National Cancer Action Team

Rehabilitation - Raising the bar for rehabilitation service provision in cancer and palliative care

Since 2007, the National Cancer Action Team (NCAT) have been working proactively with partner organisations (Department of Health; National Workforce Review Team; Rehabilitation Specialist Interest Groups and Royal Colleges, Commissioners and National Cancer Network Lead AHP Forum Members) and practitioners to raise the profile and improve the provision of rehabilitation services for cancer and palliative care patients in line with National Guidance.

These web pages have been designed for use by Allied Health Professionals in cancer and palliative care, as well as provider/commissioning organisations, to provide an update on national work that has been taken forward by the National Cancer Action Team. Additionally you’ll find here a range of products that have been developed for local use. The following areas are just some of the topics that we have been focusing on:

Cancer and Palliative Care Workforce Provision

Quantifying rehabilitation workforce provision for cancer and palliative care patients, outside of specialist cancer service providers, to date has proven to be a challenging area of work. National work has taken place over the last 18 months to undertake an evidence review and develop an evidence base for therapy interventions; develop tumour specific therapy intervention pathways and using the pathways, look at modelling service provision.

Supporting and Improving Commissioning Cancer Rehabilitation Services

A Best Practice Approach to supporting and improving commissioning of cancer rehabilitation services has been developed for local use. Included within this you’ll find an outline commissioning specification and key performance metrics. Over time these will be included within the national commissioning guidance.

Toolkit for Mapping Service Provision

A national review of rehabilitation service provision was undertaken in 2008 and was repeated in Autumn 2009. A new toolkit was developed inclusive of guidance documents and Excel spreadsheet templates for local use. This new toolkit will allow easier ongoing mapping updates of the workforce to take place.

Peer Review and Quality Measures

National rehabilitation measures have been developed to review rehabilitation service provision by cancer networks and a peer review assessment and visiting programme will commence in 2010.

 This is an exciting time to be involved nationally and to support work in cancer and palliative care rehabilitation service provision. Work is continuing on a range of national projects and the website will be updated accordingly in line with new developments. Over the coming months, through the web pages we will be showcasing models of care and we will be looking to existing service providers to promote the work that they are doing.

Allied Health Professionals help cancer patients to not only recover from the physical changes that accompany their illness or as a result of cancer treatment, but also function in everyday activities and reach their goals for physical health. However, the concept of rehabilitation in cancer requires a much better understanding by the workforce, commissioners, service planners and people with cancer as it can fundamentally improve the life of the person if their needs are identified and met.

There are a number of current issues with cancer rehabilitation:

• There is not a strong evidence base for the effectiveness of rehabilitation interventions in the literature
• Rehabilitation is not strongly articulated in commissioning leading to variation in provision across the country
• Cancer care pathways do not always explicitly reflect cancer rehabilitation as part of the process
• Addressing the provision of cancer rehabilitation is cost-effective: a patient that returns to work and/or lives independently saves money to invest elsewhere
• Well resourced cancer rehabilitation teams can reduce excess bed days and possibly readmission rates.



The Cancer and Palliative Care Rehabilitation Workforce Project commenced in November 2007 and is jointly funded by the Cancer Action Team and the Department of Health. The overall purpose of this project was to provide some answers and guidance to a number of the current issues including: quantifying the levels of rehabilitation services required for people with cancer and palliative care needs; identifying the evidence base and highlighting where there are significant gaps in evidence; creating evidence based cancer care pathways; developing commissioning guidance. Up until recently, little information was available and cancer networks are being encouraged to develop rehabilitation strategies. The results of the work will help with forecasting at both a national and local level and provide an evidence base on which local strategies can be developed.For the purposes of this project, the term ‘rehabilitation’ includes therapeutic interventions usually provided by the following Allied Health Professions; Physiotherapy, Occupational Therapy, Speech and Language Therapy and Dietetics although some symptomatic interventions may be provided by other disciplines i.e. lymphoedema services are provided by nurses as well as AHPs.

In the first instance, the project focused on nine evidence based care pathways: breast, lung, head and neck, CNS, Upper GI (2), colorectal, gynaecology and urology.

Project Objectives

• To review existing published literature/materials, as well as the consensus opinion of experts, to develop an up to date evidence base for AHP interventions across a particular tumour site pathway
• To review, revise and publish the AHP/rehabilitation related Pathways in Cancer Care
• To develop a robust formula for predicting specialist rehabilitation service needs, per tumour site, for a given cancer population
• To develop Commissioning Guidance for rehabilitation services
• To link competencies, education and training into the project as appropriate

Project process

Phase 1 - Review the evidence base

Phase 2 - Work with clinical specialists to create intervention based care pathways – This took place between January 2009 and June 2009

Phase 3 - Two workshops took place in September 2009 to define timed interventions from the pathways, develop the workforce formula with Workforce Review Team and estimate predictive workforce data

Phase 4 - Work with Cancer Networks and commissioners to understand challenges to commissioning rehabilitation services and develop commissioning guidance. This was developed in August 2009

Phase 5 - Publish care pathways, evidence review and commissioning guidance – This took place in January 2010

Phase 6 - A launch event was held on 12 January 2010

National Workforce Model

At the outset of the National Cancer Rehabilitation Project, there was a clear need for some sort of model which would allow better workforce planning. The national baseline mapping of cancer rehabilitation services and the implementation of the national Cancer Rehabilitation pathways meant that, whilst we would know the current service provision and the ideal pathways to be delivered, there was no way of knowing the workforce required to deliver these pathways.

A project was set up, working with the Centre for workforce Intelligence (CfWI), previously the National NHS Workforce Review Team (WRT), to determine a workforce model which would enable national and local (network based) prediction of the workforce required.

Workshops were undertaken with expert clinicians, and in many cases, the same expert clinicians as had devised the pathways, in order to assign activity intervention times to the pathways. Exemplar activity data was collected from a number of sources across the UK to assist in the process. The data collected at the workshops was then used by the WRT/CfWI to develop a model for workforce planning. As with all workforce planning models, certain assumptions had to be made. These assumptions were agreed by the Project Advisory Group, later by NCRAB,  and will be made clear to those using the model.

A major outcome of this project was the realisation that cancer rehabilitation activity data collection is generally poor and further developments need to take place to improve the situation. The model was developed using the most robust data available but, due the caveats stated, it must be noted that the model will predict indicative and not absolute figures.

This is the first time such a model has been developed and, as data collection improves, so the model can become more sophisticated. However, for the first time it will be possible to begin to quantify unmet need.

The model was launched at NDP in March 2011 and has now been issued to all Cancer Networks in England.

A Briefing Paper explaining the background and context to the model is available in the Documents section.

If you would like to view or use the model, please contact your local Network Lead AHP or Nurse Director or contact Jackie Turnpenney at NCAT.

The National Cancer Rehabilitation Advisory Board’s objective is that by late 2011:

• A number of PCTs will have indicative rehabilitation outcomes specified within cancer commissioning;

• Specific metrics for measuring rehab performance incorporated into the cancer commissioning toolkit;

• There will be a reduction in variation of cancer rehabilitation services up and down the country;

• Networks will share approaches on rehabilitation commissioning; and

• The evidence gap or case or change around cancer rehabilitation will be filled.