Macmillan Cancer Improvement Partnership in Manchester (MCIP)

Programme Summary

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Forward by MCIP’s Board Chair and Programme Director 3

Introduction & overview 4

The co-production model 9

Primary care 13

North Manchester Macmillan Palliative Care and Support Service 16

Advanced breast cancer 19

Primary breast cancer monitoring and aftercare 21

Lung cancer early diagnosis pilot 25

Advanced lung cancer 29

Non-clinical cancer champions 30

Workforce education 32

MCIP Legacy 34

Contents

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Forward by MCIP’s Board Chair and Programme Director

As the Macmillan Cancer Improvement Partnership (MCIP) programme reaches its conclusion, we are pleased to provide this overview of what it involved and what’s been achieved. The programme has delivered on its promises to improve cancer care for Manchester residents and it’s been a pleasure to lead this work over the past four years.

The successes achieved have been based on true collaboration and joint working between clinicians, health care commissioners and people affected by cancer. We have together created lasting changes which will bring benefits for many years to come, both in Manchester and also much further afield as others have drawn on the good practice created through the MCIP Programme.

We would like to thank all involved with MCIP. Without you the programme would not have made the impact it did. We are particularly grateful to Macmillan Cancer Support for providing the funding which made MCIP possible but also for its expertise in cancer care which has been invaluable in designing service changes. Special thanks go to our volunteers who crystallised our thinking on what needed to change and the front line clinical teams who ensured that new services have been delivered to the highest standards of clinical practice.

We have developed sustainability plans for each of the streams. We are pleased that many new services and changes have been embedded into normal practice and have received continuation funding. As MCIP concludes, the good work of our partner organisations continue, so we are confident that the impact of the MCIP change work will also continue. Our challenge to you is to keep working together to take the work started by MCIP on to new levels and into new areas! We have been privileged to lead this fantastic partnership and we are sure that the joint working as well as service changes will persist for many years to come.

Janet Tonge Denis ColliganMCIP Programme Director MCIP Board Chair and Macmillan GP

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Members of the MCIP Board and Programme Team

Introduction & Overview

When the Macmillan Cancer Improvement Partnership (MCIP) was launched in June 2014 every partner involved in this complex and wide-ranging programme knew that huge challenges lay ahead.

How could our health care commissioners, Macmillan, hospitals, GPs, people affected by cancer, Manchester City Council, St Ann’s Hospice and others work together to deliver real change that would improve outcomes for patients?

Manchester has some fantastic cancer care and treatment, and yet the city has some of the highest levels of cancer in England alongside high levels of deprivation and social exclusion. These factors can contribute to cancer incidence, late diagnosis and premature mortality. Rates of premature mortality (before age 75) from cancer in Manchester are some of the highest in England and a third of these deaths are accounted for by lung cancer. The MCIP programme was challenged with tackling a range of issues relating to cancer care policy, systems, and the design of cancer pathways and services.

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Currently, most cancer services focus primarily on cancer as an acute illness with little support provided following the end of treatment and within primary and community care settings. However, this picture is changing and advances in treatment mean that those with incurable cancer can live for many years. Even for those considered to be cured of their cancer, consequences of treatment can have a long-term impact physically, financially and socially.

Phase 1 of the MCIP programme focussed on improving the quality and coordination of care in primary, community and palliative settings. Phases 2 and 3 looked to improve early diagnosis and service improvements for breast and lung cancer patients as well as broader health and care workforce education.

Co-design and involvement of people affected by cancer has been a hallmark of the MCIP programme. MCIP worked closely with cancer patients and carers to understand their needs and expectations. Patients and carers sat on working groups and the MCIP board. Everything was created by and for people who were affected the most by cancer. MCIP also worked with a wide range of healthcare professionals responsible for cancer care to discover what was working well and what needed to be changed and how to achieve this.

Since the official launch of the MCIP programme in June 2014 significant achievements have been made in establishing and implementing ambitious cancer improvement work across the city of Manchester. This work has been made possible through £5.5 million funding from Macmillan Cancer Support.

People affected by cancer have worked with clinicians, commissioners and many other organisations to improve services across the city.

