Enhanced Supportive Care makes excellent cancer care possible - Dr Richard Berman

Dr Richard Berman - Christie consultant 

Dr Richard Berman

Cancer is changing. With better treatments, more and more people are surviving, or living longer than ever before. And as a palliative care consultant at The Christie, this means that my role has changed too.

I still work hard to ensure excellent care for patients at the end of their lives; but increasingly, I help patients much earlier, during their cancer treatment, by providing specialist care to manage their pain and symptoms. This means that we actually help patients to get through their cancer treatments, in a positive way.

And in fact, evidence from around the world shows that earlier involvement of supportive and palliative care in cancer care results in better outcomes for patients, including the potential to extend their survival.

This represents a real opportunity for palliative care. But if we want to be part of cancer care earlier, does the term ‘palliative care’ still fit?

I think it doesn’t matter where patients are in their cancer journey, people always need hope. They need to feel that the health professionals looking after them are working with them in a positive way, and doing their best to keep them feeling as well as possible, for as long as possible.

So we needed a very positive vision; a new approach to delivering palliative care. How about the term ‘Supportive Care’?

‘Supportive care’ is the management and prevention of the adverse effects of cancer or cancer treatments. At The Christie we developed this into ‘Enhanced Supportive Care (ESC)’, an initiative that promotes the earlier integration of supportive care within cancer care.

There are 6 principles:

• Much earlier involvement of supportive care services in cancer care
• Teams that support cancer patients should work more closely together
• We should adopt a much more positive approach to supportive care
• Cutting edge and evidence-based practice in supportive and palliative care
• Technology to improve our communication and way of working
• Best practice in care of patients undergoing chemotherapy

And we’ve taken some bold (but simple) steps to make this work.

The Christie has renamed our palliative care team to the ‘supportive care team’ to help break down the barriers to achieving earlier involvement of palliative care expertise.

We have worked much more closely with our oncology teams, in their clinics, and on the wards.

We have focussed much more on minimising the side effects of supportive care treatments and provide up-to-date pain and symptom management – not only to improve and maintain quality of life, but also to help patients through their chemotherapy treatments.

And we not only support patients with advanced cancer, but also those who are living with cancer as a long term illness and cancer survivors.

The work we have done around integration with oncology and early intervention has increased patient and carer satisfaction, reduced hospital admissions and most importantly, given patients hope.

ESC has been recognised nationally by NHS England, and received a national QiC (Quality in Care) patient care pathway award in February 2016.

Now, I’m delighted to be able to play a role – as NHS England’s National Clinical Lead – in encouraging and supporting more cancer centres to adopt this kind of approach. As part of this, we have recently produced guidance for providers and professionals which will help them think about how they identify and meet the changing needs of cancer patients as they go through their treatment journey.

Enhanced Supportive Care is a new initiative aimed at addressing more fully the needs of cancer patients – in particular, preventing and managing the adverse physical and psychological effects of cancer and its treatment.

Cancer can take a huge toll on those who are living with it, whatever their prognosis. But as this programme is phased in over the coming months and years, I am confident that we will be doing the best we can to reduce that toll for thousands of patients.

Dr Richard Berman FRCP is a Consultant in Supportive & Palliative Care at The Christie. He is also NHS England’s National Clinical Lead for Enhanced Supportive Care.

For more details of the supportive care services offered at The Christie, please visit www.christie.nhs.uk/services/r-to-z/the-supportive-care-team/

A tiny bit of pain is nothing compared to what cancer patients are going through - Bex Smalley

Bex Smalley, Christie fundraiser and former patient

Bex Smalley

People often ask me why I do so many charity events, especially the more daring ones. As well as the fact I am a secret adrenaline junkie, I tell them that I will always do these events for as long as I can, because without The Christie hospital I wouldn't be here today. 

When I was 17 I was diagnosed with Hodgkin's lymphoma. By the time they found it they said it had been growing for a few years as the main tumour was so large. The tumour had also collapsed my lung and there were three other tumours too. 

I received treatment at The Christie, which consisted of strong chemotherapy followed by radiotherapy. Chemotherapy was hard. And as a teenager I missed out on a lot of things over the space of that year. And although the treatment was difficult it worked and saved my life. 

Since then I have done fundraising events almost every year (skipping a year or two when I had my miracle baby after being told I would never be able to have children due to the strength of the treatment I received).

The events I have done have varied from parties, walks and runs to skydives and at the end of last week, The Christie’s first ever firewalk! 

One of my friends at work told me about the event and I had seen it in The Christie newsletter too, but I wasn't sure about doing it until I was asked to join by my friend Julie. Julie’s husband is currently receiving treatment at The Christie. 

