Louise Hunt meets the NT award-winning team dedicated to young people with cancer
‘One lad with testicular cancer said it would have killed him to stay on an adult ward – rather than the cancer itself,’ says Sam Smith (pictured left), lead nurse at the Young Oncology Unit at Christie Hospital NHS Foundation Trust in Manchester.
These may be dramatic words but they illustrate why the young oncology unit won NT’s Team of the Year Award 2007, sponsored by Unison.
When it opened in 1998, funded by the Teenage Cancer Trust charity, the unit was only the second specialist service of its kind in the UK. Since then the team has grasped every opportunity to drive forward cancer care for young people both regionally and nationally.
Previously, young people with cancer were treated in either children’s or adult wards. When the unit opened it saw only 40% of the young people with cancer in the hospital. Now, thanks to a tireless campaign to raise awareness of the unit among other health staff, this figure is almost 100%.
Sam says: ‘In the early days, there was a lack of recognition by consultants of our work, so we started doing teaching sessions for nurses and doctors about the specialist needs of young people. I would patrol the wards and talk to young people about our unit and if consultants didn’t want them to transfer, then we would support the patients in the adult wards.
‘We also did audits and found that the hospital could have treated 200 more adults if the young people were moved to our unit. It was about changing historical practice and mindsets.’
Young people (the target group being 13–24) have different needs that do not fit with children or adult services, says Sam. ‘Consultants often come to us for advice because they have a young patient who is withdrawn or not taking their treatment.
‘Young people are especially affected because they miss out on their social life, time stands still for them and a lot of their friends drop off and move on. They cope much better when they are being treated with others in the same boat. If you ask any of them, they say the most important thing is being able to share their experience with other patients who understand what they are going through.’
The young oncology unit, which comprises a team of 26 staff, provides a supportive and stimulating environment for its patients. Its support and activity coordinator, Lorraine Case, organises ward activities, including drama, pool competitions and away trips.
‘These are nice treats but they are really about keeping the socialisation going that patients would normally miss out on,’ explains Sam.
One of the key reasons Sam believes the team was picked for its award is the Christie Crew. This is the unit’s patient involvement group, which gives young people a direct say over their care and is now being used to influence national policy.
Recent patient-led projects include a film about the differences between adults and young people’s wards, which is now being used for nurse training, and the ‘don’t hide, wear with pride’ campaign. This centred around the need for patient ID cards explaining why the bearer could not adhere to certain dress codes. It was led by one patient who had experienced trouble getting into bars and clubs wearing a bandana. The campaign generated so much publicity that it prompted a visit to the unit by former prime minister Tony Blair.
As a result of projects like this, Sam says the Christie Crew is seen as a consultation group for young cancer care, giving regular talks at conferences and being called on to advise on policy for charities such as Macmillan Cancer Support.
Asked how nursing practice differs on the young oncology unit, Sam says the team are currently looking into this question as part of their own research.
‘Young oncology units are different because of the environment – it’s relaxed, there are laptops, TVs and other things for patients to do. But I think even if you took the environment away, they would still have a good experience because of the staff.
‘Nurses who work with young people usually do it because they want to work with that age group. There is a knack to it; it’s about communication and being able to deal with the whole family.’
She adds that being a dedicated service means that nurses have more time to spend with patients. ‘One of the things young people notice in other units is that staff do not have enough time to spend with them. They are woken at 7am and don’t see nurses between the drug rounds.
‘On this unit they can sleep in until 11am and eat whenever they want. And it’s not just about nursing care, like giving chemotherapy and taking bloods, it’s about the interaction with the patient and their family, playing games and having a chat. There is also a social worker and community nurse, so there is a really comprehensive package.’
At times it can be a struggle to maintain professional boundaries in an emotionally charged environment, she says. ‘What works best for us is how we support each other. We socialise outside work and the staff were hand-picked on how they would work together. We really are like a family and have a lot of respect for each other.’
For Sam and her team, the satisfaction is evident. ‘I’m really passionate about what I do and that comes from an absolute belief that young people should be treated in specialist services and I think the other nurses feel the same.
‘It is tough at times and very hard when a patient dies but they are a fantastic group of patients to work with. We have lots of laughs and they are very matter of fact – they just get on with it.’
However, the young oncology unit still faces an uphill battle in gaining acceptance beyond the hospital. ‘For me, the biggest challenge is getting everybody to believe
in what we are doing. There is still a postcode lottery and we don’t get to see everybody we should.’ She says this is often down to where a patient is prescribed for treatment. ‘Some doctors still don’t recognise there is a difference between specialist young people’s services and adult wards.’
Despite a slow change in some attitudes, the unit’s prospects are looking good. It is undergoing refurbishment to expand from 13 to 15 beds, with a four-bed day case unit. The team is also waiting to learn if it will become a principal treatment centre, under government plans to improve access to age-appropriate cancer services, which would enable it to become a 25-bed facility.
Asked why the team was chosen, Gail Adams, Unison’s head of nursing, says: ‘They are role models and make me want to be a better nurse. They are passionate, determined and dedicated to what they do, who and how they care for people.’
For the young oncology team, the NT award is the icing on the cake. ‘Winning the award is just amazing. Everyone is so thrilled to be recognised for something we have worked so hard for.’
The £1,000 award will be fairly split between topping up the patients’ activity fund and paying for a ‘staff outing to “go ape” at an outdoor activity centre’, says Sam. ‘We wanted to do both and say thanks to the nurses.’