Bringing head and neck cancer follow-up and rehabilitation closer to home was the aim of a pilot introduced by Thames Valley Cancer Alliance in 2018. But had the changes made a difference? SCW was asked to deliver an independent evaluation to support future decisions on wider roll-out.
The programme was redesigned to improve outcomes for patients from Swindon and Wiltshire. It enabled these patients to receive an increased proportion of their follow-up and rehabilitation, usually carried out in Oxford, much closer to home at Great Western Hospital in Swindon.
Our findings provided an evidence base for this pilot to become business as usual and for a wider roll-out.
To meet NHS Specialist Service requirements, cancer treatment, rehabilitation, and follow-up for head and neck cancer are delivered in tertiary centres. This ensures access to high-quality clinical care to improve patient outcomes. Having services in centralised locations, however, often results in many patients having to travel significant distances.
Head and neck cancer patients are often aged over 70 years and have other co-morbid conditions. Incidence rates are highest in the most deprived groups of patients are many are poorly placed to travel.
This enabled patients to receive an increased proportion of their follow-up and rehabilitation much closer to home at Great Western Hospital in Swindon. They then needed to assess if the pilot was indeed improving patient outcomes.
They looked to SCW and we were commissioned to undertake an independent evaluation of the ‘Care Closer to Home’ pilot. The evaluation aimed to:
- Evaluate the impact of the new pathway on patient experience, including quality of life and patient outcomes
- Generate an evidence base to support the economic case for the pilot
- Consider the effect of COVID-19 on the patient group, including the introduction of virtual consultations
- Provide an assessment for wider roll-out across the Thames Valley region
Our evaluation findings showed significant benefits to patient experience. These included a reduction in travel and waiting times, and in the levels of fatigue and stress felt. These also translated into financial benefits for patients. Both patients and staff report satisfaction with the new service. Reduced travel journeys and times had a positive environmental impact which was quantified by SCW.
Positive patient outcomes included reduced A&E attendance from 31% to 23% and subsequent hospital admission following A&E attendance from 69% to 46%. Concerns about recurrence and adverse treatment effects were reported much earlier and were able to be resolved more quickly before they become more significant.
The use of the Swindon clinic has resulted in capacity improvements at Oxford facilities. Improved clinic attendance, reduced A&E admission, and emergency admission from A&E, resulted in financial benefits and more efficient use of resources. The service efficiencies assist with both cancer and elective care backlogs.
Our evaluation provided an effective methodology to assess the impact of service redesign that can be replicated across other areas of healthcare.
The evaluation completed by SCW for as been pivotal in highlighting the benefits for patients, demonstrating the great work accomplished by the tea University Hospital Trust, and providing an evidence base for this pilot to become business as usual. Additionally, the evaluation provides us with the critical success factors to consider rolling out the pilot in other areas of Thames Valley. A big thank you to the team at SCW who delivered the project on time, with enthusiasm and kept us informed throughout - Hannah Hollis, Quality Improvement Manager - Personalised Care, Thames Valley Cancer Alliance