In times where advanced treatments and a population living longer are putting pressure on services, cancer care must transform itself to meet this demand while at the same time as providing efficient, high quality, coordinated and patient-centred service delivery.

The dynamics of cancer care are changing as never before. More people than ever are living with cancer and many more are surviving as scientific understanding expands.

As the average age of the population steadily increases, more and more people are reaching the end of life phase of the disease. Each of these groups, and each person within each group, has their own set of needs that need taking care of.  What’s more, increasingly these needs are being serviced by an ever broader range of treatments and services delivered in a variety of settings.

Add to this background the new policy and service frameworks, such as the Modernisation & Reform of Supportive and Palliative Care in Northern Ireland, the Living Matters: Dying Matters Strategy, the NI Cancer Services Framework, the NI Assembly Priority for Action Targets, and a clear challenge begins to presents itself: in the wider context of economic uncertainty, how does cancer care transform itself to meet greater demand and at the same time provide new, efficient, high quality, coordinated and patient-centred service delivery?

Genevieve Murphy, senior learning and development manager at Macmillan Northern Ireland explained: “What is needed is an approach to service development that can be applied quickly, providing a framework and process which is applicable over a range of service improvements that allows us to work in co-operation with multiple agencies.

“We concluded that it was essential to develop such an approach and be able to offer training in the use of it. We discovered that the best approach was ‘lean’”.

Funding for the programme was secured from the Macmillan Engagement Programme Fund. Participants were selected from each of the five trusts in Northern Ireland, on the basis of their involvement in service redesign and their ability to influence the outcome of projects. 

The Macmillan Service team then worked with the participants, assisting them in identifying priority service improvement projects for cancer care in Northern Ireland.  The team from Amnis then led pathway redesign activity and provided expertise in the scoping process. 

Amnis’s Mark Eaton said: “The lean approach strives to apply common sense and practicality. At its core it focuses on adding value to services provided to patients, while identifying and removing aspects which add no value.  Through concentrating on what is of value to patients, processes are redefined as value streams, removing barriers to ‘flow’ through continuous improvement, striving for perfection.”

He continued: “For those tasked with leading service improvement, lean offers invaluable insights into the skill of looking at large scale projects as a whole while also honing in on the smaller, microcosmic but equally vital elements of a process. For example, a lean approach might determine how a redesign of a discharge process might deliver a more efficient process or a better overall experience across the whole pathway.”

The focus throughout the programme is on the practical application of lean tools to real life projects, delivering improvements in the quality of care and a reduction in the consumption of resources. The aim is to accelerate existing improvement projects and help to define new ones.

Projects that participants are currently undertaking through the programme include:

  • A regional service improvement initiative which aims to introduce a new model of breast cancer follow up and will improve the quality of cancer patients’  after-treatment experience, reduce inefficiencies in hospital follow-up and enhance service coordination and integration.
  • Transforming the existing welfare benefits service to a model which supports the patient at the acute phase of their diagnosis and treatment or at end of life and provides a managed referral to those patients with less acute needs to community advice services.
  • An initiative to reduce the length of time patients are in the haematology unit and ensure an even spread of workload throughout the day.
  • An initiative that reviews the inappropriate admittance at A&E of patients residing in private nursing homes who are nearing the end of their lives, reviewing the steps involved in the decision to transfer the patient and implementing good practice protocols and training.