1. HOLISTIC NEEDS ASSESSMENT WITHIN PERSONALISED CARE

2. HNA Definition [Macmillan, 2017]
A Holistic Needs Assessment (HNA) gives you the chance to think about your concerns and discuss possible solutions. These concerns may be:
physical
emotional
practical
financial
spiritual.
You may be offered an HNA at diagnosis, during treatment or after treatment has ended. You can ask for an assessment at any time if you feel it would help.
An HNA usually has three parts:
You answer a simple set of questions or fill in a checklist about all areas of your life.
You discuss answers with your key worker.
You create a care plan together.
The care plan may include ideas to help you manage your concerns. It will also include contact details for organisations or services that could help, such as the Macmillan benefits team or a dietitian.
You will be offered a copy of this plan to take away with you. It may also be shared with other members of your healthcare team if it will help with your care.

3. Where to start….
September 2018 – Awareness of upcoming ‘Recovery Package’ that had to be implemented in January 2020.
Wanted to ensure we had addressed issues that may present themselves before it was mandatory.
What first ??!!?? – Audit/Collection of data of patients newly diagnosed on spread sheet from Sept 2018.
Aimed to commence Personalised Care Package [PCP] on first patients in Jan 2019.

4. Personalised Care Audit Tool

5. Personalised Care Audit Tool

6. End of Treatment HNA Implementation:
Nurse Led Face-to-Face Clinic set up.
Invite Letter created…and altered…and updated….
Tablet/iPad provided for HNA completion in clinic.
Audit expanded to include all elements of recovery package [including HNA]
Obtained patient information and created a ‘pack’ around patients perceived needs.
Even made a basic ‘checklist’ of what we needed at each point to make each contact equitable [and to remind us!!] as overleaf….

7. End of Treatment HNA Checklist
What to send out for recovery package appointment
Nurse appointment letter along with Dr’s OPA letter (if applicable)
Ten Top Tips booklet
Cover letter
Concerns checklist
Add patient to diary for date to be seen.
Info to take to clinic to recovery package
Relevant booklets including Ten Top Tips (to take in case patient hasn’t got one/to help discuss care plan)
Contact Card
End of Treatment Summary
Support Group leaflet
CSY leaflet
Health & Wellbeing leaflet
Care plan
After recovery package appointment
Care plan to give to patient and send to GP (take a copy to be scanned on to EPR after OPA)
Treatment summary to give to patient and send to GP (take a copy to be scanned to EPR after OPA)
Concerns checklist to be scanned to EPR
Complete Recovery package audit

8. Challenges Workforce. Clinic capacity – 5 slots a week.
Timescales - 6 weeks recommended.
Differing treatment regimes meaning difficult to protocol.
Site specific problems. [Cohort of poor prognostic palliative patients].
Patients confused by ‘extra’ appointment.

9. Overcoming challenges
Workforce:
Utilising clinical care coordinator/navigator.
Made wider MDT aware of constraints and what we could offer to them may be slightly reduced/slim lined.
Forced a service review. Macmillan and Trust.
Clinic capacity
Still difficult currently but looking to expand. Audit tool will evidence need.
Differing treatment regimes & Site specific problems:
Not one size fits all.
Don’t be too worried about uniformity.
CNS’s are best placed to know your patient and what is best for them.
Patients confused by ‘extra’ appointment:
Careful verbal explanations
Changed wording on letters inviting patients to clinic.

10. Successes We’ve learnt from our mistakes. Dynamic approach to the PCP.
Time for patients in clinic. 45 minute slot. Don’t settle for less.
PATIENTS NEEDS ADDRESSED!!
They love it- against our predictions and despite their initial reservations.
Patients needs alter along their pathway. Initial HNA’s are difficult at diagnosis when emotions very high and treatment is usually main concern.
We realised things we thought we’d addressed already and things we thought we’d informed patients about were not always clear [example].
Empowering and enabling them to have time to address issues.

11. Snapshot of data February 2019 data 13 patients diagnosed
13 patients diagnosed
Number of patients receiving HNA at diagnosis: 12 HNA’s done at diagnosis.
Number of patients receiving HNA at end of active treatment: 2 completed, 8 too ill or RIP and 2 planned.
Number of patients receiving a Care Plan at diagnosis. Includes those where no concerns were raised from the HNA: 12
Number of patients receiving a Care Plan at end of active treatment: 2
Number of patients receiving a Treatment Summary: As 2
Number of patients receiving holistic information & support through a health & wellbeing event: 2

12. Snap shot of data July 2019 data 22 patients diagnosed
22 patients diagnosed
Number of patients receiving HNA at diagnosis: 17 HNA’s done at diagnosis
Number of patients receiving HNA at end of active treatment: 17 planned (5 too unwell or RIP)
Number of patients receiving a Care Plan at diagnosis. Includes those where no concerns were raised from the HNA: 17
Number of patients receiving a Care Plan at end of active treatment: Nil as yet still on active treatment.
Number of patients receiving a Treatment Summary: As above
Number of patients receiving holistic information & support through a health & wellbeing event or: As above

13. eHNA vs Paper HNA
eHNA:
Paperwork completed at appointment, presented well & easy uploaded to systems.
Less admin time after appointment.
Concerns identified by patient generate quality information for printing.
Some patients IT illiterate. Put off appointment completely.
Ideally to be done prior to appointment, to help clinic prep.
Paper HNA:
Patients find easier to use in the main.
Not linked to information – so may need to find independently.
Can be done at appointment.

14. Additional thoughts…
Undoubtedly worthwhile to most patients – not all.
Don’t forget patient choice. Don’t add to their stress if its not suitable.
Glad its not called ‘recovery’ package now as most our patients are palliative!
Not sure how much notice other healthcare professionals take of it.
Why should implementation be aimed at just CNS’s doing this?
Next Steps Clinic Pilot -in conjunction with CSY & MacMillan – non medical staff look at different issues in a non medicalised setting and complete HNA.

15. Thanks for listening [hope it wasn’t too much like teaching your grandmother to suck eggs!!] Any questions?