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NHS trust’s chemotherapy in the workplace service proves popular with nurse and patient

Clatterbridge Cancer Centre NHS Foundation Trust offers an innovative community treatment service where people with cancer can have chemotherapy administered by nurses in their workplace
Picture shows nurse Sarah O'Donnell with patient Glenys Crisp. Nurses are helping cancer survivors to resume a normal routine by treating them at their workplace.

Clatterbridge Cancer Centre NHS Foundation Trust matron Sophia Bourne on an innovative community treatment service where people with cancer can have chemotherapy administered by nurses in their workplace

  • For many, getting back to work is an important part of their treatment journey
  • Employers just provide a room with a wash basin and nurses take equipment needed
  • Service at workplace now covers immunotherapies and other systemic anticancer therapies

Chemotherapy treatment in the workplace is proving popular among people who have cancer, who welcome it as a return to a semblance of normal life, and the scheme is also supported by employers.

Our community treatment service, called Clatterbridge in the Community, was launched by the

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Clatterbridge Cancer Centre NHS Foundation Trust matron Sophia Bourne on an innovative community treatment service where people with cancer can have chemotherapy administered by nurses in their workplace

  • For many, getting back to work is an important part of their treatment journey
  • Employers just provide a room with a wash basin and nurses take equipment needed
  • Service at workplace now covers immunotherapies and other systemic anticancer therapies
Picture shows nurse Sarah O'Donnell with a patient. Nurses are helping cancer survivors to resume a normal routine by treating them at their workplace.
Nurse Sarah O'Donnell with a patient Picture: John Houlihan

Chemotherapy treatment in the workplace is proving popular among people who have cancer, who welcome it as a return to a semblance of normal life, and the scheme is also supported by employers.

Our community treatment service, called Clatterbridge in the Community, was launched by the Clatterbridge Cancer Centre NHS Foundation Trust on Merseyside in 2015.

Patients had told us they often found it a challenge to attend hospital for chemotherapy treatment. Many rely on public transport, which can be costly and involve long journeys. Some patients are carers themselves and have to make special arrangements so they can leave home for their treatment.

Some of our patients had to decline treatment at home as they were returning to work and needed specific times for their appointments. For many, getting back to work is an important part of their treatment journey, and we wanted to help them achieve this while they were still receiving vital treatment.

Reviews and inspections ensure delivery of treatment in a safe and comfortable environment

The logical step was to extend our successful home treatment service for patients receiving subcutaneous trastuzumab with highly trained specialist chemotherapy nurses delivering their treatment in a safe and suitable area in the workplace.

After investigating its feasibility, approval was sought from our steering group and other relevant bodies such as the trust’s solicitors. A thorough review of the legal risks was carried out, covering clinical governance, regulatory and work environment issues.

After identifying suitable patients, we worked closely with each of their employers. Once they had agreed on the treatment taking place we carried out reviews and inspections to make sure we could deliver the treatment in a safe and comfortable environment.

Our vision is to provide the best care – there were also regional and national drivers

After more than six months of review and consultation with authorities and support from legal experts the service started early in 2018, when Clatterbridge Cancer Centre NHS Foundation Trust became the first trust in the UK to deliver SACT (systemic anticancer treatment) in the workplace. The employer and patient are required to sign documentation confirming they agree to the treatment taking place.

Risk assessments are completed to ensure the suitability of the environment, which include a private room or office and facilities to wash your hands.  All other essential equipment is brought directly to the patient by the nurses.

Our trust’s vision is to provide the best cancer care to the people we serve, and there are also regional and national drivers.

‘I’ve developed a lot of new skills’

Picture of nurse Sarah O'Donnell. Nurses are helping cancer survivors to resume a normal routine by treating them at their workplace.
Nurse Sarah O’Donnell
Picture: John Houlihan

Nurse perspective

‘I’ve been supported with extra education, completing my mentorship and chemotherapy courses in a year. I’ve developed a lot of new skills – being out in the community your communication skills are at a different level. I have developed into becoming a lone worker but also know that there’s always support if I need it. I get to know patients in their own environment, where I find they feel more comfortable and open up more if they have any issues’ – Sarah O’Donnell

Patient perspective

‘My job is incredibly busy, so when I was told about treatment at work I jumped at the opportunity. I simply take 20 minutes out of my diary so I can have the treatment in my workplace. The team has been unbelievably flexible and do their utmost to work around my commitments. The service has been one of the best examples I’ve seen of putting the patient first. As a patient who is living with cancer it’s made a huge difference to me and my ability to get on with my life' - Joanna Harvey

