1. Person Centred Care A Partnership Approach Pat PilkingtonJulie A Jones Cancer CNS Project Macmillan Services Effectiveness Lead

2. A Partnership Approach Macmillan Cancer Support and BCUHB By 2030 it is estimated that more than 48,800 people will be affected by cancer in North Wales (presently 27000) The NHS cannot provide all health care and support needed by patients and families Partnership recognises diverse skills and expertise Strive to improve patient outcomes and experience Evidence based approach to deliver safe, effective care Demonstrate impact; plan for sustainability Reduce harm and variation

3. What is Person Centred Care? Person Centred Care ensures: the needs of a person living with cancer are at the heart of how services are delivered, not the needs of the service people are treated with respect, dignity and compassion, ensuring care is holistic in its planning and delivery care goes beyond the clinical to address wider social/ cultural, financial, emotional, practical, psychological and spiritual concerns. Personalised care enables people to be independent and supports self-management Acknowledges expertise of everyone

4. What North Wales patients have told us... 37% not given contact details of key workers 76% not offered a written care plan 41% did not get enough support from health and social services post discharge 39% did not have enough information about how to look after the patient on discharge Only 35% said the different people treating and caring for them worked well together to give the best possible care Wales Cancer Patient Experience Survey 2013

5. Person Centred Care in BCUHB Patient Holistic Needs Assessment & Care Planning Health & Wellbeing / Rehabilitation Treatment Summary Key Worker

6. eHNA Electronic Holistic Needs Assessment Care Plan The eHNA allows for the person affected by cancer to complete the HNA questionnaire on a touch screen tablet. This information is then sent to the clinician through a secure website to begin the process of care and support planning. Care and support plans can be printed and saved for sharing with the person affected by cancer and their health care team. Each team has access to its own data for reporting and analysis, and to identify local service needs. Anonymous data collected from the assessments and care plans can be used to look at the overall needs of different groups of people. This in turn can help to inform the planning of local services. Macmillan is currently working with more than 70 cancer service providers across the UK which includes NHS Trusts, private providers and hospices

7. Testing the eHNA in BCUHB Sixteen Clinical Nurse Specialists are testing the tool in Wrexham Maelor Hospital, Ysbyty Glan Clwyd and Ysbyty Gwynedd as well as Macmillan’s Information and Support professionals in Wrexham and Glan Clwyd

8. In Summary People living with cancer face numerous issues at: diagnosis during treatment throughout their lives. Empowering patients/supporting self management eHNA to identify, support and manage patients concerns and needs Living with the impact of cancer should not be an isolated journey: Coordination across health & social care, third sector Active inclusion of patients and families Targeted activity to address their quality of life throughout and beyond the cancer experience.

9. Quotes from patient and staff Comment from one CNS “When it’s there in print, the patient is more likely to recognise and agree that it is an issue for them, you can then focus on what’s important to them and it’s quite satisfying to know that you’re really helping them.” A gentleman with prostate cancer said that after two years clinic appts, the eHNA finally drew attention to him as a person and his concerns, resulting in referral to Erectile Dysfunction Clinic, Relate and NERS.

10. Thank you very much FAQs for existing eHNA sites 2016 [PDF] Planning your care and support: Having a holistic needs assessment [PDF] Planning your care and support: Having a holistic needs assessment [PDF] Assessment and Care Planning folder The Recovery Package Holistic Needs Assessment and care planning [PDF] Assessment and care planning for cancer survivors: a concise evidence review [PDF] Assessment and care planning for cancer survivors: a concise evidence review [PDF] Holistic Needs Assessment (HNA) Executive summary - Evaluation of the eHNA [PDF] Final evaluation report - Evaluation of the eHNA [PDF