Head and Neck Cancer Rehabilitation in the Community Samantha Tordesillas South East London Community Head and Neck Cancer Team

CHANT’s History: 2004 NICE IOG 2008 – Commissioners approved business case, mapping and consultation, developed service spec Early 2009 – tender process – awarded to Lewisham Community Health Trust in partnership with Guys and St Thomas’s Launched in 2010 Initially a 3 year pilot project directly commissioned by the 6 CCGs of SE London Now substantive service with Lewisham CCG as lead commissioner

The Community Team Clinical Team Leader (SLT) 2 Clinical Nurse Specialists 3 Dietitians 1.5 Physiotherapists 3 Speech and Language 2 Admin Support Staff Serving 6 CCG’s in South East London now within the London Cancer Alliance with a population of 1.8 million

Aims To ensure that those living with and beyond cancer get the rehabilitation, care and support they need to lead as healthy and active a life as possible, for as long as possible To provide Head and Neck Specialist rehabilitation and support closer to home To provide a seamless service between acute and community care To register and manage all enteral feed requirements for patients with HNC on active rehabilitation living in SE London To provide specialist training opportunities to community staff To work collaboratively with other community services to ensure patients receive holistic care To influence reducing length of hospital stay Decrease A&E attendance and hospital readmission

Referral to the Service Adults with diagnosis of head and neck cancer, following primary cancer treatment Palliative patients with HNC where there are no treatment options GP in Lambeth, Southwark, Lewisham, Bromley, Bexley, Greenwich Patients with benign tumours requiring treatment similar to HNC Route Predominently from the Cancer Centre (Guys) Treated at neighbouring cancer centres Primary care – late effects Local hospitals Palliative Care

Community Head and Neck Cancer Team Rehabilitation and support pathways Pathways Active Rehabilitation Post treat clinic Non- curative Survivorship Altered airway discharge

CHANT additional activity Delivery of Recovery Package: Post treat HNA Living With and Beyond Head and Neck Cancer event at end of rehabilitation (Health and Wellbeing Event) Food Groups Representation on London Cancer Alliance Teaching and training

CHANT model of service delivery Referrals increasing year on year (40% increase since 2010) 275 new referrals last year Rolling caseload of around 200 patients 70:30 split between local clinics and domiciliary visits depending on clinical need Local clinics in each of the 6 boroughs Joint sessions where possible Visit to patients with altered airways within hours of d/c Strong emphasis on training and support of community staff Referrals expected to continue to rise due to HPV, increase in late effects and demographic growth

Challenges – Practical Mobile working across 6 boroughs Geographical challenge Guest service in other organisations Networking with other community services High turnover of community staff Cover for leave GSTT team lead running LGT service Ongoing changes in NHS commissioning

Challenges – workforce Recruitment – no community teams to recruit from – ‘grow our own’ - No traditional physiotherapy training route for head and neck - concern re skill retention Emotional load - working in isolation - leaving patients in their own environment - new conversations – HPV

Lessons learnt – what could have been done differently A true understanding of how our patients live Psychologist or counsellor included in the team Consider split or rotation posts to enhance staff skills across the acute/community pathway Have clear baseline data prior to service start Build in research element from the outset Secure suitable clinic space with appropriate IT solution before commencement of service Acknowledgement that HNC incidence and rehab need is on the rise and build this into business planning

Future service developments Psychologist embedded within the team B3 Multiprofessional assistant Joining B6 physiotherapy rotation to provide community head and neck training post Mobile working solution