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 is the 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 Whānau Ora 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 initiative by working with the National Clinical Lead, DHB
directors of allied health and the regional cancer networks (RCNs). Together they lead in the
development of 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 Ministry also 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.