Informing the commissioning of aftercare for people affected by cancer: The value of Macmillan health and wellbeing clinics
While the incidence of cancer is increasing, more people are alive having survived cancer, and this trend looks set to continue. Macmillan Cancer Support, with the National Cancer Survivorship Initiative, developed the concept of ‘health and wellbeing clinics’ to better support people in the survivorship phase. Health and wellbeing clinics are like a fair, where patients and families can browse stalls to pick up information on different services, and listen to talks given by clinicians, dieticians, psychology services, complementary therapists, welfare and benefits advisors, to name a few. The idea is that clinics help patients to be better-informed and more confident about taking care of themselves. This promotes recovery, health and wellbeing after treatment.
Clinics were piloted in 14 NHS Trusts in England, Wales, Scotland and Northern Ireland during 2010/11. A total of 87 clinics were held and attended by a total of 764 patients. In the context of ever tighter constraints on NHS spending, Macmillan is aware that having a strong evidence base for the impact and economic value of services is more important than ever to those commissioning services and to frontline practitioners.
What we did
In addition to measuring a number of clinical outcomes, we also used a modified version of the Client Service Receipt Inventory to identify how and whether patients’ usage of a range of health and social care services had changed as a result of health and wellbeing clinics. This was administered as part of a three-stage questionnaire completed by patients before a clinic, 2-4 weeks after attending, and again after 2-3 months.
We were able to use unit costs for types of services where patients reduced their use after attending a clinic to estimate the resulting savings. For example, based on unit costs of staff time such as £27 for district nurse visit and £43 for a 30 minute occupational therapy appointment, we can multiply up by the number of patients who reported that they reduced their use of these services in order to generate the estimated overall cost savings to services.
We found that, overall, patients reduced their use of statutory health services after attending a clinic; most notably in relation to the use of GP and district nursing. Use of hospital-based services was also reduced. A small proportion of patients increased their use of specific services in order to address previously unmet needs. This related particularly to advice on side effects of medication, as well as financial and employment advice.
The economic assessments, over and above the clinical outcomes data, gave commissioners an idea of how much clinics cost and how these costs break down, depending on the model of clinic they are interested in. These can be compared against the types of benefits generated, both monetized and non-monetized. We also looked at ‘who put in what’, in order to distinguish the contributions of the statutory and voluntary sectors.
One of the trusts involved in the pilot – South Eastern Health and Social Care Trust – has decided to continue clinics, and developed an innovative approach to follow-up based on risk stratification. This enables the Trust to deliver appropriate levels of support that addresses the real needs of patients, while securing greater efficiencies.
The findings from this piece of work, and the implications for commissioning, have been published in the Health Service Journal.