a national network to develop rehabilitation initiatives. The Rehabilitation Board is the primary source of clinical advice to the ECN Board on all matters relating to cancer rehabilitation. It has the corporate responsibility delegated by the ECN Board for enabling the application, co-ordination and consistency of policy and practice guidelines, audit, research and service improvement relating to Cancer Rehabilitation. 3.2 Membership (Peer Review measure 11-1A-301v) The Rehabilitation Board membership includes Therapy/Service Managers and Lead specialist therapists and representatives from constituent organisations of the ECN. This includes representation from the four focal AHP’s (Occupational Therapy, Physiotherapy, Speech and Language Therapy and Dietetics) plus lymphoedema practitioners. The core members are:

• Lead AHP (Chair)

• Therapy/Rehabilitation Managers representing Cancer Centres Southend University Hospital NHS Foundation Trust and Colchester University Hospital NHS Foundation Trust)

• Acute Trust Lead AHP representation

• PCT/Community Service Therapy Manager representation

• Voluntary Sector Therapy/Rehab manager

• Voluntary Sector Lead AHP representation

• Lymphoedema service representation

• ECN Nurse Director

• NSSG AHP representatives

• 2 User Representatives

Attendance at individual meetings is not limited to the agreed membership and other individuals may be invited at the Chair’s discretion. The Rehabilitation Board has secretarial/administrative support from Tara Large, Network Administration Assistant. 3.3 Chair The chair is the responsibility of the ECN AHP Lead as defined in the Rehabilitation Quality Measures. The Chair will have an annual review with the ECN Nurse Director to discuss the Board’s progress over the previous year and set the work plan for the coming year. The Chair must ensure that there is adequate representation at the Board from each group of members and ensure their involvement as appropriate. 3.4 Administrative support Administrative support to the Rehabilitation Board is currently provided by Tara Large, Network Administration Assistant who will advise members of meeting dates and will

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draft and disseminate the minutes no more than three weeks following the meeting. Other support may be required between meetings. 3.5 User involvement At present, there are two user representatives on the Rehabilitation Board. The Chair is the Board member nominated as having specific responsibility for users’ issues and information for patients. Users will be encouraged to provide feedback on local Rehabilitation Services to influence changes to current services. This will take place via regular and frequent patient and carer satisfaction surveys across all Cancer Rehabilitation services across the network. In the event that user representation is not available, the policy below will be followed to ensure users views are considered in the work of the Rehabilitation Board. Policy for User Involvement on the Network Site Specific and Cross Cutting

Groups

Interim Arrangements when User Representation is Unavailable Section 242 of the National Health Service Act 2006, as implemented by Section 233 of Local Government and Public Involvement in Health Act 2007, places a duty on Strategic Health Authorities, Primary Care Trusts, NHS Trusts and Foundation Trusts to involve and consult patients and the public in service planning, operation of services and the development of changes to services. This is a statutory duty, which requires consulting and involving as follows:

• Not just when a major change is proposed but in ongoing service planning • Not just in the consideration of a proposal, but in the development of that

proposal

• In decisions about general service delivery, and not just major changes. Peer Review Measures for the Rehabilitation Board specify that alternative arrangements must be put in place to ensure user involvement in the group where the Network is unable to establish representation. The Essex Cancer Network agreed Policy is as follows:

1. The Network Partnership Chair and the User Facilitator will be included on the circulation list for all papers relating to Rehabilitation Board meetings.

2. The User Facilitator and Partnership Chair will review the papers and identify any issues requiring user input.

3. One week prior to the meeting the Rehabilitation Board member with responsibility for user issues will contact the User Facilitator to discuss any user issues identified and the user response.

4. The Rehabilitation Board member will represent the user views at the meeting and report back to the User Facilitator within two weeks of the meeting.

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5. If an issue has been identified as substantive or critical to patient care, the Partnership Chair and/or User Facilitator will attend the Rehabilitation Board meeting to discuss.

