Taylor, Helen Jane; (2009) Multimethod analysis of NHS policy for the development of new services for ambulatory cancer care. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Modernising the provision and delivery of cancer care is a government priority. NHS organisations are being driven by the government to provide a modern fast changing and responsive service that is patient focused and provides evidence based care. One of the key objectives for these policies is the development of cancer care provision in settings both in hospitals and closer to patients' homes. The aim of this study was to analyse NHS policies on the development of new ambulatory cancer care services using multiple methods to identify areas of convergence and divergence between these policies and the perceptions and views of both patients and healthcare professionals. Thematic framework analysis was used to provide an understanding of the NHS policies, while the perceptions and views of the patients and healthcare professionals were explored using focus groups, questionnaires and interviews. The results of all three studies were then triangulated to identify gaps and tensions between the policies and perceptions of ambulatory cancer development. The study revealed a continued drive by the Government to move treatments from daycase hospital settings to outreach ambulatory care settings, including cancer. There were areas of divergence between the policies' descriptions of patient choice and flexibility and those of patients themselves. Patients' required flexibility throughout their journeys; the infrastructure of hospital; and the support a collective experience with other patients which could be lost through outreach ambulatory care developments. Healthcare professionals identified a lack of professional and physical capacity to deliver ambulatory care as expressed in the policies and the challenge of ensuring governance throughout the care of patients with complex pathologies. Moving patient care out of hospitals would meet government policy, but also introduces barriers with potential infrastructure and financial models that do not fully support such developments. This study identified that service developments driven by policy do not necessarily match the needs of patients and may not be supported by the professionals or infrastructures that would be needed to provide effective and responsive pharmacy service developments.

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