St. Oswald’s Hospice works with Newcastle Hospitals NHS Foundation Trust to deliver integrated, multidisciplinary outpatient care to people with non-curative lung cancer and significant frailty.
Frailty is a significant factor for older people with incurable long-term conditions. In many cases, patients are admitted to hospital (or need to spend extra days in hospital) due to frailty.
To tackle this problem, St. Oswald’s Hospice and Newcastle Hospitals NHS Foundation Trust (NuTH) developed a Combined Supportive Care Service (CSCS). This is a new model of care for patients with non-curative lung cancer and a frailty score of 5 and above.
Patients attend multi-disciplinary outpatient clinics at St Oswald’s, where they are assessed by an occupational therapist, consultant and other members of the multidisciplinary team as required. They are assessed holistically and provided with integrated, personalised support, so that they and their family can get the support they need to improve their quality of life and reduce the time they spend in hospital.
Outcomes
The Combined Supportive Care Service (CSCS) is able to respond quickly to patients’ needs. Patients are seen on average nine days following referral.
Having a multidisciplinary team (MDT) enables the service to provide patients with the full range of support they need. In the first 3 months of running the service:
75% of patients referred had multiple long-term conditions
An average of 8 interventions were required at each patient’s initial review
All patients required home equipment such as walking aids and changes to their medication
92% of patients saw a physiotherapist
50% of patients had input from a social worker
All patients have seen 3 or more members of the MDT
83% of patients had advance care planning (ACP) discussions.
Before developing the Combined Supportive Care Service (CSCS), the teams from St Oswald’s and NuTH had been working together as part of the NHS Elect Acute Frailty Network Programme. This aimed to improve the experience of frail older people in acute care whilst reducing hospital admissions/days in hospital.
As part of this work, they piloted the Lung Cancer Outpatient Occupational Therapy Service (LCOOTS) within NuTH. This was funded by Newcastle Hospitals Charity. Over 19 months, an occupational therapist provided proactive holistic assessment and intervention for more than 150 people from areas of high socioeconomic deprivation, who had lung cancer and frailty. This was highly successful, resulting in over 600 hospital bed days being saved, a reduction in consultant time and more patients achieving their preferred place of death.
The success of LCOOTS and the working relationships established through the pilot enabled the teams to apply for an extension of charitable funding to allow the CSCS to be established.
Challenges
It can be challenging to gain funding for a new service, and the team needed to be able to prove that CSCS would add value. It was important to be able to share data from the LCOOTS programme, evidencing its positive impact and showing that it was a cost-effective solution.
Tips and advice
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Allied health professionals make a significant impact on the lives of people living with frailty and cancer, especially as end of life approaches. Valuing all members of the multidisciplinary team is so important in order to provide a holistic, person-centred service.
Future development
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NuTH and St Oswald’s are committed to working together to develop and extend the programme. This may include seeing people with:
lower frailty scores (to find out whether working with patients earlier might improve the impact of the service)
other types of cancer
non-malignant disease.
Evaluation of the service is ongoing and learning will be shared.
