This article was first published on politico.eu on 15th November 2023.
Squaring the impossible circle: Looking to a future of improved cancer patient experience and efficient care
At a time of economic headwinds and depleted healthcare services, providing patients with a better experience and efficient care doesn’t have to be an either/or situation, as All.Can’s new report highlights.
A perfect storm is appearing on the horizon. Health systems around the world are exposed to the destabilising force of macro-economic headwinds. This volatility puts increasing pressure on health systems to pursue cost-containment measures. However, these measures represent a short-term solution, which may not yield positive system or patient benefit in the long run.
The net result is a skeleton health service run by a depleted and exhausted workforce. Yet, the unmet needs, preferences, and expectations of patients continue to grow.
The challenge is that evidence-based improvements are often overshadowed by austerity measures. Providers may be forced to make trade-offs between delivering seamless and efficient services that seek to improve patient experience or offering a bare-bone service to balance the books.
Policymakers, governments, and health systems of all shapes and sizes may see the challenge as delivering seemingly irreconcilable priorities of improving patient experience, reducing costs, and running more efficient services. However, this is not an impossible ask – if done right, seemingly opposite approaches can be mutually reinforcing.
All.Can is an international, multi-stakeholder, non-profit initiative focused on identifying inefficiencies in cancer care. All.Can has recently relaunched in the UK and is currently funded by Bristol Myers Squibb (BMS). All.Can UK is a dedicated chapter contributing to this global endeavor by focusing on connecting the dots between enhanced system efficiency, patient experience, and health outcomes.
All.Can UK believes this is crucial. At a time when healthcare systems are facing significant budget squeezes, there is a danger that, in pursuit of doing more with less, systems end up neglecting the patient experience. Not only is this worse for patients, but it is also a false economy. If the right support isn’t put in place early on, as determined by the patient’s preference, there is an increased likelihood of clinical escalation – with those patients coming back into the system through an unplanned and more costly route later down the line.1
Ultimately, improving the patient experience, achieving enhanced clinical outcomes, and delivering better system efficiencies must all be seen for what they are – inherently interconnected and mutually reinforcing.2 Take one out of the equation and the others will fall down. Previous research commissioned by BMS has already highlighted this in the context of workforce capacity – with evidence showing that when staff are stretched too far, the patients’ outcomes, safety, and experience will suffer.3
At both the global and the national level, All.Can has been working to carve the way forward for health systems facing these difficult dilemmas. It is with this in mind that All.Can UK began to explore the crucial role the third sector can play in providing support to cancer patients and the system.
Initial estimates from analysis commissioned by the group, and highlighted in a report published today, outline a conservative saving for the NHS of £40.7M per year as a result of third sector support provided directly to patients.4 All of the services considered in the analysis were complementary to clinical interventions and helped to drive better experience, outcomes, and system efficiencies across cancer care.
Of course, the caveat to this is that the third sector is under-resourced and therefore not the panacea to the many challenges facing the health system. That is why there is a need to start acting on the ambition to introduce integrated care systems by bringing together partner organisations under a broader definition of what constitutes a health system and recognising charities as a key player in healthcare provision.
The UK has a chance to achieve truly integrated care – with all organisations pulling in the same direction to the benefit of patients. All.Can UK’s report draws on the evidence of the third sector’s contribution to show how improving patient experience using holistic support can prevent further downstream costs.* This in turn helps to contribute positively to reducing system inefficiencies and ultimately saves the NHS money.
All.Can UK’s analysis is a first step toward establishing cost-constrained health economies. In particular, it offers hope for those facing perceived trade-offs. This could include, for example, choosing between a skeleton service (which has been shown to result in rising waiting lists and increased risk to patient safety) and providing holistic support interventions, which are often viewed as non-essential but can help drive significant improvements and efficiency gains for both patients and system.
A similar project under way elsewhere in the cancer patient pathway is a partnership between BMS, Macmillan Cancer Support and a range of NHS sites to develop and pilot a Prehabilitation Programme in non-surgical settings such as immunotherapy.
Prehabilitation is a process that helps prepare cancer patients for treatment, in effect acting as secondary prevention. It involves advice, assistance, and intervention to improve diet and lifestyle, increase physical activity and provide psychological support for mental wellbeing. Typically, Prehabilitation can help by reducing the length of inpatient stays and the risk of emergency readmission.
With cancer services under increasing strain, these pilots intend to demonstrate the capacity and service utilisation benefit from ‘at scale’ adoption of Prehabilitation. By freeing up staff time and capacity by reducing unplanned demand, more resources are made available to initiate the process of care for new patients waiting to start treatment.
Prehabilitation could also help make better use of the wait time between receiving a cancer diagnosis and starting treatment, supporting patients to ‘wait well’, while bringing forward the point of patient interaction with professional support and care on urgent and time-pressured cancer pathways. Early trials are also exploring the delivery of Prehabilitation via digital healthcare, which can further support the wider process of pathway optimisation.
If successful, the expansion of these pilots will be an opportunity to vastly improve a patient’s ability to receive and benefit from innovative cancer treatments by readying them for their treatment journey while delivering significant cost savings for the NHS.
The examples highlighted above and in All.Can UK’s new report show that improving cancer patient experience and delivering more efficient care doesn’t have to be an ‘either/or’ scenario.
All.Can UK will now be seeking views from experts across the health system and policy landscape to help develop a clear route forward that squares the circle for health systems aiming to do the apparently impossible.
To read All.Can UK’s new report and find out more about the group, including how to get in touch, please click here.*
* Please note that clicking on this link will take you to the BMS sponsored All.Can website.
References
1 NHS England (2017). Improving people in their own health and care: Statutory guidance for clinical commissioning groups and NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-involving-people-health-care-guidance.pdf (Accessed November 2023).
2 Doyle C., et al. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549241/ (Accessed November 2023).
3 BMS (2022). Transforming cancer outcomes in the UK: clearing the backlog, improving capacity and building services for tomorrow Available at: https://www.bms.com/gb/about-us/transforming-cancer-outcomes-in-the-uk-clearing-the-backlog-improving-capacity-and-building-services-for-tomorrow.html (Accessed November 2023).
4 All.Can commissioned data, available on file.
Date of preparation: November 2023
Job number: ONC-GB-2300528