It should be noted that these arrangements are seen as a temporary solution and not as an alternative to user representation at a Rehabilitation Board meeting. 3.6 Accountability and Communication Channels: The Essex Cancer Network Rehabilitation Board will be accountable to the Essex Cancer Network Board. Regular updates regarding progress with the delivery of the Network Rehabilitation Strategy will be provided by the Network Lead AHP to this group via the Nurse Director. Minutes of the Rehabilitation Steering Board meetings will be made available to all AHPs working in cancer rehabilitation posts within Essex Cancer Network for information and comment. The meeting minutes will also be forwarded to Essex Cancer Network User Partnership Group. The Network Lead AHP will be responsible for addressing any queries or concerns regarding the issues discussed with either the User Partnership Group chair, or the Partnership Group as a whole. 4. TERMS OF REFERENCE (Peer Review measure 11-1A-301v) The core functions of the Essex Network Rehabilitation Board are: o To act as the Network’s primary source of opinion on issues relating to cancer

rehabilitation and for coordination and consistency across the network on such issues.

o To develop and agree a Rehabilitation Development Strategy (based on the 4 level model of cancer rehabilitation) which supports the development of best practice and promotes equity and consistency in the provision of rehabilitation across the Essex Cancer Network utilising the National Cancer Action Team Rehabilitation Pathways.

o To develop and agree a Rehabilitation Service Specification (based on Network needs assessment) in order to assist in service and workforce planning.

o To support local and regional action plans in order to aid the implementation of the Essex Network Rehabilitation Development Strategy and Service Specification.

o To assist the development and maintenance of a rehabilitation section within each locality’s Cancer Service Directory which comprehensively outlines points of access for relevant rehabilitation services at different stages of the cancer journey.

o To promote effective communication and practice sharing among health professionals working in cancer rehabilitation across professions, sectors and settings.

o To develop a network wide Rehabilitation Assessment Tool to enable patients to be assessed for and offered timely access to rehabilitation at key points in the cancer journey.

o To develop and agree a Network Education Strategy which promotes the development of relevant knowledge and learning for all including core competencies for each level of the 4 level model.

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o To assist in the development and dissemination of key research and audit relating to the role of AHPs in cancer care.

o To develop an Annual Report outlining activity of the previous 12 months Further Terms: o Agenda items will be sent to the chair at least one week prior to the meeting. o If members are unable to attend apologies will be sent to the chair in advance of

the meeting with comments included on the agenda. Core members should be named and a named person nominated to attend in their absence.

o Minutes of the meeting will be made available to the Nurse Director within the Essex Cancer Network (and to other interested parties as relevant).

o Terms of reference to be reviewed in June 2012.

5. FREQUENCY OF MEETINGS The Rehabilitation Board will meet six times a year. Additional extraordinary meetings may be organised at the Chair’s discretion should the need arise. The location may be rotated at the request of the Board members otherwise it will be held in a central location (Chelmsford). The location is currently being rotated to attempt to improve attendance. This arrangement will be reviewed when meeting dates for 2010 are set. 6. AHP Forum (EPCAF) In addition there is an Essex Palliative Care AHP Forum (EPCAF, formerly EPCOT) which supports the work of the Rehabilitation Board and also acts as a forum for information sharing, discussion and peer support. The APCAF will support and work with the Macmillan AHP Lead and Rehabilitation Board in the following: • Raising the profile of AHPs in cancer care across ECN

• Providing expert AHP advice to ECN particularly through involvement in

1. NSSG workplans, clinical pathways/protocols

2. Implementation of NICE Supportive & Palliative Care Guidance, End of

Life Care Strategy and Cancer Reform Strategy/ Improving Outcomes for

Cancer

3. Workforce mapping and development

• Developing effective collaborative communication strategies across local, regional

and national sectors and networks

• Delivering the training needs of AHPs in cancer and palliative care using the 4

level model of Cancer Rehabilitation as per the Training and Education Strategy

• Work with the Network AHP Lead and Network Rehab Steering Group to

implement a Network wide Rehabilitation Strategy

The Forum is open to all AHPs within the ECN, but will have a core representational membership of at least one AHP from each of the cancer rehabilitation service

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providers within the ECN and each of the four key disciplines (i.e. Dietetics, Speech & Language Therapy, Physiotherapy and Occupational Therapy). The Forum will feed into the ECN Rehabilitation Board via the AHP Lead. 7. NETWORK CONFIGURATION - Baseline mapping of current service provision (Peer Review measure 11-1E-101v)

Specialist Cancer Rehabilitation posts (Speech and Language Therapists, Physiotherapists, Dietetics, Occupational Therapists and Lymphoedema Practitioners) across Essex have been mapped as part of the Peer Review measures and in accordance with the National Cancer Action Team Workforce Project audit tool. This mapping was completed in August 2010 following recruitment into the AHP Lead post. The results of the mapping will be presented for discussion at the Commissioning Directors Forum on 26th August 2010 and the Supportive and Palliative Care Cross Cutting Group on the 11th November 2010. The Essex Cancer Network serves a population of 1.42 million people, with an expected increase of 1% by 2012 which will increase the population to 1.48 million. The population in Essex (especially North east and South East) has been found to comprise of a higher than average number of elderly people, which will impact on cancer incidences. The Essex Cancer Network has four acute trusts:

