The Trinity Holistic Centre:Delivering Complementary Therapies in

an Integrated NHS Setting

Heather McLean & Kathryn Almond

NHS Outcomes framework (DoH, 2011/12)

Drivers • Consumer use and demand

• National Institute for Clinical Excellence (2004)

• Survivorship initiative (2010)

• Peer review - Cancer Reform Strategy (2010)

• UK Clinical Research Collaboration

• Department of Health (2010)

• NCRI Complementary Therapies Clinical Studies Development Group

• Target time to treatment

South Tees position

• South Tees Trust incidence rate (442.5 per 100,000) English average

(398.1 per 100,000)

• Late presentation and mortality rates

• Bed occupation of cancer patients

• Economic challenge

• Regional Cancer Centre 4,000 patients per year at JCUH

• Complementary therapies not directly NHS funded

• 2500 patients seen per year. quadrupled our contact in last 2 ½ years

over 50% patients

Definition: • British Medical Association (1993):

• Complementary therapies are those that ‘work alongside or in conjunction with orthodox medical treatment’

• Alternative therapies are those that ‘are given in place of orthodox medical treatment’

• The National Institute of Health and Clinical Excellence (2009) :“Complementary therapies are used alongside orthodox treatments with the aim of providing psychological and emotional support through the relief of symptoms.”

• Manual of Cancer Services (2010) :“a range of specific therapies, which are offered to patients with cancer, as having potential benefit, but which are not offered as an alternative tumour reduction (cancer reduction, tumour ablation or removal) method to any of the conventional treatments offered by the network (surgery, radiotherapy, chemotherapy, endocrine therapy or biological therapy)”.

What holistic support is!

• About the persons’ non clinical needs (& their family too)

• Supportive care

• Integrated with clinical colleagues

• Risk averse

• Aiming to support families every step of the way

Service model

Supporting patients, carers and staff

Complementary therapy

Emotional

&

psychological support

Wellbeing

(physical activity & diet)

Safe space & wellbeing support hub

Access to the purpose built centre and gardens and trained staff volunteers

Opportunities to adapt, develop and deliver new and person centred initiatives

Every step of the wayDiagnosis & Treatment-Counselling and complementary therapies offered within Holistic Centre, on chemotherapy day units (2 locations) & all wards.--No max for complementary therapy sessions. Free for all patients and their family-Look Good Feel Better sessions-Hair loss clinic-Headstrong service-Group relaxation sessions-Targeted support for head & neck radiotherapy patients-Hair & beauty service for inpatients-Referral into all local Macmillan information centres-Guided mindfulness (June 2015)-Movie sessions (June 2015)-Sensory room experience sessions (June 2015)

End of life-Counselling and complementary therapies offered within Holistic Centre and all wards -Free for patients and their family-Available after bereavement for family

Survivorship• Auricular acupuncture for Hot flushes –

all patients• Targeted evaluation tools for hot

flushes and peripheral neuropathy• Breast, bowel and lymphoma cancer

support group• Monthly drop in afternoon teas – open

to all• Host multi disciplinary health and

wellbeing clinics: generic & cancer specific

• Physical activity support: Tai chi, healthwalks, running group, gardening

• Healthy eating support: Eat well feel good programme

• My Viewpoint programme• Returning to your new normal

programme• Choir• Guided mindfulness (June 2015)

Prevention-Host & deliver health promotion activities for awareness campaigns-Staff team trained (RSPH 2)to talk about cancer awareness & prevention – family influence. ‘Make every contact count’.-Working with genetics team for future model of support for high risk patients.

Centre environment: refurbished rooms & garden. Trained staff & volunteers for ‘listening ear’

Children & young people-Counselling service for cyp affected by a cancer diagnosis-Family days for support and signposting-Young adult movie and music sessions (July 2015)

Evaluation: Specific tools for pain, peripheral neuropathy & hot flushes. Wellbeing star in

development.

Pathway: 1 referral, triage and regular review ‘open door’

Wig fitting service to help you keep the day job …

A ‘safe space’ amidst the clinical environment

Haven for the whole family

Help in celebrating special times

Patient

• Patient preferences & involvement

• Bio psychosocial model

• Demand led

• Demographics

• Complex

• Identify & prioritise

• Opportunities

Why patients access & why staff refer …

• Relaxation

• To be able to offer ‘more’ to patients

• Time … we have it!

• Not to be poked and prodded.