The investment by Macmillan in MCIP has created real changes for patients. The vision was that people affected by cancer in Manchester could say that they had the best support and treatment from an expert team who made them feel cared for and in control. All improvement work has been co-produced by people affected by cancer, clinicians and commissioners from different organisations working together to improve services. MCIP’s Partnership Board members included:

• Macmillan Cancer Support• North, Central and South Manchester Clinical Commissioning Groups (now

Manchester Health & Care Commissioning)• People affected by cancer• Manchester GPs

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• Manchester City Council – Public Health and Adult Social Care• Central Manchester University Hospitals NHS Foundation Trust and University

Hospital of South Manchester NHS Foundation Trust (now Manchester Foundation Trust MFT)

• The Christie NHS Foundation Trust• Pennine Acute Hospitals NHS Trust• St Ann’s Hospice

MCIP also worked closely with Manchester Cancer, the Greater Manchester Cancer Vanguard and other change programmes.

The MCIP Programme had a number of key projects. These included:• Primary and palliative care: This focused on reducing variations in care

through development of a Locally Commissioned Service based on 24 cancer care standards, practice based cancer champions and workforce training.

• Learning and Development: This was about training for non-cancer specialists in Manchester’s health and social care workforce.

• North Manchester Macmillan Palliative Care and Support Service: This was about improving care co-ordination through development of a new model of integrated community based palliative care for patients with a life limiting illness in North Manchester as a pilot for the rest of the city.

• Lung Cancer improvements: This included a ground breaking early diagnosis pilot and a review of the diagnosis to treatment pathway for those with advanced lung cancer.

• Breast Cancer improvements: These included a new monitoring and aftercare pathway based on the recovery practice and work to improve consistency in care for advanced breast cancer patients.

User Involvement Volunteers discuss materials for MCIP's Advanced and Secondary Breast Cancer Project

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Real changes for people affected by cancer

The investment by Macmillan in the MCIP programme has created real changes for patients and a focus for NHS Commissioners and providers to change practice and investment.

Our change programme was based on the Macmillan 9 outcomes and national cancer improvement areas matched to local need. The MCIP Programme Scope diagrams below illustrate how all the projects fit together and form one coherent programme of work.

MCIP programme areas linked to the local cancer plan priorities and Macmillan 9 values

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The co-production model

BackgroundPatients and carers were at the heart of all of MCIP’s work. More than 50 people affected by cancer were involved in a range of activities and events to improve cancer services and pathways.

Roles included:• Board and working group membership• Focus group participants• Communications advisers• Engagement volunteers• Service promotion outreach• Networking events• Film case studies• Media interviews• Mentoring• Peer to peer interviewing

Why was this needed? In order to ensure that MCIP’s work remained relevant and improved the experience of people affected by cancer in Manchester it was vital to have a co-production model.

Patients, carers, relatives and friends of people affected by cancer were integral to ensuring that new systems and services match the needs of the people who are going to use them. MCIP have engaged with many communities throughout the programme to hear the voice of many people affected by cancer which has included gathering case studies and hearing views from different community groups.

“It’s been a unique partnership, I think, because you’re working across the different areas - you’ve got the Trusts, you’ve got the CCG, you’ve got Macmillan, you’ve got the hospice. It’s quite a unique partnership, but what’s made it work, I think, is the communication. It’s getting your values and your core principles out at the start, so everyone’s clear about what you’re doing and why you’re doing it.”

“The way I look at it is like designing a car, if you don’t ask the passenger where they want to sit when you put the seats in, it’s not going to be a very comfortable ride for them.”

Two of MCIP’s highly valued and long-serving User Involvement Volunteers Mike Thorpe and Tom Harrington manning an information stall at North Manchester General Hospital

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“I’m always very proud to tell other cancer charities about how MCIP have put ‘Manchester on the map’ with the projects they’ve developed over last two years.”

What has it achieved?Feedback from people affected by cancer (pabc) has resulted in many changes across the programme. Some highlights are:

• Clearer explanations used for new services and appointments such as ‘An Exit Consultation’ was changed to ‘Moving On Appointment or Treatment Summary Appointment’.

• Patient views were used to improve pathways to ensure bone health was correctly monitored for breast cancer patients.

• A minimum standard was developed for Treatment Summaries based on patient experiences so all patients and GPs received appropriate, easily understandable information from their cancer care team.

• Widespread changes were made to the patient information leaflets for the lung health check programme to make them easier to read and to answer patients questions about the service.