• Basildon and Thurrock University Hospital University NHS Trust • Southend Hospital University NHS Foundation Trust • Colchester Hospital University NHS Foundation Trust • Mid Essex Hospitals Trust

The Essex Cancer Network has four Primary Care Trusts:

• NHS South West Essex PCT • NHS South East Essex PCT • NHS North East Essex PCT • NHS Mid Essex PCT

Within Essex Cancer Network there are four adult hospices:

• St. Luke’s Hospice, Basildon

• Fair Haven Hospice, Southend • St. Helena Hospice, Colchester • Farleigh Hospice, Chelmsford

In addition there is the Helen Rollason Centre in Chelmsford which provides lymphoedema services. The organisational workforce template below (part of the NCAT baseline mapping tool) illustrates the presence or absence of specialist services in provider services across the network. As the therapy teams within MEHT and St Andrews work as separate teams and are under separate management, these teams have been looked at individually for the mapping process purposes.

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The apparent gaps in services are covered by other agencies, e.g. Farleigh Hospice will refer patients requiring Speech and Language Therapy or Dietetic input to the MEHT services, and therefore there is a visual but not an actual gap in services. As can be seen, there are level 4 practitioners in many areas to give training and support to team members. This will be looked at in more detail within the Training and Education Strategy. The Hospices in South Essex utilise the Macmillan Teams within the local PCT or acute rehabilitation services and do not employ any therapy staff, with the exception on 4 hours of Physiotherapy input at St, Luke’s Hospice. The details of the mapping report indicate that based on the population size of 1.42 million served by the Essex Cancer Network the total WTE of specialist Cancer Rehabilitation posts is marginally below the National Average. The total number of posts was found to be 29.5 which translates to 20.77 per million population, the national average being 21.53 per million. Total posts per AHP group, per million population can be seen in the graph below.

Essex Cancer Network Baseline Mapping

NHS Dietetics SaLT Physio OT Lymphoedema

MEHT

St Andrews Unit

CHUFT

SHUFT

BTUHFT

NHS Mid/Central Essex

NHS North East Essex

NHS South East Essex

NHS South West Essex

Voluntary/Charity

Farleigh Hospice

St. Helena Hospice

Fair Haven Hospice

St. Luke's Hospice

Helen Rollason Centre

North Essex Lymphoedema Service

Level 4 Clinician in post Level 3 Clinician in post General/Rotational Clinician in post No service

12

0

1

2

3

4

5

6

7

8

9

Diet SaLT OT PT Lymph

National average

ECN

The audit illustrates a lower than average number of Specialist Dieticians (3.5WTE) and Physiotherapists (5.3 WTE) working within oncology and palliative care in the Essex region. Although there are posts in existence the audit shows that Basildon and Colchester have a very limited Specialist Dietetic Service with the posts here being generalist or rotational, meaning they are not included within the specialist category. Numbers of Occupational Therapists (11.6 WTE) are higher than the national average, as seen in the above graph. Numbers of Speech and Language Therapists (4.3 WTE) and Lymphoedema practitioners (4.8) are roughly as the National Average. Specialist Speech and Language Therapists are most highly represented within Mid Essex Hospitals Trust and Southend University Hospital Foundation Trust. It should be noted, however, that the Speech and Language Therapy posts at Southend Hospital are currently covered by locums, as is one post (o.8 wte) at MEHT. A lot of effort has been focussed on the Lymphoedema Services within the past few years which has lead to a good number of Lymphoedema practitioners across the region, with 3 centres offering Lymphoedema services in North and Mid Essex, and South Essex having a service from Basildon PCT/Macmillan team. Physiotherapy As illustrated in the graph the numbers of Specialist Physiotherapist posts are relatively low compared to the national average. Within North Essex there is 0.57 WTE of Band 6 cover at Essex County Hospital, but this is currently a rotational post and therefore cannot be considered specialist. There is an additional 0.2 WTE of Band 7 hours working within the Out-patient department, dealing with general oncology and haematology patients. The hospice has a relatively large number of Physiotherapists compared to South Essex Hospices, having a 6 day service currently running. There are currently no specialist community physiotherapy services available from the acute trust or PCT for physiotherapy in the community, but patients are able to access specialist input if referred to the hospice – patients must be under the care of the hospice as a whole and are not able to be referred directly to physiotherapy. At Mid Essex Hospital Trust the oncology ward is currently covered by 0.5 WTE of a Band 7 who also covers medical wards. This team is currently undergoing a