• To feel ‘normal’

• 62% of patients

• All MDT areas refer in

Demand & use 2015

Patient numbers seen based on actual Jan-Oct & forecast Nov- Dec 2015

• Average 524 people accessing the centre per week (excluding inpatient support)• Use by 4 active support group (bowel cancer, lymphoma, breast & crohns/ colitis)• Host Look Good Feel Better (132), Hair loss clinic (493) , headstrong (144), provide headscarves all conditions (32) • From 2016 hosting teenager cancer trust youth support worker and targeted services • Sensory space developed from input by LD acute liaison nurse• Well used (avg 80 ppm) by therapeutic care team as distracting and calm environment for distressed patients

Safe space & support hub

Total patients seen 2475 Host clinical psychologist (cancer services) 5 ½ days pw Trinity green fingers 304Carers seen 294 Host Relate Eat well feel good Inpatients seen 587 Adult counselling Service 53 Take a strollWard locations 23 Children & Young People & families (pilot july –Oct) Tai chi Services provided: Enrich Running clubGroup relaxation Mindfulness My viewpointHair & Beauty Big noiseClinical hypnotherapy CraftsMassage South Tees singers Acupuncture Look Good Feel BetterAuricular Acupuncture Wig service reiki Headstrong

The plan

Training & Good Governance • Therapists, MDT & Medical Students

• Support clinical care pathway

• Knowledge, Expertise & Support

• Empowered & Accountable

• Policies & Protocols

• Competency based frameworks

Evidence

• Clinical & Cost

• Evidence based

• Demand led

• Therapists, MDT, Partners

• Consistency & Quality

• Highlight good practice

Measuring Impact – the challenge!• Pain scores (Acupuncture)• Hot flush daily interference scale (auricular acupuncture)• Peripheral neuropathy• CORE scores (Counselling)• Warwick-Edinburgh (all) – Jan 2016 onwards• Qualitative: Focus groups & patient experience questionnaires

Examples:

58/39% CORE score reduction (1:1 counselling/ Group activity)

100% of those accessing the centre and gardens would recommend to families and friends.

98.5% of those accessing any of our services (across locations) would recommend to families and friends.

Testimonials:“I didn’t know where to start to explain to our young daughter about my cancer and the treatment that I was going to have. Jo (CYP counsellor) worked with each of us as individuals and as a whole family at our own pace, I feel more confident in both tackling the treatment but also knowing how to ensure my daughter understands what is happening and that she can ask us questions. Jo helped us keep talking.” Patient Sept 2015

A little recognition

• Patient Safety Awards – finalist in cancer care 2015

• Macmillan Quality Environment Mark – 2015

• South Tees STAR awards

Hear from those we work with …

http://southtees.nhs.uk/services/trinity-holistic-centre/users/

Questions & Contact

Heather McLean Business Managerheather.mclean@stees.nhs.uk

Kathryn AlmondHead of Complementary Therapykathryn.almond@stees.nhs.uk

01642 854839

Reference Material

DiagnosisStage Symptom

Emotion

Complementary

Therapy

Evidence base Comments

Finding out that something is wrong

Diagnosis

Fear/ Anxiety

Worry/ Grief

Acupuncture

Aromatherapy

Reflexology

Self Help techniques

Taylor et al (2004) Kim.SG et al (2007)

Costello et al (2004) Molastossis (2005)

Must not overload patient with information

Access and signposting to appropriate information sources

Surgery Stage Symptom

Emotion

Complementary

Therapy

Evidence base Comments

Going through

treatment

Surgery

Fear/ Anxiety

Worry/ Grief

Acupuncture

Auricular Acupuncture

Auricular seeds

Aromatherapy

Reflexology

Self Help techniques

Homeopathy

Kim KB (2007)

Walling (2006)

Shu Ming Wang (2001)

Knarndal (1998)

Haker (2000)

Karst (2007)

Mora (2007)

Billhult & Dahlbergh(2001)

Morrell et al (1997)

Corner (2006)

There is no literature on the efficacy of homeopathy pre op but some patients have found it beneficial

Aromatherapy not recommended on same day as anaesthetic

Chemotherapy Stage Symptom

Emotion Complementary Therapy Evidence base Comments

Going through treatment Situational anxietyFlight or Fight

FAST TRACK ACCESS TO COMPLEMENATRY THERAPY TEAM

Harris & Almond Service evaluation (2007)Corner (2006)

Chemotherapy Anticipatory Nausea/ Nausea

Fatigue

Acupuncture/AuricularAcupuncture/Auricular ear seedTeach specific use of Acupressure points

Suggest Sea BandsReflexology

AromatherapyReflexology

Walling (2006) Dundee (1990)Shin (2004) Roscoe (2002)

Grealish (2002)

Wilkie (200) Sloman (1995)Grealish (2002)

Poor peripheral circulation Peripheral neuropathy

Hair loss

Constipation, loss of appetite

Acupuncture Reflexology

Self help with homeopathy/ Bach flowers and breathing/

Visualisation/ relaxation emotional/ moral support

Grealish (2002)Harris & Almond (2007) service evaluationHammar (1999)

Radiotherapy Stage Symptom

Emotion Complementary Therapy Evidence

BaseComments

Radiotherapy

Considerfamily/supporters

Fatigue

Site specific symptoms discussed in service relevant pathway

EgXerostimaConstipationPain

Acupuncture/Auricular Acupuncture/ Auricular ear seed

Aromatherapy/ReflexologySelf help suggest and breathing/ visualisation strategies

