Evaluation of the Macmillan Cancer Care Co-ordinator and Community Cancer Care Sisters work-stream for the South Tees Integrated Cancer Care programme (Macmillan South Tees Evaluation)

Background to the programme: The Macmillan Integration of Cancer Care programme (MacICC) was established in February 2014 as a partnership programme between Macmillan Cancer Support and South Tees NHS Foundation Trust and is scheduled to finish in December 2018. This evaluation is focused on the two new roles that were developed and implemented as a result of the programme; the Cancer Care Coordinator (CCC) and the Community Cancer Care Sisters (Community Sisters).

Evaluation Approach: The evaluation was formed from two main approaches. Firstly, we used interviews and group discussions and read available literature to describe the experiences and opinions of staff and patients and to understand what sort of benefits the roles might bring about and why. Secondly, we gathered data about areas of the services that we expected to change as a result of the roles being introduced. For instance, the amount of Accident and Emergency services being used by people with cancer diagnoses, the amount of time that might be saved for other members of staff and reductions in missed appointments.

Findings: One of the key findings was that the roles were highly valued by the people in the roles, their colleagues and patients. They clearly filled gaps in services. There was very good evidence about how the CCC roles had improved patient experiences; for instance, by reducing waiting times, providing somebody to talk to that had time to deal with their concerns and increasing the extent to which all patients’ needs were assessed. Service-users valued the Community Sisters' family-focused approach and focus on the whole person rather than immediate clinical needs. Outcomes included being able to cope better with the illness and to return to a more normal life of activities. Some specific activities, such as making treatment recommendations, helping to make difficult decisions and intervening to solve problems with other services were reported to be particularly important.

Before the roles were introduced there were more than 30 people every month waiting longer than 62 days. We observed a reduction, so that the number of long waits was consistently below the average from 3 months after the roles were introduced, and at one point dropping below 10 people per month. At 21-months after the new roles, there had been a reduction of about 245 attendances to A&E per month, which could be equal to a saving of about £381,850 over the course of the 21 month observation period.

Conservative estimates for the return on investment indicated a break-even point at 13-months and a £1.05 return for each £1.00 invested over 21 months. This includes the considerable costs for initial development of the roles.

Conclusions and recommendations: The new roles are widely regarded as valuable both in terms of health service efficiency and patient experience. We found good quality evidence to support the claim that the new roles helped to provide the right care, at the right time, with the right person. The evidence that we gathered from talking to people and understanding how the programme might work was supported by the examination of the other available data.

The findings support the further adoption and spread of the CCC roles to other cancer specialties and the expansion of the Community Sister roles so that more people, particularly those in more remote areas can benefit. The economic evaluation indicates that this should result in further savings across the health care system to offset any additional costs in providing the service. There is also potential for the roles to take on additional responsibilities to further improve pathways for cancer care and support.

It should be recognised that this was a rapid evaluation, and there were limitations in both the quality and type of information available, and therefore the conclusions that can be drawn also have limitations and rely on certain assumptions that needed to be made. Whilst we believe that the evaluation presents a strong case for the benefits of these roles for a wide range of people and services, they would benefit from more in-depth investigation, particularly if there are plans to scale up the programme workstream.