The members of Nottingham University Hospitals NHS Trust’s SCOPES Oncology team are entirely focused on improving care for older people. Together, they aim to reduce unnecessary hospital stays and speed up recovery following an operation.
Meeting their mission does not just involve liaising with patients, however. It also necessitates close cooperation with carers.
“The team is multi-disciplinary,” explains Rob Morris, consultant geriatrician for the Systematic Care for Older People in Elective Surgery (SCOPES) programme. “So there is me, a nurse, an occupational therapist, a physiotherapist, a social worker, and a dietician.
“We all see the patient, and all meet afterwards to discuss what our intervention plan is going to be. And all of those conversations would not be as useful or as constructive unless carers were there.”
There are now 6.5 million unpaid carers in the UK, and research from Macmillan estimates almost 1.5 million people are currently caring for someone with cancer. Caring can involve helping with dressing, with healthcare tasks, with shopping and housework. But it could also mean giving the patient a lift to hospital, liaising with professionals, and supporting an individual’s knowledge of their condition.
Dr Morris reports that the SCOPES team is always keen for carers to come with patients to appointments. “And that’s not just a recognition that there are carers involved, but absolutely a recognition that their role, in all of older people’s care and treatment, is absolutely crucial.”
The role of unpaid carers is becoming more important in supporting recovery
He adds: “The degree and depth and breadth of what you can intervene with is multiplied – not just added to, but multiplied – by a carer.”
For Victoria Harmer, Macmillan consultant nurse in the breast cancer unit at Imperial College Healthcare Trust, the importance of carers is only increasing. She argues that, as care shifts closer to home and out of hospital, the role of unpaid carers will become more important in supporting recovery. And in turn it will become increasingly important for nurses and other clinicians to identify and support these individuals.
“We’ve got to adapt our pathways to really ensure that [they are] robust and that there’s a two way communication so that no one is in worry or anxiety,” she suggests.
The need to do just that has been underscored by research from Macmillan Cancer Support. Late last year the organisation published a report that revealed unpaid carers to cancer patients are now providing more hours of care and undertaking more complex tasks that ever before. Yet more than half don’t receive any support, even though the person with cancer would not be able to cope without them.
The report also shows the impact of demographic change. More than one in 10 people who are caring for someone with cancer are “sandwich caring” – looking after a parent or older relative at the same time as caring for children who are living at home.
Many individuals see themselves simply as the partner, child or friend of the cancer patient
It is why the charity offers a range of support for carers, including information, emotional support, and help with work and finances. Macmillan also provides guidance for nurses and other healthcare professionals on identifying and supporting those carrying out a caring role.
The challenge – as Harmer emphasises – is that many individuals see themselves simply as the partner, child or friend of the cancer patient. The term ‘carer’ may not mean a great deal to them. Nurses can play a crucial role in identifying such individuals, and signposting to the right services.
At Imperial College Healthcare Trust, for instance, a new project in the plastics unit is trying to ensure those who support breast cancer patients to get the information they need.
“Every week, one of the consultant plastic surgeons does an information session,” explains Harmer. “So rather than go through all of the information about the operation with individual patients, they see them all together. They have an hour, and the next step is that they will individually see the surgeon to pick up any points. And carers can be there as well, and bring up questions.”
Because she is clear on the potential impact of carers not receiving support. “Carers are wonderful,” she says. “And we would collapse without them.”
Macmillan has an extensive programme of support for carers of people with cancer, to which nurses can refer people. For more information on how to identify and support carers, visit www.macmillan.org.uk/supportingcarers