• Changes were made to the locally commissioned primary care service based on patient views, so that for example GPs made more speedy contact with people when first diagnosed to offer support.

• Patient feedback was used as the basis for the changes in palliative care that resulted in the new North Manchester Macmillan Palliative Care and Support Service model being introduced.

MCIP's User Involvement Volunteers receiving a well-deserved Macmillan Award from one of our public champions, broadcaster Andy Crane

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PABC legacyThe main legacy of the user involvement work lies in the successful design and implementation of new services which provide better care and support to people affected by cancer. The work of our fabulous volunteers has also been externally recognised and won’t be forgotten. Our User Involvement Group:

• Received the Richard Hambro Award: people affected by cancer working with the MCIP Programme received the Regional Award for leading and inspiring change

• Have designed an armchair featuring their words and images. Once complete the chair will be exhibited around Manchester to promote user involvement in cancer services.

• Created a library of films, many featuring people affected by cancer and the work of the MCIP Programme

• Will be featured in a Volunteer’s Yearbook capturing the personalities and contributions of User Involvement volunteers

“I would hope it has contributed to improving the service and also making it more personal. I believe it gave a voice to users rather than being done to. We had a real impact in changing things for the better. I believe we as a group have helped define what a good service looks like.”

MCIP would like to thank all User Involvement Volunteers, without you the programme would not have made the impact it did. Special thanks go to those who helped us understand more fully what needed to change and for their tireless work throughout the last four years.

Volunteers taking part in a panel discussion at MCIP’s Tackling Cancer Care in Manchester in Feb 2017

MCIP Programme Manager Chris Mathewson asks a question of the volunteer panel at Tackling Cancer Care in Manchester

Lung Health Check patient Michael Brady in discussion during MCIP’s Curing Lung Cancer: A Paradigm Shift event in September 2017

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MCIP’s Events Had Huge ImpactVolunteers Mike Thorpe and Michael Beswick in discussion with Macmillan’s Ali Davenport

MCIP Clinical Lead Dr Wendy Makin addresses the Living With and Beyond Cancer Conference in Manchester

Writer Caroline Aherne supported MCIP from the outset. Speaking here at our official launch in June 2014

A panel discussion at MCIP’s launch at Manchester Town Hall June 2014

The launch of the North Manchester Macmillan Palliative Care Support Service

Volunteer Tom Harrington at an outreach event in

Lower Blackley

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Primary Care

What was the project?The Locally Commissioned Service (LCS) was an enhanced primary care service to help improve the consistency of primary care support to people affected by cancer. It was co-designed by people affected by cancer together with Macmillan GPs and health commissioners, it created 24 clear standards that practices had to attain.

Why was it needed? Good practice was already taking place in many Manchester primary care settings but care was not always consistent or based on the latest and best practice.

Designing and delivering training to clinical and non-clinical staff and supporting practices through facilitator support was key to improving systems and procedures. What has it achieved?The primary care change work:

• Created 160 practice ‘Cancer Champions’ (clinical and non-clinical) who led practice based change work

• Delivered a workforce development programme to practice staff in the areas of early diagnosis of cancer, acute oncology, communications skills, survivorship and palliative care

• Ensured improvements in systems and processes including the use of cancer review templates, cancer and palliative care registers, and regular GP palliative care meetings

• Macmillan Info-Points were installed at all participating practices

Infopoints are in all of the LCS’s Manchester GP practices

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Some key outcomes are summarised below.

• Palliative care: Over 800 ‘missing’ patients not on palliative care registers were ‘found’ so that their care could be better coordinated. Over the period of the LCS, the number of patients on palliative care registers increased from 1,517 to 2,365. The number of regular practice meetings to discuss patients on the palliative care register increased 55% from 49 to 76 practices.

• Early diagnosis: The number of practices contacting non-responders for screening increased by 193% from 27 to 79. One practice that sent 235 ‘did not attend’ letters to breast screening non-responders had seven patients receive a confirmed diagnosis after screening.

• Improved patient information: Many patients shared feedback that the information provided at Macmillan Information points had been helpful in signposting them to important services. The project also ensured that the number of practices informing patients entitlement to free prescriptions increased from 45 to 79.