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restructuring process due to new building works, and this post is subject to change. St Andrews Burns and Plastics unit has 1.5 WTE Specialist Physiotherapists working with Head and Neck and Breast Reconstruction patients as part of their caseload. As these two units work as separate teams they have been considered separately during this mapping process. Again, the number of Physiotherapists within the hospice (1.5WTE) is relatively higher than in South Essex and community patients can access this service. There are no other specialist community physiotherapy services available within Mid Essex. Basildon and Thurrock University Hospital Trust has a limited physiotherapy service on Orsett Ward and has a contract with St Luke’s Hospice for 4 hours per week to cover the in-patient unit and day hospice. Until recently this was the role of the medical Band 7 Physiotherapist who had a special interest in Oncology and Palliative Care. While this Physiotherapist has been on Maternity Leave, however, the services have been split and the ward is covered by a rotational respiratory Band 5, while the hospice is covered by a rotational band 6. For this reason the results of the mapping process show that there is no specialist service available at BTUHT. The Physiotherapy team are currently employed by South West Essex PCT but are to be transferred to Basildon Hospital Acute Trust in November following the merger of SWE PCT with North East London PCT. All community rehabilitation services have generalist posts which mean that there is no specialist physiotherapy available for oncology and palliative care patients in the satellite hospitals or the community. Southend Hospital has a rotational Band 5 (0.75WTE) covering the oncology and palliative care ward with no other specialist posts within the acute trust. Fair Haven Hospice has no funded Physiotherapy posts but access Physiotherapy services via the PCT. Occupational Therapy The number of specialist Occupational Therapy (OT) posts appears to be higher than the national average within the Essex Cancer Network. It must be taken into consideration, however, that the majority of the OT workforce are working within palliative care, not specifically oncology. This is especially evident in Mid Essex, where many of the patients with neurological diagnoses are seen by the hospice team as there is no designated Neuro-rehabilitation within this area. An audit is to be carried out within hospice teams to determine the percentage of the caseload that is specifically oncology related, and in future mapping exercises this data will reflect oncology caseloads. The OT team within CHUFT cover both Essex County Hospital and St. Helena Hospice, as the funding for all of these posts is from the acute sector. The Essex County Hospital has 1WTE but this is a Band 6 rotational post at present and is again not considered to be specialist. This person does however work very closely with the OT’s at the Hospice and gets a lot of specialist training. The Hospice OT’s work within the community for patients referred via the ECH OT department. The PCT has no specialist OT input. Mid Essex Hospital Trust currently has 0.5 WTE of a static Band 6 working on the oncology ward, supported by 0.3 WTE Band 7. This is subject to change with the reorganisation of ward this autumn. The hospice has a team of 1.6 WTE OT’s covering the inpatient unit and community patients. This team link very strongly with the hospital OT team. Basildon Hospital has 1 wte OT working on the palliative care ward, currently funded by the PCT but due to be transferred to Basildon Acute Trust in November. This is a secondment post but the secondment period has been extended from 6 months to just over 2 years, with no indication at present as to pick up for the funding after this