Employer perspective

‘We have supported our colleague in every way we can. Sometimes we don’t even know she is having treatment in her office. The nurses are so professional – the normal day just keeps ticking along. It’s a great example of the NHS working with patients and putting them at the centre of treatment and support, not the other way around' - Karen Howell, chief executive, Wirral Community Health and Care NHS Foundation Trust

The Five Year Forward View sets out a vision for more healthcare to be delivered locally to patients and in the community setting. The cancer strategy developed to align with this NHS report recommends that NHS England encourage the delivery of chemotherapy in community settings as part of improving the chemotherapy pathway for cancer patients.

Locally, the Healthy Liverpool Programme aims to transform healthcare services across the city by 2020 and has identified cancer as a priority. A key element of cancer care in Liverpool will be ensuring patients are able to access their treatments as close to home as possible.

We know there is a shortage of nurses nationally and want to make Clatterbridge Cancer Centre NHS Foundation Trust as attractive as possible to the current and future workforce, offering them new skills to improve recruitment and retention.

Every patient would recommend the service to others

As well as improving the job satisfaction of our team, Clatterbridge in the Community has produced fantastic feedback from patients. In fact, every single patient was satisfied with the workplace treatment service, all of them would recommend the service to others and all said their dignity was respected at all times. Patients were also asked what they considered to be drawbacks to the service, and they said there were none.

Picture of matron Sophia Bourne, who writes about a community treatment service in which nurses take equipment to the patient’s workplace, helping them resume a normal routine.
Matron Sophia Bourne 

Securing the full support of patients’ employers was key. We work in partnership from the start of the process to ensure they are fully briefed and supportive of their employee receiving treatment at work and to ensure our requirements are met.

To date employers’ response has been 100% positive. Both large and small employers have willingly made a suitable room available that can be adapted as a treatment room, meeting health and safety standards expected for chemotherapy interventions, with minimal disruption.

The number of people with cancer who want to return to work is increasing 

Clatterbridge in the Community has also saved money. Overall, the cost saving for 2017 was estimated to be £389,273 (£182 per treatment episode) and an independent economic study undertaken by the Royal College of Physicians, commissioned by the Innovation Agency, found the service to be cost-efficient. We have been able to reinvest the funds saved to increase nursing numbers and give nurses more time to care and develop their skills and knowledge through conferences and events.

Read more articles on chemotherapy

There is currently a small cohort of patients receiving treatment in the workplace. This number is expected to increase quickly and we are committed to this as a long-term initiative as people extend their working lives into their late sixties and early seventies.

The number of people who are living with cancer and want to return to work is increasing – it is estimated that by 2030 another 130,000 people with cancer could return to work after treatment if they have the right support in place – and supporting employees with cancer and better management of side effects are likely to become increasingly important issues for employees.

It’s allowed people to stop feeling like a patient

Patients are receiving treatments for longer periods of time, some for up to two years, instead of a shorter set cycle with chemotherapy.

We have already extended the service provided by offering immunotherapies and other systemic anticancer therapies in the workplace, of which Clatterbridge Cancer Centre NHS Foundation Trust is a national exemplar. And with our contractual and governance framework now in place, the service can be rolled out more quickly to other workplaces.

Not all patients want or are suitable for treatment in the workplace, but for some cancer survivors returning to work is a fundamental step that helps restore a sense of well-being. For those patients, workplace treatment has allowed them to regain some normality in their lives and stop feeling like a patient.

Ten steps to setting up a workplace service

1. Identify which SACT (systemic anticancer therapies) treatments could be offered to patients and what specific tumour groups this might involve

2. Gain approval from management, set up a steering group and seek advice from the trust’s solicitors regarding liability issues

3. Develop robust policies and procedures for workplace treatment

4. Ensure it is cost-effective to deliver

5. Ensure experienced and qualified chemotherapy nursing staff are in place to deliver and support the service

6. Approach a selective group of patients to ask if they would be interested in receiving their treatment in their place of work

7. Fully engage with employers to ensure they support staff in allowing their treatment to be delivered in the workplace and that safety requirements can be met

8. Ensure robust processes are implemented to enable effective communication between patients and employers

9. Monitor to ensure that health and safety governance is adhered to, including policy and procedures

10. Carry out a yearly audit of the service


Sophia Bourne is a matron at the Clatterbridge Cancer Centre NHS Foundation Trust, Merseyside


Further information

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