• Populated cancer registers: During the LCS period the number of patients on cancer registers had increased by 30.5% which supported more proactive care to avoid crises and improve patient experience.

• Improved staff confidence: The percentage of key staff attending training that report an increase in confidence in advising and supporting people affected by cancer exceeded its target of 75%.

Project legacyThe LCS Cancer Standards have continued in a revised form as the Manchester Care Standards. A new Palliative Care Facilitator team will be in place from February 2018 to support further practice developments especially around palliative care.

An additional project was created in 2017 to support the non-clinical cancer-champions role developed as part of the LCS. Further information on this is included later in this report.

We are delighted to report that Macmillan included the Manchester Primary Care LCS as an example of best practice in their Ten Top Tips for Commissioning Guide and that the Macmillan Information Points remain in place within practices.

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User Involvement Volunteer Nina Jackson co-designed the LCS and appeared in a poster publicity campaign

Manchester’s Macmillan GPs (L-R) Sarah Taylor, Denis Colligan and Amanda Myerscough. This small team played a huge part in every area of MCIP’s success. Successful GP engagement is a crucial factor

MCIP user involvement volunteer Nina Jackson said:

“The Macmillan Infopoints are such a simple idea, but they make a big difference to patients. Knowing that there’s a receptionist or nurse who you can talk to about cancer is a major help for anyone who has any worries at all about cancer.”

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North Manchester Macmillan Palliative Care Support Service (NMMPCSS)

What was the project?Launched in April 2015, it ensured that patients with life-limiting illnesses in North Manchester could have better care coordination.

The project brought together professionals and trained volunteers to deliver the full package of support to patients based in the heart of the community to deliver:

• Round-the-clock telephone advice as well as visits and care in the home• Dedicated professionals working together seven days a week from 8am – 8pm• An open referral system for patients, carers and professionals.• Help with managing symptoms as well as psychological and emotional

support• Ensuring patients had a say in their care

Patient Michael Beswick:

“I think the most significant point in realising where the team was coming from was when my GP arranged a Multi Disciplinary Team meeting and invited my family to join in as well. It was a very intense meeting. Everybody was listening and they were all putting in their contribution at the right time and at the right pitch.“It was only afterwards that I realised that everybody there was caring for me.” “I’m not going to sit here and just curl up and die. I’m looking for ways to keep going and so far they’ve managed that very well.”

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Why was it needed? Prior to the NMMPCSS, the number of patients on GP Palliative Care Registers in North Manchester was low – 359 compared to 800 expected and there was a much higher number of people dying outside of their preferred place of care than elsewhere in the country. The ability to coordinate care early was hindered by the lack of shared practice in identifying patients in their last year of life. By the end of the service pilot, the number of patients on the registers in North Manchester was above 800 and in line with expected levels meaning that care could be coordinated for these patients at such an important time.

What has it achieved?The new service remodelled palliative care services and created a community hub from which services could work better together and more fully meet the needs of patients. The daily meeting between the palliative care team and the district nursing service has improved the communication and the ability to deliver timely more integrated care to patients and support carers. In addition, a weekly multi-disciplinary team meeting (MDT) chaired by a consultant in palliative medicine also takes place.

A newly created Assistant Practitioner role in palliative care now supports the clinicians and patients to implement their care plan and has proved an extremely valuable part of the whole package of palliative care and support in the community. This new way of working has meant that that:

• All patients now contacted on the day of referral• GP palliative care registers have increased by 80% and 31 practices out of 36

now have regular palliative care meetings• 82% of patients died in their recorded preferred place of care in 15/16

compared to 59% in 14/15• Average caseload deaths in hospital reduced from 21% in 14/15 to 13% in

15/16• Deaths routinely reviewed to assess if patients were able to die in their

preferred place of care• Consultant and team regularly review patients admitted to hospital to

determine if admissions could have been prevented• Hard work of the clinical team at PAHT and community staff recognised by the

CQC inspection who rated the service as ‘outstanding’• International journal of Palliative Nursing awards who presented the team with

Multidisciplinary Teamwork Award

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Project legacyNorth Manchester CCG (now MHCC) took the decision in November 2016 to permanently fund the service. It now provides a model for the rest of the city.