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time. There is a community Macmillan team with 2 WTE Macmillan Funded OT’s (band 6 & 7) who cover the community and St Luke’s Hospice. There are currently good links between the acute and community teams. Southend Hospital has 1 WTE Specialist OT working on the oncology & palliative care ward. There is a large community team dealing with Long Term Conditions and palliative care consisting of 6 OT’s ranging from band 5-7. This team also takes referrals for patients at Fair Haven Hospice. Speech and Language Therapy There is currently no dedicated oncology or palliative care Speech and Language Therapy service within North Essex. Patients are referred from the acute and community sector to the Speech and Language Department and prioritised accordingly. Within Mid Essex there are 1.8 WTE Specialist Speech and Language Therapists mainly treating patients with head and neck cancer, as St Andrews is the specialist centre within Essex for this type of surgery. This team covers both acute and community patients, and also takes referrals from Farleigh Hospice when required. There is currently a Band 8 vacancy (0.8 WTE) which is being covered by a Band 7 locum (1 WTE) The oncology ward is covered by rotational staff. Basildon and Thurrock has 0.5 WTE Speech and Language Therapy posts funded for oncology and palliative care. Orsett Ward is covered by rotational staff. St Luke’s hospice refer to the hospital team when required. Southend Hospital currently has 2 WTE Speech and Language Therapy posts, one working with Head and Neck patients, the other working with upper GI cancer. These posts cover acute and some community work as there are no specialist oncology services within the local community team. Both of these posts are currently filled by senior locums. Fair Haven Hospice refers to the community team. Dietetics CHUFT currently has a rotational band 6 in post at Essex County Hospital with 0.2 WTE of specialist Head and Neck input from a Band 7. There is a community Dietetics team which has general staff. Patients from the hospice are referred to the hospital team. Mid Essex has approximately 1.5 WTE staff working with oncology patients, particularly within St Andrews unit. This team covers the acute and community work, including patients from the hospice. Basildon currently has a team employed by the PCT that cover the oncology caseload but there is no specialist oncology service and the patients are therefore seen by general staff. This team also cover community head and neck patients within the Southend area while they are on enteral feeding. The Palliative care ward is covered by a rotational Band 5. There is currently no funding for the haematology day unit but patients are seen on an as and when basis. Southend Hospital has 1.8 WTE for oncology services with 0.8 band 7 treating head and neck patients and 1 wte band 6 treating upper GI, lung and gynae patients. The palliative care ward is covered by a rotational post. There is currently a community team but they have no specialist Oncology posts. Lymphoedema North Essex has a reduced capacity at present due to vacancies but there is 1 WTE lymphoedema practitioner providing a service for secondary cancer. This service is currently hosted by St Helena Hospice.

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Mid Essex has 0.8 WTE within the PCT based at St. Peter’s, Maldon and 1WTE working from the Helen Rollason Centre. South Essex have 2 WTE nurses working within the team which is part Macmillan funded and PCT funded and cover Basildon and Southend regions. This includes 0.4 WTE service level agreement with St Luke’s Hospice.

3.8, 13%

0.3, 1%

0.75, 3%

0.3, 1%

1.4, 5%

0.4, 1%

6.15, 21%

16.4, 55%

General

Gynae

Breast

Lung

UpperGI

Colorectal

H&N

Pall Care

16

0

1

2

3

4

5

6

Acute PCT Voluntary

Dietetics

SaLT

OT

Physio

Lymph

As can be seen from the above graph, most of the funding for specialist posts is from the Acute sector, followed by the PCT’s and charitable/voluntary sector respectively. None of the Lymphoedema services are funded by the acute Trusts. Although Dietetic services are available in the community, it would appear that all specialist services are funded by acute trusts. There is also a lack of specialist physiotherapy within the community sector – this may be due to the fact that the hospices in North and Mid Essex cover many of the oncology patients in the community. This is not the case in South Essex, however, which demonstrates a particular gap within the service. The data that has been collected from this mapping exercise suggests that there are gaps within speciality roles which may be having an impact on patient care, as in some areas patients have access to specialist services while in others the same client group has input from rotational or generalist staff. The results of this mapping exercise will be inputted into to the Workforce Tool that has been developed by NCAT to determine whether there are workforce gaps that require development. The NCAT Rehabilitation Pathways have been designed to provide a Gold Standard of Cancer Rehabilitation. These pathways will be audited to compare current service provision against these pathways and this information, combined with the Workforce Tool will be the basis for the Service Needs Assessment and subsequent Service Development Strategy for the Rehabilitation Board. This takes into account recommendations from site specific IOG’s in relation to number of rehabilitation staff required for a particular client group. The distribution of level 3 & 4 clinicians will also be used to develop a training and education strategy across the network, which will enable generic/rotational staff to have access to knowledge and supervision from specialist clinicians. 7.2 Cancer Rehabilitation Services and contact details (Peer Review measure 11-1E-117v) An in-depth Service Directory listing specialist oncology and palliative care AHP services across the region has been developed. All numbers will be checked and updated every six months to ensure accuracy. The Macmillan AHP Lead will be held responsible for keeping the details up to date, as she holds the database of all staff.

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The directory is available for all acute, primary care, relevant social enterprises and voluntary sector staff. A separate leaflet for patients will be developed listing specialist services, contact and referral details.

