1. Enhanced Supportive Care
NHS England via BNSSG CCG
Dr Miranda Flory UHBristol

2. What: Pilot new service
Take home messages
Proactive, multi-disciplinary, 2 extra clinics
Provided by palliative care, dietitians, OT, physio; from time of diagnosis not need
What: Pilot new service
People with palliative lung, UGI, HPB cancer
Identified at MDT meeting
BNSSG: UHB, NBT, Weston
Who for
Reduce admissions and stay length
Help people get through chemotherapy better
Improve symptoms and quality of life
Aim

3. Definitions: What is ESC
Palliative Care
End of life Care
Supportive Care
Enhanced Supportive Care
Holistic needs-based in advanced progressive incurable illness
Last year of life; or last days of life
Prevention and management of the adverse effects of cancer and its management
Proactive, earlier, ‘positive’ (palliative) supportive care

4. Background The Christie, Manchester…CQUIN Benefits shown:
Cost savings, reduced admissions
NHS E South of England roll out
BNSSG Pilot
Oct-Jan data on potential cohort, recruitment etc, aiming for 2020 start

5. BNSSG pilot

6. Diagnoses Exclusion OG HPB Lung Oesophageal Pancreas Any lung primary
Stomach
Cholangiocarcinoma
?HCC
Exclusion
NET
GIST
IPMN
Non-OG/HPB/Lung primary

7. How it will impact MDT Currently From start date : March 2020
Data collection at MDT meeting
Need to be clear on ‘palliative’ or ‘not curable’
From start date : March 2020
Adding to Somerset Cancer Registry
Invitation to extra clinic; includes IPOS form
‘ESC cohort’ will be receiving extra input
Site specific CNS still key worker

8. Data so far: 8 weeks OG HPB
22 with 7 needing SPCT now – so 15 relevant
HPB
50 with 10 needing SPCT now
Needs screening for doubly discussed etc

9. Questions for you? Should we include HCC? If so which stage?
Are all patients brought back to MDT if outstanding results e.g. awaits immunos/PET?
Post-op e.g. Whipples - if not cleared margins – is that palliative?

10. Summary New pilot for people with palliative OG, HPB and lung cancer
Thank you for your help…
Any questions?

11. IPOS: Integrated Palliative Care Outcome Scale

12. Frailty score

13. National Cancer institute

14. Benefits and risks
Shown elsewhere: patient benefits, reduce admissions and cost savings
Risks
Outcomes unknown
Recruitment
Clinical engagement
Overwhelming demand
Funding ongoing beyond pilot