Members of the NMMPCSS team taking their message to the people of North Manchester. Outreach stalls like this one at ASDA in Harpurhey were vital in communicating the service and its accessibility to the wider public

Members of the NMMPCSS at their weekly Multi-disciplinary Team meeting (MDT)

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Advanced Breast Cancer

What was the project?MCIP worked to ensure that there was more consistent support in place for patients with locally advanced and metastatic disease who are being treated with non-curative (palliative) intent.

The project worked with worked with patients cared for within the city of Manchester and registered with a Manchester GP. The aim was to ensure that clear definitions of roles for key workers and care coordinators were in place and to better define the interface between the Breast Clinical Nurse Specialist and palliative care nurses. The aim was that every patient should know who their key contact was throughout the treatment pathway.

Why was it needed? People diagnosed with advanced breast cancer, along with their families and carers, have complex needs. They may require support and care over a period of time and often cross between different treatment locations and cancer care settings. Scoping identified gaps in information and support available and discrepancies between provision and related national guidance (NICE 2015, 2015a, 2015b, 2011). The project ran from February 2015 to December 2016 and sought to establish the current advanced breast cancer service provision across the city of Manchester and set up an ideal pathway of support and care.

What has it achieved?• Redesigned pathway including a shared vision of supportive care and HNA

for all patients• Clear definition of roles and responsibilities of professionals and agreed

processes for the transfer of the key worker role• A new credit-card sized “Support for You” was card distributed to all patients

at diagnosis• A new “Working Together for You” booklet• Treatment summaries piloted to improve and standardise communication with

GPs• A dissemination plan to communicate key messages about pathway

improvements

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Project legacy• Working group continue to meet bi-annually to embed improved practices into

services• Improvements have been disseminated through Greater Manchester Breast

Pathway Board and Macmillan networks

The Advanced Breast support card was co-designed with patients

Ros Fox, Macmillan Secondary Breast Care Nurse Specialist at The Christie with the MCIP Advanced Support For You Card

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Primary breast cancer monitoring and aftercare

What was the project?In the city of Manchester, approximately 300 patients ever year are diagnosed with primary breast cancer at Pennine Acute Hospitals NHS Foundation Trust (PAHT) or Manchester University NHS Foundation Trust.

This project sought to better support patients after treatment for breast cancer by developing a recovery-orientated programme of support. This included:

• Redesigning follow-up pathways• Developing and introducing new processes and protocols for mammographic

surveillance• Introducing Treatment Summaries and Written Care Plans• Promoting supported self-management through Health and Wellbeing Events• Ensuring effective triage for patients who need to re-access services• Developing and introducing pathways to monitor bone health and cardiac

function in high-risk groups

“Breast teams have worked with patients to design a new approach to recovery from treatment.

“This encourages and supports people to be active, look after their health and get in touch with professionals when they need help or advice.

“MCIP work is leading the way in new models of cancer care in Greater Manchester.”

Dr Wendy Makin - MCIP Clinical Lead

“Many breast cancer patients simply do not need to be seen by their consultant following treatment. It’s important for them that they leave behind as far as possible the hospital environment and are given support outside to help them pick up their lives again as a person rather than a cancer patient.”

Professor Nigel Bundred, MCIP Breast Clinical Lead

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Why was it needed? The number of people living with and beyond breast cancer is rising. Traditionally, patients who have been treated for primary breast cancer are followed-up with annual mammography and annual clinic review with a breast clinician for at least five years or until breast screening age is reached (47-52 yrs, depending on area), whichever is longer.

As the incidence and prevalence of breast cancer continues to rise, this traditional approach to aftercare is:

• Unsustainable • Not always meeting the individual’s needs• Based on a medical (illness) model rather than a self- management (wellness)

model

This new model of aftercare was launched at Pennine Acute Trust and University Hospitals of South Manchester (now Manchester University Foundation Trust) in October / November 2017. The new model focuses on recovery and means that their normal routine is not disrupted by unnecessary hospital appointments. Instead, patients can quickly access the breast care team and hospital if and when they need to and there are now increased recovery support options.