After signing up, I expected that in my fundraising kit I would read about how it is all an illusion and we wouldn't really we walking on hot coals! But that wasn't the case. So in the weeks leading up to the event I was getting more and more nervous. 

When the day came I plucked up the courage to turn up and we received an hour’s training. The trainer was a world record holder for walking on hot coals! He told us all that although it seems impossible to be able to put our bare skin on something so hot, it is in fact very possible and wouldn't cause any lasting effects. 

After the training session we were taken outside and put into groups. 

This is when I saw the hot embers and my fear kicked in again. But our trainer was the first one to walk across to show us that it can be done with ease. 

When it was my turn I stood staring at the glowing coals and my brain was telling me I was foolhardy to be considering this. But the crowd was cheering me on and I set off. 

It felt like I thought it would, like I was walking across extremely hot coals, some small embers were sneaking in between my toes and burning my skin, but the walk wasn't long and by the time I was off I was wiping my feet and dipping them into buckets of ice water. 

The team then asked me if I wanted another go and of course I said yes. 

After two walks across the ‘fire’ I was surprised to see that there were no blisters or raw skin and that my feet weren't sore at all. 

I would definitely recommend others try this event as it helps to conquer fear and also it isn't an average fundraising event either, which I think is the reason why I managed to raise over £1500! Thanks to all my friends and colleagues who sponsored me.
  
So I will keep on doing these events, no matter how outlandish they seem at first, because it is all worth it to help such an important hospital and support the hard work that they do every day to save more and more lives. 

A tiny bit of pain is nothing compared to what the patients are going through and all the money goes towards a better future for people living with cancer.

If you want to know more about our charity fundraising activities please go to www.christies.org/get-involved/ 

As the senior sister on Ward 1, the results of the Friends and Family Test are extremely important to me and my team - Emma Turner

Emma Turner, senior sister on Ward 1

Emma Turner, senior sister on Ward 1

As the senior sister on Ward 1, it’s really important to me and my team of dedicated nurses that we deliver the very best possible standards of care for our patients. Patient care is always our top priority at The Christie, no matter which part of the hospital you are in. 

Getting feedback from our patients is one of the most important ways we can find out how we are doing and learn what we need to do to drive improvements to our service. 

One of the best ways we have to gather feedback is through a survey called the Friends and Family Test (FFT), an anonymous survey which we ask all of our patients to complete when they are discharged.

The Friends and Family Test asks patients two questions; how likely they are to recommend our ward and what were the best/worst aspects of the service. The results of the FFT highlight the aspects of our care which make a difference to our patients and how we can make it even better. The percentage of patients who are ‘extremely likely’ to recommend our care is also fed back monthly as the ‘Friends and family score’.

As the senior sister on Ward 1, the results of the FFT are extremely important to me and my colleagues.

The feedback allows us to focus on what really matters to our patients, driving us to provide world class care that is centred on the patient experience.  By giving our patients a voice in the development of our service we have found that even small changes have improved their time with us.

Just one example of patient led change is our staff board. On the suggestion of a patient, we developed a board next to the nurses’ station which displays pictures of the nursing team on shift that day, their names, role and who they are looking after. The picture of the patient’s nurse that shift is also placed on the board next to their bed.

This has been warmly received by both the patients, relatives and by staff as it ensures a designated staff member can be recognised at all times. Personally, I feel that involving patients and listening to their feedback not only improves the ward but reminds them that their individual journey is at the heart of our care.

As well as allowing patients a chance to steer the development of the ward, the FFT also allows them to give the ward positive feedback. For me, informing staff of the praise we receive is one of the best parts of my job. It reminds staff that the work and dedication they put in really makes a difference, and that good care changes lives.

After some incredible feedback I just had to make a poster displaying some of the comments on the ward because everyone deserves to be reminded that, and I quote, we provide the same service as a “5 star hotel.” This type of feedback gives us all the drive to give that little bit extra every time, as well as reassuring new patients about the quality of our care.

Finally the FFT score provides us with the ultimate review of the care we provide – whether they would recommend the ward to their friends and family - or not. I am proud to say that since the official opening of Ward 1 we have never dropped below 96%. And have had the best score in of any wards at The Christie since October 2015.

This score reflects that the care we provide is gold standard and patient centric, reassures new patients that they are safe in our hands and encourages our staff to always go the extra mile.

So if you are a Christie patient, please take a few minutes to fill out the Friends and Family Test. Your feedback really does make a difference and helps us to improve care for all patients.

You can read more about the Friends and Family Test and see some of the feedback from our patients by visiting www.christie.nhs.uk/about-us/our-standards/patient-surveys/the-friends-and-family-test/