2 Recommendations and Action Plan

2.1 Parking

2.1.1 There needs to be sufficient parking spaces, both for disabled and non-disabled people, in fairly close proximity to the Centre. In addition, monitoring of car parking facilities is needed to ensure that non-disabled drivers do not occupy disabled parking spaces.
Action
The Trust is currently trying to improve parking facilities for both disabled and non-disabled people. The importance of the developments in car parking in relation to the development of the new Cancer Centre are clearly understood and will be addressed during the planning process.

2.2 Waiting areas in outpatients

2.2.1 The provision of sub-divided waiting areas would help to reduce the anxiety, and enhance the comfort of patients waiting to be seen. However, it is important that the smaller waiting areas also provide a degree of space.
Action
Waiting areas throughout the proposed Oncology and Haematology Day Hospital, plus the new Cancer Centre, have been sub-divided to avoid large waiting areas. Consequently, patients will wait in smaller, specific waiting areas, adjacent to the area in which they are being seen or treated.

2.2.2 Consideration needs to be given to means of reducing waiting times in the outpatients department and ensuring that patients are seen at their specified appointment times.
Action
Waiting times remain a significant issue in oncology. The new Centre will be purpose-built and will contain more diagnostic and treatment equipment than is the case currently, which should help to address some of the waiting issues. In addition, the systems for providing services to patients will continue to be reviewed on an ongoing basis, in order to improve the patient experience.

2.2.3 There needs to be a degree of privacy in chemotherapy treatment areas when this is required by patients.
Action
The chemotherapy treatment areas are separate from the general waiting areas in both the new Day Hospital and the new Cancer Centre building.

2.2.4 A queuing system needs to be in place which ensures that patients are informed when they will be seen, know when they are being called, and which gives them the opportunity to use catering and toilet facilities without missing their appointments. However, there were mixed views as to whether a personal approach (by staff) or a tannoy or ticket system was best.
Action
The Trust is investigating new methods of allowing patients the freedom to move (e.g. to dining areas and toilet facilities) without being concerned about missing their appointment times (e.g. using bleeps or an equivalent technology).

2.2.5 Sufficient seats need to be available to accommodate both patients and relatives. A mix of seating types (high and low; soft and firm) is needed. In addition, reclining chairs and trolleys are important for patients who need to lie down.
Action
The Trust intends to address these issues.

2.2.6 Adjustable armrests and chair-side tables are required for patients receiving chemotherapy.
Action
The Trust intends to address this issue.

2.2.7 Small changing rooms attached to the radiotherapy bunkers are required (either inside or outside of the bunkers), to ensure patients' privacy.
Action
It is planned that there will be small changing cubicles adjacent to the radiotherapy bunkers in the new Cancer Centre.

2.2.8 There should be easy access to drinking water, tea/coffee and toilet facilities.
Action
These issues will be addressed in the new Centre and, where possible, the Trust is trying to improve conditions in the interim period.

2.2.9 There should be separate waiting areas with and without TV. In addition, background music might help to relax patients.
Action
This issue will be explored further by the Trust.

2.2.10 Catering facilities - providing good-quality, healthy food - should be easily accessible. However, the café needs to be separate from the waiting areas.
Action
The cafes servicing both the Day Hospital and the Cancer Centre are separate from the waiting areas, but near enough to be easily accessible.

2.2.11 Outpatients need access to information: they need to know they can approach staff for information generally and have ready access to written information in both the outpatients' department and the psychosocial centre.
Action
The Trust is currently seeking to address this issue.

2.2.12 The particular needs of new patients (what to expect and feeling anxious) need to be recognised and addressed.
Action
The Trust is currently seeking to address this issue.

2.2.13. It is important for patients to be able to bring relatives with them when having treatment.
Action
The Trust acknowledges this and intends that waiting areas should have sufficient, comfortable space to allow this to happen.

2.2.14 Outpatients need support and counselling and there needs to be better assessment of patients' needs for support and counselling. In addition, the work of support/counselling staff needs to be co-ordinated generally.
Action
The Trust is currently undertaking a review of all its 'Supportive Care Services'. The recommendations of this review should address the particular issues raised by the patient focus group participants.

2.2.15 Outpatients need to have easy access to information and support and know how to access such services from cancer charities.
Action
The Trust will explore these issues.

2.2.16 The waiting areas should be bright, and colour co-ordination of particular areas would be helpful in finding directions.
Action
The issue of finding directions, including colour co-ordination, will be addressed in the interior design of the Cancer Centre.

2.3 Inpatient beds

2.3.1 Every bedspace should have provision for the storage of personal effects.
Action
Provision is being made for the storage of personal effects for all patients.

2.3.2 Noise levels at nurses' stations need to be managed to minimise disturbance to patients in nearby beds.
Action
The Trust acknowledges this point.

2.4 Facilities for adolescents

2.4.1 Each bedroom needs to have a shower and access to a bath.
Action
Each adolescent bedroom will have an en-suite shower and WC.

2.4.2 TV, video, stereo and playstation equipment is required.
Action
Entertainment media (TV, video, stereo and playstation) will be provided.

2.4.3 A sofabed should also be provided, to enable a parent to share the room with the adolescent.
Action
Parents will have a facility to allow them to sleep in the bedrooms with their children.

2.4.4 Menus should provide a good variety of food choices.
Action
This aspect will be further explored with the Catering Department and the Dietetics/Nutrition Department.