Basildon Locality

Basildon & Thurrock Hospital University NHS Foundation Trust

Service Area Contact Number

Basildon In-patients 01268 524900 ext. 8773

Basildon Out-patients 01268 524900 ext. 8773

Physiotherapy

Neuro-rehabilitation 01268 598875

Occupational Therapy Basildon In-patients* 01268 524900 ext 8427

Dietetics Basildon In-patients/community

01268 524900 ext. 3957

Speech and Language Therapy

Basildon In-patients/community*

01268 524900 ext. 8578

St. Luke’s Hospice


Physiotherapy Day services/Breathlessness clinic*

01268 524900 ext. 8773

Occupational Therapy Referred to Macmillan Team*

01268 448532

Lymphoedema South Essex 01268 448523

South West Essex PCT


Basildon 01268 297644

Billericay/Wickford 01277 621132/4

Thurrock 01268 297834

Physiotherapy

Brentwood 01277 695149

Occupational Therapy Macmillan Team* 01268 448532

Dietetics Basildon & Southend 01268 593957


All areas 01268 524900 ext. 8578 O7957934205 (urgent referrals)

*denotes specialist services available, other services are generalist.

Chelmsford Locality

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Mid Essex Hospitals Trust


Broomfield In-patients* 01245 514197

Broomfield Out-patients 01245 514198

Physiotherapy

St. Andrews (H&N, Breast)*

01245 516220

Broomfield In-patients* 01245 514196 Occupational Therapy


01245 516009

Broomfield In-patients 01245 514473 Dietetics


01245 514473

Broomfield In-patients 01245 514190 Speech and Language Therapy St. Andrews (H&N)* 01245 514190

Farleigh Hospice/Voluntary Organisations


Physiotherapy In-patient/community* 01245 457300

Occupational Therapy In-patient/community* 01245 457300

Lymphoedema Helen Rollason Centre* 01245 463633

Mid Essex/Central Essex PCT


St. Peter’s, Maldon 01621 727237 Physiotherapy

Braintree Community Hospital

01376 555900

St. Peter’s, Maldon 01621 727244 Occupational Therapy

Braintree Community Hospital

01376 308545


Community (H&N)* 01376 559505

Lymphoedema St. Peter’s, Maldon 01621 727250

* denotes specialist services available, other services are generalist.

Colchester Locality

Colchester Hospital University NHS Foundation Trust


Colchester General (out-patients)*

01206 742550

Physiotherapy

Essex County (in-patients)*

01206 744458

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Community 01206 742293


Amputee Service 01206 742264

Essex County (in-patients)*

01206 744458 Occupational Therapy


Colchester General 01206 742668 Dietetics

Essex County/Community*

01206 744552


All services 01206 742560

St. Helena Hospice


Colchester* 01206 845566 Physiotherapy

Clacton* 01255 221222

Colchester* 01206 845566 Occupational Therapy

Clacton* 01255 221222

Lymphoedema (hosted by Hospice)

Colchester* 01206 848168

NHS North East Essex/Anglian Community Enterprise


Clacton 01255 201603

Harwich 01255 201218

Physiotherapy

Halstead 01787 291025

Clacton 01255 201602 Occupational Therapy

Harwich 01255 201218

Dietetics Clacton 01255 201717

Speech and Language Therapy (ACE)

Clacton, Harwich & Halstead

01206 518525

* denotes specialist services available, other services are generalist.

Southend Locality

Southend Hospital University NHS Foundation Trust


Southend In-patients 01702 385244 Physiotherapy

Community 01702 435555 ext 6692

Southend in-patients* 07795051646 Occupational Therapy

Community 01702 435555 ext 6692

Dietetics Southend In-patients/community*

01702 385331

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Southend In- patients/community Head & Neck*

01702435555 ext. 6694

Fair Haven Hospice


Physiotherapy Referred to SHUFT 01702 435555 ext 6692

Occupational Therapy Referred to PCT 01702 442128

Lymphoedema South Essex 01268 448523

NHS South East Essex


Occupational Therapy Southend community 01702 442128

Dietetics Covered by Basildon Team

01268 524900 ext 3957


Neuro-oncology Southend Community*

01702 578609

* denotes specialist services available, other services are generalist. 8. CANCER REHABILITATION PATHWAYS (Peer Review measures 11-1E-102v to 11-1E-112v) The National Cancer Action Team (NCAT) Rehabilitation Project issued, in January 2010, evidence based National Cancer Rehabilitation clinical pathways for 8 tumour types: Breast 11-1E-102v Lung 11-1E-103v Colorectal 11-1E-104v Gynaecology 11-1E-105v Upper GI 11-1E-106v (there are 2 pathways for upper GI) Urology 11-1E-107v Head & Neck 11-1E-109v Brain/CNS 11-1E-111v The Network AHP Lead and Rehabilitation Board has developed draft Network specific referral pathways. These referral pathways were designed with the intention of providing cancer care providers (especially key workers) an outline of triggers for referral, and link with the service directory for details of service providers and contact details/referral channels. This should ensure appropriate, timely referrals that are standardised across the network. These draft pathways have been submitted to Network Site Specific Groups for final ratification. Three pathways (Head & Neck, Brain & CNS and Skin) have been signed off and it is anticipated that the rest will be signed off within the next six months.

