Making every assessment count: delivering value through holistic needs assessment (HNA)

Conducting a Holistic Needs Assessment (HNA) offers a valuable opportunity to have a therapeutic interaction led by a person living with and beyond cancer. Furthermore, the HNA is a means, not an end, to supporting personalised care which will be determined through the actions agreed during the care planning conversation. The expectation to ‘tick the box’ and focus on numerical targets can be a distraction but shouldn’t deter health and care professionals from keeping the ultimate purpose and essential process of an HNA front and centre.

The NHS Long-Term Plan offers a comprehensive model of personalised care and commits to offering a holistic assessment of needs and care planning as a core intervention in personalised supportive cancer care (NHS England, 2019). A clear commitment to care planning is seen in cancer strategy across the UK nations (Wales Cancer Network, 2023; The Scottish Government, 2023; health-ni.gov.uk, 2019). HNAs provide a formal opportunity for health and care professionals to address person-centred goals, at key times in the disease trajectory. Individuals can then access timely support that is relevant, appropriate, and sufficient for their needs.

See also: Holistic Needs Assessments

As the person living with and beyond cancer works through the assessment tool, they can see that any practical, emotional, financial and/or spiritual concerns they may have, can be raised with equal importance alongside their clinical needs. Furthermore, Macmillan’s eHNA platform ‘ranks’ concerns based on the individual’s priorities, enabling their health and care team to promptly address the most acute issues identified.

Assessment and care planning process

- Person living with and beyond cancer completes the Concerns Checklist

- Joins consultation with professional to discuss concerns and co-create their care plan

- Discusses self-management opportunities and professional support available

- Receives information and resources, and appropriate referrals are arranged

- Receives a written copy of their completed care plan, which is also shared with other relevant professionals where required and with their consent, such as their GP

- Agrees a review date set with professional to monitor progress.

The steps laid out above highlight this is a process which should progress from identification of individual concerns to an in-depth care-planning conversation with a designated professional, appraising options and determining realistic goals to co-create the care plan (Le Boutillier et al, 2023). Whilst this conversation may well be regarded as an intervention, further actions are likely to be needed involving referrals to available resources and service and deciding on a review date.

Once the written care plan is completed it can then be shared (with permission) with the wider health and care team and utilised in their subsequent consultations. This saves repeating information, can endorse the action plan, and ultimately builds commitment to the process. 

Within the latest NCPES survey, published July 2023 containing data between April-June 2022, 66.0% of respondents reported a member of their care team helped to create a care plan to address any needs or concerns and of these 98.7% reported a member of the team reviewing the plan with them to make sure it continued to reflect their needs or concerns. The estimated percentage of individuals diagnosed with cancer who received a care plan via Macmillan’s eHNA platform in 2022 across the four nations is as follows: England 15%, Scotland 12%, Wales 6%, Northern Ireland 13%, shown below in the table by number of care plans completed.

Evidence suggests the content, delivery, and timing of personalised care planning differs across the four nations. (Young et al., 2015). We know the nature of the care-planning conversation will vary depending on the context and care setting as well as an individual’s concerns. A team response may well be required to address communication and information needs, symptom/concern management, as well as referral to appropriate services – all of which take dedicated space and time. However careful consideration should be given to who is most skilled, has the appropriate knowledge and is best placed to provide the supportive conversation.