Frequently Asked Questions
What is the ‘Cancer Psychological and Social Support Initiative’ and how will this new workforce support adults with cancer?
The Guidance for Improving Supportive Care for Adults with Cancer in New Zealand, showed patients had variable access to supportive care interventions. A national framework was developed to address supportive care, in which the Ministry of Health (the Ministry) prioritised psychological and social support needs. Budget 2014 provided up to $4.2 million a year to fund a Regional Lead in each of the six cancer centres, and over 30 additional full-time equivalent psychologists and social workers across the country. The overall aim of this initiative is to address gaps and to improve overall access and timeliness of access to psychological and social support services for adults with cancer. This initiative builds on existing services in DHBs and the community, to ensure the emotional and psychological needs of cancer patients are assessed, and patients and whānau receive the support they need.
This service is meant to be targeted towards patients who have high and complex needs, what does this mean?
High and complex needs in this context relates to patients who have multiple issues such as, unrelenting distress; and the presence of a range of risk factors such as a history of mental illness and, little or no social support. The service focuses on providing psychological and social support to adults with cancer whose needs have not met by existing services. Referrals may also include patients who have more complex cancers, or complex treatment plans (eg, head and neck cancers).
Communities who find it more difficult to access and utilise services are another referral priority, such as, Māori and Pacific communities, people with socio-economic disadvantage, remote and rural populations and people with co-existing physical, social or mental health issues.
How does the Initiative fit with the existing workforce?
This service is part of a broader psychological and social support service for adults with cancer. The existing psychological and social support workforce provides care to a broad range of patients. They focus on meeting the general needs of patients and providing additional assistance if required, such as assessing general health and well-being, and ensuring patients are given the right information and support links.
It is noted that any health professional a patient sees along their cancer pathway is also responsible for that patient’s psychological and social wellbeing.
What part of the patient pathway are the roles focused on?
The initiative fits within the Faster Cancer Treatment (FCT) programme, which focuses on the ‘front of the treatment pathway’. This isthe period from high suspicion of cancer through to completion of cancer treatment, under cancer services.This service works with patients to identify their psychological and social needs and to be responsive to those needs. Therefore it is likely that there are differences in the approaches taken by different regions. Patients will have regular needs assessments during this time to identify any areas where support can be offered.
How will patients’ access support once they have moved beyond the ‘front of the treatment pathway’?
This new workforce will have a key role in referring and facilitating the transition from hospital/DHB-based services to primary care, cancer NGOs and other existing services. To support this, the new workforce will complete a needs assessment and arrange onward referral and transition. The initiative is committed to working collaboratively with NGO’s, providers in primary care and community settings, who may be more appropriately placed to assist those beyond the ‘front of the pathway’.
The need for support during the post-treatment or survivorship phase is also acknowledged, but it is expected that the wider supportive care team will provide care during this part of the journey as this is out of scope for this initiative.
Are the roles hospital or community based?
This service may be provided from a range of settings and this will vary from DHB to DHB. In an aim to reduce barriers to accessing psychological and social support services, care can be delivered from hospitals, the community or in domestic settings in accordance with local DHB policy and protocols.
Is the initiative aimed at working with patients (only) or with whānau as well?
The initiative focuses on working with patients. The initiative workforce can also work with the patient and their whānau in support of the patient, integrating WhānauOra principles. If the family member or whānau member requires individual work, then it may be more appropriate to refer this individual to another agency/service.
Why have DHBs been asked to appoint psychologists and social workers?
The initiative is based on previous national work relating to supportive care, which identified gaps in existing psychology and counselling services. There are currently very few psychologists and social workers specialising in supportive care for adults with cancer. This new workforce will aim to address this gap and make a significant contribution to the supportive care needs of people with cancer
What leadership is being provided to the Initiative?
Leadership is provided by the National Clinical Lead, Regional Leads and the Ministry.
The National Clinical Lead provides the overall leadership and support to this new workforce. Their role is to guide a consistent service across the country. This involves having strong relationships with the Regional Leads, DHBs, Regional Cancer Network Managers, external evaluators, cancer NGOs and with the Ministry.
The Regional Leads provide support and are the key contacts for the new workforce in each region. They ensure a regional focus on the initiativeby working with the National Clinical Lead, DHB directors of allied health and the regional cancer networks (RCNs). Together they lead in the developmentof a cohesive regional service. The Regional Leads are key in the development of regional referral pathways and supporting the use of tools developed as part of this service. It should be noted that the new workforce and Regional Leads are accountable to their employing DHB.
The Ministryalso has a role in overseeing the initiative through the monitoring of DHB reporting. The reports will provide the Ministry an opportunity to be responsive to any concerns or emerging issues as the initiative progresses.
The Ministry also provides support and advice to the National Clinical Lead and the six Regional Leads in implementing and developing the service. The Ministry also supports the new workforce through the hosting of the national forum each year.
How will the initiative be evaluated?
The Ministry have commissioned an external evaluation, which will inform ways to improve the service. The external evaluation will be undertaken by Sapere Research Group Limited. The evaluation will assess the Initiative to understand whether it is:
- improving the experience for patients, including their family and whānau, with cancer
- improving the overall access and timeliness of access to psychological and social support services.
DHBs and Regional Leads are expected to participate in the evaluation and provide all information/documentation, including facilitating surveys and providing data to Sapere. This will be used to support quality improvement and ongoing development of this service. DHBs and the new workforce can expect ongoing communication regarding the evaluation and its process.
What is Faster Cancer Treatment and how does it relate to this initiative?
The FCT programme is a key focus of the National Cancer Programme. The FCT programme is designed to reduce waiting times for appointments, tests and treatment and standardise care pathways for all patients wherever they live. Prompt treatment is more likely to ensure better outcomes for cancer patients. Lengthy waiting times can add to the stress on patients and family at an already difficult time, so it is important that people have a clear expectation of how quickly they can receive treatment. This new workforce will support improved access to psychological and social support services for patients with cancer.
Is the funding for the initiative sustainable?
DHBs currently receive funding for the Initiative via a Crown Funding Agreement (CFA) variation. The Ministry is committed to developing a well-established and sustainable service. CFA variations are usually used in the initial phase of an initiative to support monitoring of implementation. The expectation is that at some point (either at conclusion of the initial 3-year CFA or after a subsequent period) it is likely that the funding and service requirements will be devolved to DHBs.
To support and sustain the service once funding is devolved to DHBs it may be that cancer psychological and social support service expectations are set through the Service Coverage Schedule, which defines the agreed level of service coverage that the Ministry and DHBs are held accountable to.