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There are 3 tumour group pathways required for the Peer review measures that have yet to be developed nationally. These are: Haematology 11-1E-108v Skin 11-1E-110v Sarcoma 11-1E-112v Until these National Pathways are developed, local referral pathways have been developed according to current service provision in conjunction with local teams. Further details of the pathway work can be found in the Work Programme. 9. SERVICE DEVELOPMENT 9.1 Service Specification and Service Needs Assessment (Peer Review measures 11-1E-113v) and (Peer Review measures 11-1E-114v) The service specification is defined within the Manual for Cancer Services - Rehabilitation Measures (2008: 19) as “the quantifiable level of services that are required to support cancer rehabilitation needs across the Network”. The Macmillan AHP Lead and Rehabilitation Board are currently developing a network wide service specification including number of specialist staff, location of services (including services that need to be commissioned), waiting times and standards for each service. In order to provide robust evidence for commissioning workforce planning within the service specification the National Cancer Action Team Rehabilitation Project has developed a workforce model which indicates the quantifiable levels of therapists (level 3 & 4) required to deliver the agreed national cancer rehabilitation pathways. Data from the Essex Cancer Registry will be entered into the model for each tumour site and the results from this will be used to form a rehabilitation service report for each tumour site with an evaluation of the current services and projected services required as predicted by the model. These reports will form the basis of the service specification by combining each of these reports and including information from the 3 pathways not yet included in the workforce model. The service needs assessment will highlight the difference between the mapping report (2010) and the service specification. These documents will form part of this constitution once completed. 9.2 Rehabilitation Service Development Strategy (Peer Review measures 11-1E-115v) The draft Essex Cancer Network Rehabilitation Service Development Strategy will be developed with the support and assistance of the Essex Cancer Network Rehabilitation Board using the information gathered in the Service Strategy and Service Needs Assessment. The strategy will outline a 3 year plan for the growth and development of a rehabilitation service within Essex that will be adaptable and responsive to local needs within the rapidly evolving field of cancer care. To enable this, the strategy will examine key national drivers in the context of local priorities in

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order to determine a series of Network wide initiatives to support the continued advancement of a modern cancer rehabilitation service within Essex. Key principles that will guide the development of this strategy include the need for service user involvement in decision making, the need to ensure equitability of service provision across the Network, the need to foster opportunities for professional growth, mentorship and practice sharing among cancer rehabilitation professionals and the need to gather clinically relevant information that focuses on outcomes of value to service users. The strategy will embrace the following broad objectives: o To ensure that AHP cancer services within Essex are adequately resourced to

meet the needs of all people affected by cancer.

o To identify local rehabilitation pathways for people with cancer that enable a cohesive transition between acute, community and palliative care and promote equity of service provision across the Network.

o To ensure the views of service users are paramount in shaping all decision making regarding the design, development and evaluation of cancer rehabilitation services.

o To establish formalised mechanisms for working with commissioners in examining gaps in practice and developing services that effectively and efficiently address these gaps.

o To align the practice development, research, audit and education agendas among AHPs in cancer care in order to promote the delivery of practice which both contributes and responds to the evidence base.

o To establish processes that ensure that the rehabilitation needs of people with cancer are at the forefront of all planning and decision making regarding service development in Essex.

o To facilitate and contribute to collaborative working, practice sharing and communication among AHPs both within Essex Cancer Network and nationally.

o To promote the maintenance of meaningful information and data sets regarding cancer rehabilitation provision within Essex that can be used to support informed decision making regarding service design and development.

o To support the implementation the Cancer Rehabilitation Measures (2008) and assist in the local Peer Review process.

