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One team working in blood cancer care

Heather Gilmour Heather Gilmour, Network Lead for King’s Health Partners Haematology Institute, blogs about how haematology staff across our partnership are working as one team to provide care closer to home.

As part of the King’s Health Partners Haematology programme, we are working as one team across Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts to provide more services ‘closer to home’ for blood cancer patients.  Several studies have demonstrated that care at home can be safe and effective, and that many people prefer to be treated at home.  We know that regularly travelling to hospital for ongoing outpatient treatment can be stressful and tiring for many of our patients – and we know that some even decline treatments that could make a difference to them because of this.

At the same time, for people who are currently admitted for care as an inpatient, sometimes for relatively long periods of treatment (eg weeks for stem cell transplant), being in hospital for so long can be isolating and lonely and can make it even harder to get back to ‘normal’ life once back at home. 

Innovating how we care for people

For us, thinking about how we could provide ‘care closer to home’ has meant looking at all of our patient pathways, across our partner trusts, and thinking through whether and how some or all of the care could be provided in a different way.   We also looked at experience elsewhere in the UK and internationally, there are lots of positive models to learn from and we are really excited about the potential to improve patient experience and outcomes in this way.

blood cancer did you know graphicAfter lots of groundwork looking at the opportunities, we now have a small team of clinical leaders and stakeholders from across King’s Health Partners Haematology working as  ‘one team’ to pilot three new ways of providing services:

  • providing sub-cutaneous chemotherapy in the patient’s home
  • reducing long inpatient stays by providing some types of chemotherapy, currently only given on the wards, on an ‘ambulatory’ (walk-in) basis – people will attend daily for treatment but can go home at night (or to a local hotel if they live further from our hospitals)
  • changing the way we provide some kinds of outpatient services so that people don’t need to come to the hospital as often – including using telephone and video-conferencing clinics, improving sharing of blood test results between hospitals so that people can have blood tests closer to home, and supporting patients to monitor and report their own symptoms regularly.

 Collecting service user opinions

We have completed scoping and initial planning work for the pilots - and this has included interviewing patients who would be eligible to receive the new services.  It’s been really helpful to understand the variety of views and preferences patients hold.  For example, when we asked patients about having chemotherapy at home, most people were in favour:

Coming four times a week takes a toll on our family. I do like seeing the consultant but having treatment at home would save me a lot of time.
My family works, so it would have been much easier to fit my treatment into our lives if I had had it at home. It would also be a much more comfortable environment.
I definitely would like to have received treatment at home as I am quite worried about picking up infections while I know I have low immunity while on chemo.

But not everyone wanted to receive their care in this way:

I definitely think it’s a good thing to give patients the choice to have chemo at home, though I would not want it myself. I would feel more comfortable coming to the hospital and being with a specialist.
The benefit of coming in and seeing the nurse is them always keeping an eye on you. I only come in once every three months so I would rather come in.

Rolling out one team working

We are currently planning how to pilot the new services in a ‘one team’ way, ensuring that people living across south east London and beyond can receive care closer to home regardless of which hospital they currently attend for blood cancer treatment.  We will work together to develop and pilot new chemotherapy protocols and standard operating procedures (SOPs), working across different trusts to avoid duplicating the work involved and to ensure we learn from each other’s experiences.

I spoke to Dr Kirsty Cuthill, Consultant Haematologist at King’s College Hospital NHS Foundation Trust and one of the team of clinical leaders working on the pilots. Commenting on the benefits of providing care closer to home, she said: 

In my own specialty area of myeloma, the new treatments we can offer mean that people survive longer into older age on ‘maintenance’ treatments – but they are increasingly likely to be frail and less able to cope with the strain of regular travel to the hospital.  Providing care closer to home is the ultimate goal in terms of improving patient experience for these patients in particular.

The King’s Health Partners Haematology Institute is aiming to bring together our strengths in clinical service, research, and education to deliver exceptional outcomes for haematology patients. Our vision is to develop cures and vaccinations for haematological conditions so that future generations do not have to face lives with these diseases.