Evaluating the UCLH-Macmillan Cancer Support Partnership

Background

The University College London Hospital (UCLH) NHS Trust and Macmillan Cancer Support partnership, which formally commenced in April 2012, has at its heart the aim to deliver a better patient experience with high-quality care coordination for cancer patients and their families and carers. The approach was influenced both by evidence from the 2010 National Cancer Patient Experience Survey, which highlighted some weaknesses in patient experience at UCLH NHS Trust, and by a belief that by carefully attending to the whole patient journey, the experiences of patients and carers can be transformed.

The UCLH-Macmillan Cancer Support partnership committed to improve the entire care pathway, from diagnosis through to palliation, and to embed in this a system that actively engaged patients and carers in decision making at all steps along their journey. The new system was to include providing relevant and accessible information and improving care and emotional support.

Specific key changes included a support and information service, a learning forum for cancer nurses, one-to-one support for patients and an extended and restructured volunteering service. Central to the intended improvement was a new building with a dedicated outpatient clinic area, day care and chemotherapy services, day surgery, and on-site diagnostic services to diagnose and treat cancers and haematological disorders.

Evaluation

RAND Europe and the Health Services Research Group at Cambridge University, who together form the Cambridge Centre for Health Services Research (CCHSR), were commissioned to undertake an evaluation of the UCLH–Macmillan Cancer Support partnership.

The evaluation focused specifically on the workings of the partnership and aimed to identify and analyse the views of stakeholders, including staff and volunteers, on how well the partnership is working, how it has changed attitudes and ways of working, and the approach of leaders within the partnership.

The evaluation also tried to determine if, at this early stage, there were perceptible changes in patient experience compared with comparable changes in patient experience elsewhere in the NHS.

Methods

The evaluation applied both quantitative and qualitative methods:

• In-depth interviews with 21 staff and volunteers conducted between May and August 2014. Interviews focused on understanding how staff at different levels/in different roles experienced the cultural change the partnership seeks to achieve. Interviews took place between May and August 2014.
• An online survey of 88 staff members involved in the delivery of cancer services conducted between December 2014 and January 2015. The survey explored whether and how a wide range of staff experienced change in ways of working and approaches to patient care.
• In-depth interviews with 16 senior strategic and operational managers (partners) within the partnership conducted between April and June 2014. Interviews sought to explore the impact of and the value that partners place on the partnership and whether or not objectives had been met and why, and to so provide a narrative and learning about the partnership, how it has developed, what it has achieved and what the challenges have been. Interviews took place between April and June 2014.
• Analysis of the 2012/13 and 2014 waves of National Cancer Patient Experience Surveys, building on the analysis of waves 2010 and 2011/12. The specific focus of the analysis was on the degree to which UCLH reported improved patient experience relative to elsewhere in the NHS over time.
• A learning event with members of staff to elicit their reflections on findings.

Findings

• Within broadly positive perceptions across the board, there were important variations – with senior staff being more positive and optimistic than frontline staff
• There was a positive ambition, vision and expectation among leaders, but this was not always communicated to the whole organisation
• Staff wanted to understand what the partnership meant in specific terms for their jobs and careers
• There was strong support for strengthening learning through partnership working
• There was a danger that positive changes might be undercut by growing pressures on staff

Recommendations

On the basis of these findings, the evaluation identifies five recommendations:

1. Create a learning environment to help bridge the perceived gap between high-level vision and specific working practices, to inform the future direction of the partnership and to spread the lessons learned more widely
2. Ensure that readily available, relevant and timely data on patient experience are routinely used
3. Optimise the wider networks of the partners
4. Communicate specific goals to reinforce the high-level vision
5. Support culture change and engage with frontline staff

Project Team