Physical Activity in North Wales Julie A Jones Macmillan Services Effectiveness Lead June 2015
Person Centred Care Mrs Pat Pilkington, Person Centred Care Manager Mrs Jo Garzoni, Health & Well Being Coordinator
Betsi Cadwaladr University HB • Acute, primary, community and mental health services – pop^ 676,000 • 3 district general hospitals; 18 community and acute hospitals • over 90 health centres, clinics, community health team bases and mental health units. • 121 GP practices and NHS services provided by North Wales dentists, opticians and pharmacies • Over 16000 staff • > 27000 living with or beyond cancer, estimated to rise to more than 48,800 by 2030
Recovery Package – Translating Person Centred Care Locally in North Wales
Person Centred Care in BCUHB Holistic Needs Assessment & Care Planning Health & Patient Key Worker Wellbeing / Rehabilitation Treatment Summary
PA: Aim Across BCUHB To improve the health, fitness, and quality of life for cancer diagnosis patients, increasing the potential to live life actively and independently, and decrease clinical dependency. • To improve confidence and skills of HCP to provide advice, and support patients to become more physically active. • To develop and promote PA/exercise opportunities in local communities for PABC, their family and carers • To work in collaboration with NERS, LA and third sector organisations across North Wales.
Health and Wellbeing • BCUHB are piloting Health and Wellbeing events with a view to establishing such events as an integral part of the cancer pathway across North Wales. • Developing and implementing rehabilitation pathways across BCUHB for people living with and beyond cancer. • Maximising physical activity opportunities and facilitating a cultural shift in the approach of clinicians to education for patients
BCUHB PA Lead • Project lead responsible for clinically championing the importance of physical activity to clinical teams across HB • To facilitate and support training and up skilling of clinical teams to enable a change in clinical behaviour and • To embed PA into the cancer care pathway for patients.
Engaging with Professionals Health care professionals working with adults with a cancer diagnosis. These groups included : • Multi-Disciplinary Teams • Medical and Clinical Oncologists • Surgeons and surgical teams • Clinical Nurse Specialists • Therapies and Clinical Support staff • Radiotherapists • Nursing and Healthcare Support Workers Exercise schemes delivered by NERS Exercise Professionals (level 4 Cancer Rehabilitation training)
Engagement • Survey of health care professionals in collaboration with Bangor University • Attendance at clinical meetings, MDT, individual staff • NERS leads; 43 NERS volunteers trained at L4 • Survey of walk leaders across Gwynedd to understand needs • Awareness of people living with and beyond cancer and consequences of treatment • Integrated with Person Centred Care
Evaluation • CaPASEF – to standardise evaluation • NERS – number of referrals to determine increase • Collaboration with Bangor University – staff attitude and behaviours towards PA • Patients – via Health and Well Being clinics
Physical Activity: Exercise through NERS Embedding physical activity into the cancer care pathway for patients through the National Exercise Referral Scheme (NERS) and local opportunities North Wales NERS Cancer Referrals 60 55 48 50 39 40 34 32 April 2012- March 2013 30 April 2013-June 2014 23 20 9 10 6 2 0 0 0 0 Anglesey Conwy Denbighshire Flintshire Gwynedd Wrexham
Opportunities • A monthly walk in Denbighshire in partnership with the Physical Activity Development Officer from Denbighshire County Council. • Activity walks in Wrexham in conjunction with Actif Woods Wales. • Developing a strategic approach to understanding training needs of volunteer walk leaders across Gwynedd in conjunction with the Physical Activity Development Officer from Gwynedd County Council.
Challenges/Opportunities • Strategic engagement due to restructuring within the health board • Engagement of staff on the ground due to competing priorities/increasing patient activity • Structure of the health board • Engaging patients to reduce clinical dependency • Culture shift – core business
Successes • Feedback from PABC • Working towards sustainable change by engaging all HCP (primary and secondary) – a traditional therapist role • Integration of PA into PCC across the HB to embed PA into psyche of organisation • Working with engaged/enthusiastic individuals e.g. NERS exercise professionals, volunteers
Influencing Pathways
What has helped us / worked well? • Formulating a communication strategy • Utilising improvement methodology • Inform and educate • Raising awareness and effective marketing internal and external to the organisation • Understanding “What’s in it for me?” • Tailoring information needs to your audience • Engagement with the MDT (via the patient pathway). • Engaging with primary care through locality leadership teams, GP clusters, District nurses • Impact measured through routine monitoring
Patient Story • Female with breast cancer • Surgery x3, chemotherapy, radiotherapy, Herceptin • Following chemotherapy, commenced ‘little bits’ at a gym • Exercise professional gave her advice and guidance on what to do • Exercise professional had cancer training which made feel patient feel fully supported • In turn, resulted in patient having confidence to achieve her goals
Patient Story “Because I had my surgery in the summer, over this winter it has got me out of bed. It’s given me motivation, it’s so easy when it’s a horrible day to just roll over, and then you are sitting there feeling sorry for yourself and I thought, no I am not doing that, I’m going to move. “ “It [PA] has certainly motivated me to get out of the house and meet different people.“ “I have changed my lifestyle now. I am doing more things to keep me fit now, after the cancer, than I did ever before.“
Thank you Jo.garzoni@wales.nhs.uk Pat.pilkington@wales.nhs.uk Julie.jones14@wales.nhs.uk
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