9.3 Role of the Rehabilitation Board in Influencing Delivery of the Strategy The Essex Cancer Network Rehabilitation Board will be responsible for leading on the delivery of the key objectives outlined in the Service Development Strategy. Progress on the delivery of this strategy will be monitored using the Network Cancer Rehabilitation Work-Plan and reviewed routinely at Rehabilitation Board meetings. 10. TRAINING & EDUCATION STRATEGY (Peer Review measures 11-1E-116v)

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The Manual for Cancer Services - Rehabilitation Measures (2008: 19) stipulate that the Network Cancer Rehabilitation Board should produce a Network specific Cancer Rehabilitation Training and Education Strategy to support the development of a workforce with the knowledge and skills necessary to deliver high quality cancer rehabilitation in relation to the 4 level model of care. Within the Essex Cancer Network a survey of learning needs amongst clinicians has been carried out, taking into account the expected interventions contained within the NCAT National Rehabilitation Pathways. This has provided useful information regarding current AHP priority areas for learning and thus support the design and delivery of relevant packages of education within the Network. Where possible, the rehabilitation learning needs will be aligned with the broader Essex Cancer Network Education Strategy in order to make best use of resources and maximise opportunities for cross professional learning. The Network Lead AHP is currently a member of the Network Supportive and Palliative Care Cross Cutting Group and the Training and Education Forum and is therefore well placed to highlight the importance of AHP education within these areas. Education and training has been included as a standing item on the Essex Cancer Rehabilitation Board agenda to ensure that focus is maintained on this important element of practice. The EPCAF Forum will be used as a free resource for training and education to share current good practice, knowledge and skills which is particularly important for the large numbers of lone workers. The Essex Cancer Network has also committed to annual study days for both specialist and non-specialist staff to share new initiatives and service developments. There will also be annual audit days to ensure that best practice can be shared throughout the network.

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Appendix 1 - Outline of Role

Network Lead Allied Health Professional (AHP)

Introduction

This section describes the appropriate scope for this role and revises the key responsibilities

of the Macmillan Essex Cancer Network AHP Lead.

Scope of the Post

To be responsible for developing the contribution of allied health professionals to cancer

rehabilitation and survivorship, with effective multi-professional collaboration, and service user

participation. This role will provide professional leadership for assessing need, planning

provision and informing the commissioning process to improve cancer rehabilitation services

across the network.

Key Responsibilities

Professional engagement with provider organisations

• Promote effective communication across professional and organisational boundaries.

• Ensure there are named lead AHPs for Trusts and establish working links with any

specialist AHPs from the network site-specific groups. To include links with cancer leads for

PCTs.

• Ensure succession planning and leadership development is encouraged with opportunities

for Trust cancer AHPs to develop key skills required for progression to network lead AHP

posts as required.

• Ensure that network strategy relating to rehabilitation is inclusive of Trust clinical expertise.

Professional leadership within network team and network structures

• Provide professional advice to the management team, the cancer network groups and

network board.

• Advise and support the service improvement lead to ensure the effective implementation of

the Modernisation Agenda, and the redesign of local cancer rehabilitation services as

required.

• Lead or support in the adoption and implementation of nationally determined priorities

including the NICE Improving Outcomes Guidance and the CRS.

• Lead and provide direction to the relevant supportive and palliative care network groups to

support the implementation of the supportive and palliative care guidance.

• Provide advice and support to the network site specific groups raising the profile of cancer

rehabilitation issues relevant to those specific sites.

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• Advise on the necessary actions required to prepare for peer review and ensure that

resulting action plans are agreed and progress regularly monitored.

Workforce planning

• Assess the needs of the AHP workforce and develop a common education strategy with

local stakeholders (including SHA and HEI's).

• Develop and promote implementation of a strategy for recruitment, retention and

succession planning across the network for allied health professionals.

•Ensure that the workforce component of the network strategy for rehabilitation is robust and

agreed by the network board.

Research

• Promote a comprehensive programme of research/audit in cancer and palliative care

rehabilitation is established across the network.

• Encourage evidence based practice through research, audit and training.

Commissioning

• Provide advice and support in the development and implementation of the network service

delivery plan and enabling strategies as it relates to AHPs and cancer rehabilitation.

• Provide AHP leadership for the implementation of cancer rehabilitation service

reconfiguration arising from the Implementing Outcome Guidance and other NICE guidance.

• Ensure active Rehabilitation input into commissioning arrangements for LDPs and service

reconfiguration.

Other

• As part of the national lead AHP forum, provide advice and actively contribute to any new

national initiatives relating to the cancer rehabilitation agenda.

• The network lead AHP will work closely with the Modernisation Agency, Cancer Action

Team, Cancer Policy Team, Department of Health and the Healthcare Commission to advise,

contribute and shape national initiatives including the cancer rehabilitation agenda.

essex cancer · pdf fileposition macmillan ahp lead; chair of rehabilitation board name kate...

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