“I was able to discuss concerns without being rushed and felt the nurse was genuinely concerned about me. All my questions were answered and I feel more positive about the future” (quote from patient on new pathway)

What has it achieved?The redesign of the patient pathway has focussed on changing the way people are supported following their breast-cancer treatment. As part of this pathway redesign, a new Treatment Summary Appointment was introduced. This is a 45 minute, nurse-led appointment at which a treatment summary is completed, a Holistic Needs Assessment is offered, a Written Care Plan is developed if required and the patient is invited to a Health and Wellbeing Event. The appointment aims to prepare the patient for supported self-management. As a result:

• 71% of patients diagnosed in the last twelve months have been assessed as suitable for supported self-management

• 100% of patients are now offered a holistic needs assessment• 97% of patients receive a written care plan• 94% of patients who returned questionnaires were satisfied or very satisfied

with their breast cancer treatment

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• 95% of patients who returned questionnaires were satisfied or very satisfied with the information and advice given at their moving-on appointment

Project legacyThe revised approach redesigned two aftercare pathways and those for monitoring bone and cardiac health. These are successfully operating and will remain in place after the end of the MCIP programme. It also revised processes and protocols for mammographic surveillance and established an Aftercare Coordinator role. The new Treatment Summaries, Holistic Needs Assessment and Written Care Plans as well as the Health and Wellbeing Events will continue to be offered after MCIP closes. The project has also led to:

The production of a new diet film for use at breast cancer Health and Wellbeing events nationwide. This will be shared via Clinical Nurse Specialist forums, Macmillan networks and Greater Manchester Pathway Board.

Knowledge and learning from the breast pathway redesign will impact on other areas including follow-up for colorectal and prostate cancer patients.

Breast care teams at MFT (was UHSM) pictured top and PAHT pictured bottom.

“The breast care nurse at my Moving On appointment was particularly warm and understanding – she explained side effects of radiotherapy and reassured me. I appreciate the plan to feed back the results of my mammogram as quickly as possible.” (Quote from patient on new pathway)

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Lung cancer early diagnosis pilot

What was the project?The Macmillan Cancer Improvement Partnership in Manchester (MCIP) worked incollaboration with the lung cancer team at the Manchester University Hospital Trust (Wythenshawe Hospital). The service was funded by Macmillan Cancer Support and commissioned by Manchester Health and Care Commissioning.

The aim of the pilot was to find lung disease especially lung cancer at an earlier, and therefore more treatable stage. Evidence shows that lung cancer survival rates are much higher the earlier a cancer is found.

Smokers and ex-smokers aged 55 to 74 in fourteen GP practices were invited to attend a community based Lung Health Check, which could offer them an immediate on-the-spot low-dose CT scan. The Lung Heath Check was based in supermarket car parks with a one-stop shop design to make taking part as easy and convenient as possible. It was conducted by a lung specialist nurse and included discussion about symptoms, a breathing test (spirometry) and a calculation of a person’s individual lung cancer risk. Anyone at high enough risk was invited to have an immediate low-dose CT scan in a mobile scanning unit.

Specialist NHS Consultants reported the CT scans usually within 14 days. Most scans were negative and required no further action. Where there was a finding that needed follow-up investigation, scans were reviewed by the lung cancer team at Wythenshawe Hospital and patients invited to attend the chest clinic. Other lung health problems found were referred back to local GPs for follow up advice and investigation where needed.

Why was it needed? Too many people in Manchester are dying from lung cancer and there are high levels of other lung problems such as COPD. Most lung cancers are diagnosed at a late stage where survival is poor. Manchester has some of the highest rates of smoking in the country, which is a major factor in poor lung health especially in large sections of the city’s deprived communities.

Lung cancer is a very common cause of death in Manchester in people under the age of 75. The combination of high levels of smoking and older age result in north and south Manchester having some of the highest rates of lung cancer in the country.

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What has it achieved?The pilot diagnosed 46 lung cancers affecting 42 patients, more than one lung cancer for every scanning day. Almost 80% of cancers were early stage and only 1 in 10 had advanced lung cancer (stage 4). Potentially curative treatment was offered to 9 out of every 10 people with lung cancer. This was a marked difference to lung cancer diagnosis outside of screening where half of patients have advanced disease and therefore do not have a curative treatment option.

The input of GPs was crucial to the success of the project with fourteen practices in three clusters taking part. The pilot practices played a pivotal role in communicating and engaging with patients. Without this GP input in tandem with a concentrated community engagement strategy, people would not have used the service to the extent that they did. The community engagement work was led by Manchester Health and Care Commissioning in combination with Macmillan Cancer Support, Black Health Agency for Equality and MCIP volunteers. It was a fantastic achievement that so many people wanted to have a lung health check!