2.4.5 A small kitchen is needed to enable parents to cook for their children.
Action
An adolescent lounge will be provided to allow adolescents to have a relaxation area away from the general adult ward, and small kitchen facilities will be provided in this area.

2.5 Artwork and landscaping

2.5.1 There needs to be variety in wall pictures/paintings and other types of art.
Action
There will be a variety of artwork throughout the new Centre.

2.5.2 The display of comment boards in waiting areas (to give patients the opportunity to share their experiences/comments with other patients) could be explored.

2.5.3 Bedroom walls could have bulletin boards to enable patients to display their own photos/pictures.

2.5.4 Occasional exhibitions would enable patients to try art therapy and display own artwork.
Action
There will be areas within the new Centre where it will be possible to mount exhibitions.

2.5.5 Radiotherapy bunker rooms need ceiling imagery (e.g. ceiling tiles or projections) to give patients something pleasant to focus on.
Action
The issue of imaging within radiotherapy bunkers is being explored both with the equipment manufacturers and the design team for the new building.

2.5.6 Background music in radiotherapy bunkers could help distract from equipment sounds.
Action
Background music is already provided in bunkers, but the issue will be explored again at a future date.

2.5.7 Garden areas are important for providing space away from the wards. (i) Both open-air and enclosed green spaces are required. (ii) A conservatory, with seating, was felt to be important (near the dayrooms and/or in the hostel). (iii) Water fountains would be relaxing and therapeutic. (iv) Plants should reflect the changing seasons. (v) Garden areas should be well maintained. (vi) Surfaces should allow for drip stands to be moved around. (vii) A gardening club would provide an activity for patients.
Action
All of the above suggestions (i-vii) have already been shared with the landscape architect for the new building.

2.6 Link with psychosocial centre

2.6.1 A physical link is necessary not just to provide access, but also to ensure the psychosocial centre is used.

2.6.2 The Psychosocial Centre should be easily accessible from the main building.

2.6.3 The link should be semi-enclosed (e.g. a sheltered walkway).
Action
The Psychosocial Centre will be a short distance from the main Centre. The route of access between the two buildings is currently being explored.

2.7 Hostel accommodation

2.7.1 A mix of single bedrooms and family flats are needed.

2.7.2 A communal kitchen and sitting room would provide space for patients to meet and interact.

2.7.3 Basic cooking equipment (e.g. a microwave) and a fridge are required in each room.

2.7.4 At least two payphones should be provided.

2.7.5 A library/information area in the hostel would be helpful.

2.7.6 A supply of crafts and jigsaws would provide an activity for patients.
Action
All of the suggestions made by the patients will be addressed when designing the new hostel accommodation. It is planned that all rooms will be en-suite (shower and WC) and will have a small kitchen with basic cooking facilities. The need to have communal spaces for socialising within the hostel will be addressed.

2.8 Miscellaneous design/layout issues

2.8.1 Familiarity of surroundings is important for adolescents.

2.8.2 The Centre needs to cater for the needs of disabled people.
Action
The Centre is designed to address all current disabled access standards.

2.8.3 The provision of computers would provide an activity for patients.

2.8.4 Separate lounge facilities should be allocated for smokers.
Action
Two small smoking lounges have been installed adjacent to the ward areas, and these lounges will be ventilated.

2.9 Service issues

2.9.1 Lymphoedema and wig services are important aspects of the overall service.
Action
The Trust will continue to review the provision of these services.

2.9.2 Where patients have appointments for blood tests only, it should be ensured that these tests take place and delays in waiting for blood tests are minimised.
Action
The Trust will continue to review the processes by which patients receive their treatment.

2.9.3 The planned information strategy should address a degree of duplication currently, in that, sometimes, two files are held per patient.
Action
An information strategy for the Cancer Centre is currently being examined and developed.

2.10. Communication/information issues

2.10.1 Staff communication with patients generally could be improved.
Action
The Trust will keep the issue of communication with patients under ongoing review.

2.10.2 Some patients want more detailed information at the time of their diagnoses (on treatment options, hair loss and wig replacement, plastic surgery and genetic counselling).
Action
The issue of 'information-giving' is different for each patient and staff will seek to address the needs of the patient as an individual.

2.10.3 Patient preferences for particular types of treatment need to be taken into account when treatment decisions are made. The Trust acknowledges this issue.

2.10.4 Staff needs to be mindful of demonstrating empathy with patients and be aware of the practical difficulties that some patients experience in attending hospital. The Trust acknowledges this issue.

2.11 Support issues

2.11.1 There is a need for support when patients finish their treatment. In particular, it would be helpful if a health professional or support worker in the local area made contact with the patient. For example, the hospice daycare service in Ballymoney was highlighted as a very good support service.
Action
This issue will be raised with the group currently undertaking a review of the Supportive Care Services.

2.12 Care/staff issues

2.12.1 It is important for patients to be seen, without appointments, when they experience complications after their treatment.
Action
Patients currently receive specific advice on what to do if they experience complications after their treatment.

2.12.2 A number of training needs of staff were highlighted: for GPs in relation to neutropenic patients; and for some nursing staff and junior medical staff in relation to blood taking. In addition, awareness needs to be raised among domestic staff of the susceptibility to infection of neutropenic patients.
Action
These issues will be raised with the relevant staff groups.

2.12.3 Patients need to feel confident that they can highlight issues with staff without feeling vulnerable in doing so. The Trust acknowledges this issue.