This week’s blog comes from @DebbieProvanRD, the National AHP Lead for Cancer Rehabilitation, and it marks the start of the September Takeover – a month of blogs by Scottish AHPs leading the way in Cancer Rehabilitation.
I started my 18 month, 2-day a week secondment as the National AHP Lead for Cancer Rehabilitation in April 2012. It was a daunting time and for a while I felt I lacked direction as it was clear to me there was a lot to do and a lot to achieve. Never one to shy away from a task, and frequently one who is told to focus and start small, I wanted to do it all; and so it was great to be given a mentor and to meet the other National Leads on a monthly basis, as they helped me overcome some challenges and forge a path. One of the main issues I faced when I began was the fact that AHPs had limited involvement in cancer services, as cancer pathways have always tended to be based around a medical model, and so generally AHPs have been clustered around the acute treamtent phase of the illness and have only been called upon when specific problems have been identified. Another problem was the limited evidence base for cancer rehabilitation; which is understandable given the fact that cancer encompasses over 200 conditions; rehabilitation can focus on physical, vocational, psychological, spiritual and/or financial issues; and the prognosis and treatment pathway for a cancer diagnosis will differ from individual to individual.
Despite the above, I intended to review the provision of cancer rehabilitation and the role of AHPs within rehabilitation across Scotland. I hoped this would enable me to establish the impact of each approach on outcomes; which would in turn determine the economic worth of each programme/approach, and ultimately lead to recommendations about the design of future service developments.
What became clear very early on was that multidisciplinary approaches to cancer rehabilitation in Scotland were scarce and where programmes did exist, the approaches were varied and the costs, aims and outcomes unclear. Looking back I knew this was likely, for the reasons already listed and because cancer can (and does) affect anyone; the landscape of Scotland is vast and varied (with its large cities and remote and rural communities) and so access to services and specialists will differ; there is a growing number of cancer diagnoses year on year and so existing services are under pressure to cope with new demands; there is a greater number of cancer survivors year on year as earlier diagnosis is more common and treatments improve, which ultimately leads to late-effects of cancer treatments which were previously unknown. There are also a growing number of services and organisations involved in the provision of cancer services and the purpose and design of these services are often varied and occasionally complex. Finally there is the changing shape of healthcare with its co-production and asset building approaches, and the integration agenda. And while I knew all of this before I began, I guess I tried not to think about it as I hoped and prayed that the complexity of my new role was being over-estimated!
Flipping and Reframing
Despite my long list of challenges, it is probably worth pointing out that these challenges were also great opportunities, and I believe they have all helped to contribute to the successes we have had during my 156days in post.
The Wider Team
The vast extent of my challenge meant I really had to lead, build partnerships and enable others and I managed to do this through a number of programmes and channels. I have become involved in some research, both as a steering group member and as a co-researcher. I have also sat on the Transforming Care After Treatment Programme Board where I have presented papers on the need for rehabilitation, and supported the design and re-design of existing services so they have a greater impact, and support the holistic needs of people affected by cancer. I have worked with NHS Inform to improve information provision, and I have also worked with voluntary organisations and colleagues to improve access to physical activity programmes. Finally I have uncovered some wonderful examples of innovation and service development led by AHPs across Scotland, and as my post comes to an end I would like to take this opportunity to highlight these to you via the AHP Scot Blog during the month of September.
Now It’s Your Turn
My hope is that by showcasing these pieces of work, AHPs, other healthcare professionals, policy makers, researchers and the general public will see the need for further development of cancer rehabilitation services and understand why AHPs are core. I also hope we can learn from each other and advance practice through sharing, discussion and debate. So please get involved; share your thoughts, experiences, challenges and successes through commenting on the blogs, contacting the authors, chatting on Twitter and/or raising the issues with colleagues.
On Monday 16th September we hear from @MandyHT1 who shares her experiences of rehabilitation in Palliative Care