The graph below shows the difference in the stage at which lung cancer is normally diagnosed compared to the point at which it was found in participants of the pilot, who had not reported symptoms. Because most cancers were found early it was possible to offer most patients potentially curative treatment.

Lung cancer: stage shift

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30

20

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Lung cancer stage

1 2 3 4

normal Greater Manchester figures

Pilot targeted screening figuresC

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LHC_impact_slide.pdf 1 10/03/2017 10:51

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Case studyMichael Brady, aged 64 is a retired factory operative from Harpurhey. He was diagnosed early with lung cancer after attending a Lung Health Check at a mobile CT scanner unit parked at his local shopping precinct. Michael was already being treated for COPD and had regular x-rays to monitor his condition. He was invited to attend the Lung Health Check as he was aged between 55 and 74, had previously smoked and was registered with a participating GP practice. Michael underwent radiation treatment at the Christie NHS Foundation Trust, Manchester.

“I was scanned on the Tuesday there and then at Harpurhey Precinct and then I was sent a hospital appointment and attended that within a week of my Lung Health Check.

The doctor told me that they’d found a cancer in one of my lungs that was about the size of a pea. He said that it could be got rid of by radiation therapy and that I wasn’t to worry.

I know I’ve got cancer and it is scary, but I’d rather know. I know what I’m dealing with and I’d rather know now than in a few months or years’ time when it will be too late.

I honestly feel as though this Lung Health Check has saved my life.”

Project legacyThe pilot results showed that the ambition to find lung cancer at a much earlier stage has been realised. The high demand for the service demonstrated that many Manchester people wanted to take advantage of the lung health check opportunity.

Following its success Manchester Health and Care Commissioning has agreed to provide £4 million of NHS funding to extent the service acrosds North Manchester. This area was chosen because it has the highest number of lung cancer deaths among the under-75s in England.

NHS England also announced in November 2017, that the Manchester model of lung health checks will be scaled up in other areas of England.

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The MCIP Lung Health Check Pilot team:L-R Dr Richard Booton (MFT), Dr Phil Barber (MFT), Denis Colligan (Macmillan GP), Dr Phil Crosbie (MFT), Janet Tonge (MCIP Programme Director), Dr Haval Balata (MFT)

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Manchester Lung Health Check Pilot Successes In The News

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Advanced lung cancer

What was the project?The project aimed to better support people with advanced lung cancer by improving links between teams caring for patients and palliative care services, and ensure effective working between hospital, primary and community teams.

Why was it needed? An audit identified gaps in palliative care support and coordination for people with advanced lung cancer. Communication between clinical lung teams and palliative care services were identified as needing improvement for advanced lung cancer patients.

What has it achieved?In wave 1 of the project the MCIP Quality Improvement Facilitators worked with local lung teams. They:

• Developed an agreed Holistic Needs Assessment protocol to be adopted by all professionals

• Developed a standard on the use of Written Care Plans for patients with Advanced Lung Cancer

Wave 2 of the project involved the formation of a Task and Finish group consisting of Lead Cancer Nurses and Lung CNSs from the four Trusts in the city of Manchester who devloped and shared MCIP Pleural effusion algorithms with the Pleural leads from North, South & Central and produced a ‘Pleurodesis Decision Aid’.

Dr Phil Barber, MCIP Lung Clinical Lead with patient Paul Murphy at Harpurhey

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Non-clinical cancer champions

What was the project?This work in 2017 re-engaged with the non-clinical champions through a series of workshops, resulting in the development and co-production of responsibilities designed to deliver additional benefits to the people living with and beyond cancer in their community.

Why was it needed? The aim was to encourage self-sufficiency and sustainability as well as ensuring that consistent advice and guidance for patients and their families was available through the non-clinical cancer champions’ role.

What has it achieved?A large part of the non-clinical cancer champion’s role was to provide information and signpost to services that are available in the community that people affected by cancer may want access to.

