Macmillan’s electronic approach to assessment is simple but effective. It starts with people affected by cancer, filling in a questionnaire about their concerns on a touch screen computer (a tablet). The information is then sent to a secure care planning website, where the issues affecting the person are ranked in order of priority. Using these results, health or social care professionals develop the care plan with the person, and also review data to identify trends and local service development needs.
In 2010 Macmillan, in partnership with the National Cancer Survivorship Initiative (NCSI), began testing HNAs with 11 NHS test communities. This led to a small pilot project to trial the concept of an eHNA with four test sites. The aim of this project was to understand the impact an electronic assessment tool would have on the HNA process and its impact on assessment and care planning for the future.
The initial testing was conducted over one year, and began with scoping and developing of the eHNA tool. The sites chosen to test and develop the eHNA were Guys and St Thomas’ NHS Foundation Trust, North Bristol NHS Trust, East Kent Hospitals NHS Foundation Trust, and St Helens and Knowsley Hospitals NHS Trust.
A priority for the eHNA project was making the assessment and care planning process easier for the person affected by cancer and their healthcare professional. This in turn would allow more assessments to be carried out, more care plans to be written, and potentially more needs to be met.
A key decision at the start of the pilot project was to use tablets for the assessment process. This allows the person to complete the assessment on their own with express consent, and to highlight concerns that would be difficult to bring up in a normal conversation.
Although Macmillan took this innovative approach in using tablets, many of the pilot sites had no policies in place to manage and control their use, meaning that the teams trying to pilot eHNA were pioneering this technology in their Trusts. The reliance of the tablets on the availability of a WiFi signal was another unexpected area of difficulty. Many hospital areas were not covered by WiFi at all, or the coverage was patchy at best. Trusts worked hard to overcome this, and tablets and WiFi are now more widely accepted and established.
Alongside the technical issues information governance (IG) requirements around storing identifiable NHS data within the NHS network prompted further development to ensure the eHNA met with Trust and national policy.
Macmillan sits outside of the NHS network, and consequently has no access to individual identifiable data – this is restricted to the Trust that carried out the assessment. However, it is recognised that there is tremendous value in having access to aggregated data to identify areas of concern, and more importantly to highlight potentially unmet needs. This data is an exciting new area that could in time lead to the delivery of a more timely and effective range of services to the people who need them the most.
Progress so far
A report from Ipsos Mori provides snapshot results of a survey looking at people’s experiences of completing an eHNA, HNA or neither assessment (to provide a counter factual argument). A very brief overview of some of the main findings is provided below.
Most people living with cancer, particularly those who completed an eHNA, felt that they had received support at the right time:
'I’m not sure there’s ever a good time, but for me at that particular point I knew I was going to be having surgery and it was a good time to think about what I was going through.’
The holistic needs of people living with cancer appear to be better met for those who have completed an electronic assessment, compared with those that recall completing a paper assessment or can’t recall an assessment at all.
‘I remember it being quite interesting because it covered a lot of things I didn’t think we would talk about – emotional as well as physical needs really.’
‘It was something on the questionnaire that I might not have thought was in her [the nurse’s] sphere really without the questionnaire.’
Benefits to people living with cancer:
The benefits to people living with cancer have been identified by Sarah Thompson, CNS at GSTT, as:
’Holistic Needs Assessment is an important part of the person’s treatment because it allows us as nurses to be able to focus on individual needs and their primary concerns.’
One person I was caring for commented that:
’Having a CNS supporting my treatment made a huge difference. Even now treatment has finished, I still require physical and psychological support, which has been highlighted and demonstrated by the Holistic Needs Assessment.’