Project Overview
Nationally, Trusts are tasked with implementing Personalised Care and Support Planning (PCSP).
The NHS Long Term Plan for Cancer states that “where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support” (NHS, 2019).
Personalised care means that individuals have choice and control over the way their care is planned and delivered – it is based on what matters to them. Making care personalised means that people with cancer are supported to make decisions about their care through identification of their concerns and goal setting, facilitated by health care professionals (Macmillan, 2020).
Other long-term conditions may impact on an individual’s needs if they receive a cancer diagnosis. A Holistic Needs Assessment (HNA) uses a personalised approach to care and support planning and helps to ensure that people’s needs can be identified, and support planned appropriately (Macmillan, 2020). An HNA and a Personalised Care and Support Plan (PCSP) help to create an individual’s guide through their cancer journey, from diagnosis onwards (Macmillan, 2020).
The aim of this project was to recruit Personalised care Champions from each Trust across Wessex. The role of the Trust-based Personalised Care Champions includes the support of the delivery of high-quality Personalised Care interventions within cancer pathways across the region.
Personalised Care Champions
The Personalised Care Champions were recruited from each Trust across Wessex. Support for the project was acquired from the Lead Cancer Nurses across the region. The launch of the Personalised Care Champions project was held in August 2023 with all the recruited Champions in attendance. The Champions will contribute to a Wessex-wide network of clinicians with an interest in Personalised Care to allow sharing of good practice. The Champions will work together to understand current practice and thinking relating to personalised care.
The team devised a project mission statement and vision:
Mission Statement: To promote personalised care interventions, to all health care professions, so that they become core skills. This will ensure that all patients will receive a personalised care approach across the continuum of their care.
Vision: The health care workforce is valued and empowered to deliver high quality personalised care across the continuum
The Champions will work as a team to develop a learning culture across Wessex. They will form a dialogue between the workforce and the WCA Personalised Care Team and work with WCA to standardise the assessment tools across Wessex They will promote the use of personalised care interventions across the region.
Currently, the data that is recorded nationally around personalised care interventions is not thought to accurately reflect clinical activity. There is an awareness of some of the issues around capturing an accurate picture of current practice, but there are also aspects that we need more information on to establish the reasons for data inaccuracies.
Personalised Care Champions 2023/24
The team worked together to investigate ways to establish what current clinical activity around personalised care interventions looks like. They devised two surveys to assess individuals’ and teams’ current practice regarding personalised care interventions. The aim was to understand the detail of how these are offered currently within cancer pathways. The survey data will provide a starting point for considering how personalised care is delivered, prioritised, and supported more widely within cancer pathways in Wessex.
The surveys were as follows:
- A short survey for all healthcare professionals working in cancer care in secondary care settings to help gain an understanding of their current practice and training needs.
- A representative from each site-specific team would complete a structed conversation to allow completion of a survey with their local Personalised Care Champion. This survey would help to gain an understanding of current clinical practice regarding completing personalised care interventions across the region. The content of this survey was structured around the COM-B model for behaviour change – looking at the teams’ capability, opportunities, and motivation to conduct personalised care interventions:
The surveys were conducted at the end of 2023 with the data collected and collated at the beginning of 2024. The data was analysed by the team at a regional level and at a local level for each Trust. The COM-B model was used to analyse the data acquired from the structured conversation survey.
Project Interventions
As a result of the survey data analysis (using the COM-B model), several interventions were identified that could be developed to help to improve personalised care intervention clinical practice and recording.
| Capability | Opportunity | Motivation |
| A “top tips” information package to assist with the recording of data.
Process mapping at a local level, to enable further understanding of who completes the personalised care interventions, where they are completed, when and how this happens.
Creation of a teaching package to promote personalised care interventions and how to record the data. |
Escalation of resource concerns such as access to a private space to have personalised care conversations, and access to computers, phones, and desk spaces.
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Development of Best Practice Guidelines.
Mentoring and role modelling by the PC Champions |
Project Timeline