The need for support can be at any time throughout a patient’s journey, whether it be whilst receiving treatment or a number of months or even years after. The role is not only there to support patients, but carers, family member and anyone who may need it. Outcomes included:

• Development of a protocol for a non-clinical cancer champion hotline service within GP practices

• Updated and new non-clinical cancer champions literature• Staff-facing leaflet promoting best practice

This project provided support for networking between the non-clinical cancer champions across Manchester and developed a model of service providing a helpline directly into the GP practice for PABC for non-clinical issues.

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Project legacy• Sharing of best practice across GP practices• Learn and share events planned for 2018• Contact information for non-clinical cancer champions shared with Macmillan

GPs for continued engagement

UI Volunteer Nina Jackson who played a pivotal role in MCIP’s primary care work discusses the programme with Macmillan’s Chief Executive Lynda Thomas at an event at Manchester Town Hall

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Workforce Education

What was the project?The aim of this project was to increase the cancer-specific knowledge, skills and awareness of non-cancer specialists working in primary, community and palliative care. In wave 1, face-to-face training was delivered to more than 280 staff, covering cancer awareness, living with and beyond cancer, end of life and palliative care. Ten to fifteen percent of the targeted community workforce received training in General Cancer Awareness and Sage and Thyme. The community workforce who benefitted from training included Administrative and Reception staff, Unregistered Support Workers in Health and Social Care, and Registered Nurses and Allied Health and Social Care Professionals.

Wave 2 built on the success of Wave 1 through development of an e-learning programme for the non-cancer specialist community workforce and offer of enhanced General Cancer Awareness training sessions for the non-cancer specialist community workforce.

An e-Learning package and was developed and launched in May 17, covering:

• The nature of cancer• Cancer prevention and screening• Staging and investigation• Cancer treatment types• Palliative, end of life care and bereavement• Living with and beyond cancer

Why was it needed? The project addressed gaps identified in the cancer-specific knowledge of the non-cancer specialist health and care workforce.

What has it achieved?• Delivered training covering cancer awareness, living with and beyond cancer,

end of life and palliative care across the health and care workforce• Developed an e-learning programme for the non-cancer specialist community

workforce

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Project legacy• E-learning programme now hosted on Macmillan website, Greater Manchester

Cares and Gateway-C. The web site www.GreaterManchestercares.co.uk is now a centralised location for training across Manchester

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The MCIP Programme Legacy

Whilst the real legacy of the programme is the improvement in cancer care that MCIP leaves behind, the team are delighted that our work has been recognised in a number of awards for the MCIP programme work, for programme members and work closely connected with the programme. These are:

• Macmillan Cancer Support - Richard Hambro User Involvement Award: people affected by cancer working with the MCIP Programme received the Regional Award for leading and inspiring change

• Macmillan Cancer Support - Service Excellence 2017 Award for Breast Monitoring and Aftercare team in the category of Excellence in Service Improvement

• International Journal of Palliative Nursing awards Multidisciplinary Teamwork Award for the North Manchester Macmillan Palliative Care and Support Service

• NIHR Greater Manchester Clinical Research Awards - Best Community Research Contribution: Community Lung Health Study for the University Hospital of South Manchester NHS Foundation Trust

Cakes and Smiles at the Macmillan Coffee Morning stall at MCIP’s Curing Lung Cancer - A Paradigm Shift in September

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• Health Service Journal - Finalist in the categories of Acute, Community and/or Primary Care Services Redesign –for the whole programme

• Health Service Journal Award - Finalist in the category of Supported Self Care for New model of breast cancer aftercare

• Spirit of Manchester award finalist for PABCs Nina Jackson and Tom Harrington

In addition a wealth of brochures, documents and reports have been produced by the MCIP team.

• Documents and brochures on https://be.macmillan.org.uk/be/default.aspx• An armchair designed by people affected by cancer featuring their words

and images. Once complete the chair will be exhibited around Manchester to promote user involvement.

• A library of films, many featuring people affected by cancer and the work of the MCIP Programme

• Volunteer year-book featuring accounts by MCIP volunteers

Volunteers Ruth and Leila at work on the User Involvement ‘armchair’ exhibit

For more information on MCIP please go to: Twitter: #MCIPMcr Pinterest: www.pinterest.com/nhsinmanchester/macmillan-cancer-improvement-partnership YouTube: https://www.youtube.com/channel/UCSBU-LeaHPbowyVoOGN4FKw Flickr: https://www.flickr.com/photos/127670636@N07/