Integration

This category is for nominees and teams who have improved the coordination of services and enabled integration across settings such acute, primary, social and voluntary or through digital services, to provide a seamless experience for people living with cancer.

Integrated Support Welfare and Bereavement Team

St Andrew's Hospice

The Integrated Support Welfare and Bereavement Service in North East Lincolnshire has brought together Macmillan palliative care social workers and Macmillan social welfare advisers with palliative care social workers, a spiritual care lead, bereavement coordinator and caseworker from St Andrew’s Hospice in Grimsby.

By working in partnership, this fully integrated team have pioneered a new way to offer excellent holistic support to people at the end of life, while also increasing efficiency and avoiding workload duplication.

What the winners say 

‘We know we make a difference to a lot of people. For example, some of the people who refer themselves to our bereavement service are in crisis, and our interventions enable them to continue living.’ - Liz Phillips, Bereavement Service Coordinator

Two women and two men standing inside a building
Image: Integrated Support Welfare and Bereavement Team

 

GP Direct Access Project Team

Southern Health and Social Care Trust

Historically, lung cancer patients have low survival outcomes because they are usually diagnosed at an advanced stage due to a lack of any obvious early signs and symptoms.

The GP Direct Access Project in Northern Ireland’s Southern Health and Social Care Trust, in partnership with the Southern Integrated Care Partnership, have set out to change this by implementing a new pathway that allows GPs to refer patients directly for specialist low dose CT scans which can detect lung cancer at an early stage.

The initiative has significantly reduced the amount of time that patients and their families spend anxiously waiting for appointments and test results.

What the winners say

‘We’re fast tracking people through the system in a leaner and more user-friendly way. Before, we would have sent them to hospital as a red flag referral, but now we can send them for a scan straight away. It’s better for patients and their families, and it’s good for GPs too because we feel that we’re really empowering them.’ - Gerry Millar, Macmillan GP Facilitator

The GP Direct Access Project Team standing outside
Image: GP Direct Access Project Team

 

Pancreatic Cancer Rapid Diagnostic Service

East Lancashire Hospitals NHS Trust

The five-year survival rate for pancreatic cancer stands at just 7% – a figure that sadly hasn’t improved for almost 50 years. Because this cancer type notoriously presents at a late stage, 80% of patients are diagnosed at a non-curative stage of the disease. The Pancreatic Cancer Rapid Diagnostic Service (RDS) at East Lancashire Hospitals NHS Trust is working to change this by supporting earlier diagnosis.

The service offers a personalised and rapid diagnosis of patients’ symptoms. By working collaborative with colleagues across the Trust, the Lancashire and South Cumbria Cancer Alliance and primary care networks, the service has reduced the average wait time from GP referral to diagnosis from 46 days to 21 days. It also offers crucial holistic support to patients at the point of referral rather than the point of diagnosis. 

What the winners say

‘Our work continues. We don’t have the magic bullet, but we do have the tenacity to keep trying to do things differently for these patients. We simply cannot accept that it’s okay to have a cancer with a prognosis that hasn’t changed for 50 years.' - Daren Subar, Clinical Lead for RDC and HPB surgeon 

Two women and two men standing outside a building
Image: Pancreatic Cancer Rapid Diagnostic Service

 

Hammersmith and Fulham Links Service

Hammersmith and Fulham GP Federation

Hammersmith and Fulham GP Federation, in partnership with Macmillan Cancer Support, have established a link worker service – a dedicated team of professionals who support patients with non-medical issues that impact on their health and wellbeing.

The team comprises of 14 link workers, five of whom were originally funded by Macmillan but are now sustainable and taking giant strides in improving the lives of people with cancer.

Based in GP practices across Hammersmith and Fulham, the link worker team has a demographic that was chosen to reflect the BME communities of the borough. They can help patients with a broad range of issues from housing disrepair to benefits, from loneliness and isolation to income maximisation, and from mental health to weight management.

The team actively seeks out new ways to fill gaps in patients’ needs by working with voluntary and community services including Citizens Advice, Law Centres, Maggie’s and the Macmillan Cancer Navigator Service at Imperial College.

What the winners say

‘The programme is all about empowering and enabling people to help themselves. First of all, the link worker conducts a personal social prescribing assessment with the patient where, together, they work out an action plan. The benefit of the link worker service is that an appointment with us is 45 minutes, while a GP traditionally only has ten minutes. What’s more, we can see the patient up to six times.' - Val Chaggar, Programme Support Manager

Two women sitting talking to each other
Image: Hammersmith and Fulham Links Service

 

Finalists

To view all the Integration Excellence finalists watch the video below and click here.