Visualisation/ relaxation emotional/ moral support

Acupuncture

Walling (2006)

Wells(2001) Sloman (1995)Grealish (2002)Gilliard (1995)Wilkie (2002)

Payne (2002) Filshie (2001)

Patients Choice and tolerance

Avoid Site entry and exit

Living with consequences Stage

SymptomEmotion

Complementary Therapy Evidence Base Comments

Living with the consequences of cancer

Anxiety Stress Depression

Pain

Neuropathy

Hot Flushes Night Sweats

Relaxation

Acupuncture

Reflexology Massage

Reiki

Reflexology

Aromatherapy

Auricular Acupuncture

Sloman (1995)Payne (2002)Walling (2006)

Harris & Almond service evaluation (2007)Knarndal (1998)Haker (2000)

Hodgson (2000) Pan (2002) Wilkie (2000)

Oleson (2003)

Stephenson (2003)

Grealish (2002)

Soden (2004) Corner(2006) Hammar (1999)

De Valois (2007)Harding Harris & Chadwick (2008) in press

Survivorship Stage

SymptomEmotion

Complementary Therapy Evidence Base

Survivorship

Living with consequences of treatment

Anxiety / stress worry Pain Chemotherapy induced peripheral Neuropathy Hot Flushes Fatigue Altered Body Image

Acupuncture Aromatherapy Reflexology ReikiAuricular Acupuncture Touch therapies

Ernst et all, 1998. Ferrell-Tory & Glick, 1992.

Dossey et al, 1995. Corner et al, 1995. Van de Riet, 2000. Manasse, 2001. Hadfield, 2001. Grealish, 2002. Gambles, Crooke & Wilkinson, 2002) Fellows, Gambles, Lockheart, Wood, Wilkinson, 2003. Gillard,

1995. Stephenson, 1996. Botting, 1997.hills & Taylor, 2002. Wardell & Engerretson, 2001Filshie, 1990.

Alimi et al, 2000. Johnstone et al, 2002. Leng, 1999 ) Keller & Bzdek, 1986. Gorden et al, 1998. Neate & Neate, 2001.

Benor, 2001. Hills & Taylor, 2002Miligan, 2002. Stephenson, 2000. Hodgkinson, 2001 Ferrell-Tory & Glick, 1992. Smith, 1994. Wilkinson, 1995. Field,

1998. Byas, 1999. Van de Riet, 2000. Wilkie, 2000. Grealish, 2002South tees Gynaecology – 3x arms single blind placebo controlled

trail (Teesside university, Harris & Almond) Audit dataHarding, Harris, 2008. service evaluation south tees, Harris &

Almond, 2004-2012. Wyon et al, 1994. Cummins, 2000. Hammar, 1999 Oleson & Flocco, 1993. Gould & Macpherson, 2001 Fellows, Barnes & Wilkinson, 2003 Bredin, 1999. Van der Riet, 1999

Palliative Care & End of Life

Stage

SymptomEmotion

Complementary Therapy

Evidence Base Comments

Dying End of life care

Anxiety

Pain

Breathlessness Anxiety

Pain

Relaxation

Reiki

Reflexology

Aromatherapy

Reflexology

Acupuncture

Sloman (1995)Payne (2002)

Oleson (2003)

Milligan (2002) Stephenson (2003) Hodgkinson (2001)

Wilkie (2000)Kyle (2006)

Soden (2004)Pan (2000) Hodgson (2000)

Dillon (1999) Walling (2006) Filshie (2001)Knarndal (1998)Haker (2000) Oleson (2002)

Commissioning Intentions Health and Wellbeing strategies• http://www.redcar-cleveland.gov.uk/partnership-

rcbc.nsf/198533b51589d3778025786b003d08b5/$File/HealthWellbeingStrategy_web.pdf• http://www.middlesbrough.gov.uk/CHttpHandler.ashx?id=6380&p=0• http://www.nypartnerships.org.uk/CHttpHandler.ashx?id=21125&p=0• http://www.stockton.gov.uk/documents/839159/jointhealthandwellb.pdf• http://www.hartlepoolpartnership.co.uk/partnership/site/scripts/documents.php?categoryID=3• http://www.darlington.gov.uk/PublicMinutes/Cabinet/October%209%202012/Item%207a%20-

%20Appendix%201.pdf

CCG Commissioning intentions (most recent publication at Feb 14)

• http://www.southteesccg.nhs.uk/includes/documents/Commissioning%20Intentions%20South%20Tees%20CCG.pdf

• https://www3.northyorks.gov.uk/n3cabinet_healthandwb/reports_/20130925_/05ahwbstrategyc/05ahwbstrategyc.pdf

• http://www.hartlepoolandstocktonccg.nhs.uk/wp-content/uploads/2014/01/HaST-CCG-Public-GB-pack-28-01-14-REVISED.pdf (p39-45)

• http://www.darlingtonccg.nhs.uk/publications/