Providing innovative treatments to patients is central to the ethos of the Clatterbridge Cancer Centre NHS Foundation Trust. It is one of the UK's leading specialist centres, employing more than 350 registered nurses and treating more than 30 000 patients with solid tumours and blood cancer each year. In 2015, the hospital's chemotherapy directorate began providing treatment to patients in their homes, as part of its Clatterbridge in the Community team.
This service expanded in 2018 to include Treatment at Work, offering patients the opportunity to receive their chemotherapy treatment in their workplace. This service as the first of its kind in the UK, and was developed for patients receiving subcutaneous trastuzumab after some of them had to decline treatment at home because they were returning to work and needed specific appointment times. The service has so far been delivered across 10 workplaces (warehouses, offices, shops and cafes) in Cheshire, Merseyside and Lancashire.
Angela White is Clatterbridge in the Community service manager and leads the team of nurses treating patients in their workplaces. She said: ‘The aim has always been to make patients’ treatment journeys as smooth as possible. Getting back to work is a really important part of the journey for many people with cancer and the team wanted to help them get back a sense of normality, while still receiving vital treatment in a safe and comfortable environment.’
‘Treatment at Work is beneficial for patients in all sorts of ways.’ Angela continued. ‘Many rely on public transport, which for some can be costly and involve long journeys. For many continuing to work is not only vital as a source of income, but to continue a sense of normality, to be mentally stimulated and to continue to enjoy important relationships with colleagues.’
Assistant manager for the service Aimee Davies was instrumental in setting it up. On implementing it in workplaces, she said: ‘We needed to have the full support of workplaces, so we work in partnership with them from the start to ensure they are fully briefed to ensure our requirements are met. The response from employers has been 100% positive. All willingly made a suitable room available to adapt as a treatment room, meeting expected health and safety standards for chemotherapy interventions. The greatest challenge was to put in place the appropriate legal contractual, service liability and governance framework needed to provide cancer treatments in locations outside hospital settings. This was vital to ensure we delivered the safe and excellent care we are renowned for at the Clatterbridge Cancer Centre.’
To create a robust, sustainable model, the team had to work closely with the Trust's pharmacy team to identify which systemic anti-cancer therapies could be offered to patients and which specific tumour groups this may involve. Helen Poulter-Clark is the Trust's chief pharmacist. She said: ‘Being able to offer patients treatment outside a hospital environment is one of our biggest success stories, not only for patients but for our staff. The fact we've been able to do this using our centre's nurses and pharmacists, rather than a home care company, is fantastic.’
Angela added: ‘We spent a lot of time developing watertight policies and procedures for workplace treatment and had to ensure we had the right team of experienced, qualified staff to not only deliver the service, but also support it. Our administrators are as vital a part of Treatment at Work as the nurses.’
As part of setting up the service, the team worked with patients and steering groups to gauge the appetite for the service. Since it was established, feedback has been overwhelmingly positive: in a survey carried out by the team in 2019, 100% of patients said they would recommend it to others if it was an option, 100% were either very satisfied or satisfied with the service and 100% said that they had confidence in the care they received.
Jo Shepherd, who is an HR Director for another NHS trust, but a patient of the centre, said: ‘My job is incredibly busy, so when I was told about treatment at work I jumped at it. I simply take 20 minutes out of my diary so I can have my treatment. The team are unbelievably flexible and do their utmost to work around my commitments. The service has been one of the best examples I've seen of putting the patient first. As a patient who is living with cancer it's made a huge difference to me.’
Jo's employing trust said: ‘We have supported Jo in every way we can. Sometimes we don't even know she is having treatment in her office; the nurses are so professional—the normal day just keeps ticking on. It's a great example of the NHS working with patients and putting them at the centre of treatment.’
Clare Bennet, matron of chemotherapy at the Clatterbridge Cancer Centre, said: ‘The team have made huge strides over the past 2 years, setting up the service from scratch and supporting patients through the pandemic. But we have more work to do. We want to set up a support group for patients wanting to return to work. There are more than 750 000 people of working age living with cancer in the UK and as many as 63 000 want to work but are unable to do so. We want to make sure we can offer this support to our patients here.’
As the only cancer centre in the country offering this service, what words of wisdom can the team offer to others wanting to set up a similar project? Aimee says: ‘Partnership working with the employer from the beginning is vital. Once you have all the legal and governance approval, the most important thing is building that relationship to ensure everyone is happy and comfortable, and a suitable room is identified to provide a safe environment to deliver treatment. ‘Not all patients want to have or are suitable for treatment in the workplace, but for those who are, the service has allowed them to work and enabled them to gain some normality back in their lives and stop them feeling like “a patient”.’