Claire Gilfillan and Kay Wilson are clinical nurse specialists based in Gwent, south-east Wales. In this blog, taken from the RCP Cymru Wales report, Cancer care at the front door: the future of acute oncology in Wales, they reflect on the challenges of providing a joined-up acute oncology service (AOS) across four sites. The Aneurin Bevan AOS team tweets at @ABB_AOS.
With four acute hospital sites in Aneurin Bevan University Health Board (ABU), we struggle to staff four front doors with only three nurses. We’re recruiting for a bigger team, which will help, but the long-term challenge is how we provide equity of care for AOS patients with limited resources. We provide cross-cover for each other at the moment with three senior nurses across four sites, although we’re going up to six nurses (four senior, two junior) plus a senior nurse manager very soon. It’s a complex situation. Do we put one senior nurse in each of the four hospitals? But some hospitals will have a more acute intake than others, and so the workload will be different: more intense, more pressurised in that hospital, so is that fair?
Over the coming months, as the business case for south-east Wales is rolled out, we’re planning to recruit therapists to the team. There’s so much to decide about the model of care. What happens if a patient has back pain and they are triaged to a smaller local hospital, then it turns out to be a spinal cord compression? Or if they have a bad reaction to their cancer treatment that seems straightforward, but it’s actually immunotherapy toxicities, which can be very serious?
In an ideal world, perhaps a single take for ABU patients would work, but in reality, for our health board, that’s virtually impossible. The definition of AOS is so broad, and the critical care centre is not an appropriate setting for an assessment unit, it doesn’t have the bed capacity. Neither can we concentrate the AOS take at one of the local hospitals, because the specialties simply aren’t there.
We don’t currently have an acute oncology assessment unit, but there is now a same-day emergency care (SDEC) unit that’s just opened at the Grange. We’re very interested in how we can build acute oncology into SDEC. It’s an entirely new way of working for us. There’s a lot that comes through the emergency department that we could treat in an ambulatory unit, if we had a robust pathway and scoring system in place. One day, in the distant future, we could even have AOS nurses in the community who could assess patients at home.
We can contact the community resource team for ambulatory patients, although records are not yet on the same digital platform, which makes things more difficult. That’s supposed to be happening quite soon though. Digital working will make the transfer of patients much easier because everyone will have access to the same information. Communication is a big thing.
If I could wave a magic wand, I’d want enough staff and resource to always have an AOS specialist at the front door. That’s how we’d make the biggest impact and avoid problems developing, because we’d have someone with expert knowledge involved from the start. We need to get cancer patients to the right place, first time – it could be many different places, but the most important thing is that there is AOS in DGHs to support these patients and work with other hospital teams to provide high-quality care. Patients should be able to go to one place and have access to all the specialties: SDEC has to play a big role in this.
We’re in a positive place at the moment. There’s the south-east Wales business case, there’s funding, people are giving AOS some attention. I think AOS is where palliative care was 15 years ago if I'm honest. So, let's get excited about what the future can be! Let's forget the past – let’s move forward and build something that we can all be proud of.
Clinical nurse specialist
Aneurin Bevan University Health Board
Lead nurse for acute oncology services
Aneurin Bevan University Health Board