Implementation of the ACE programme, Wave 2 2017-18 Realist Evaluation

I Ablett-Spence, Jen Howse, GP Rubin

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    Abstract

    The ACE (Accelerate, Co-ordinate, Evaluate) programme was initiated in June 2014 as a set of pilot projects that tested specific interventions and models with the aim of improving cancer diagnosis pathways. It was supported by NHS England, Cancer Research UK (CRUK) and Macmillan Cancer Support and it ran during 2015 and 2016. Subsequently, and in response to the most recent cancer strategy for England (Achieving World Class Cancer Outcomes (2015)), a second wave of pilot projects specifically addressed the implementation of Multidisciplinary Diagnostic Centres (MDC). These pilots have been evaluated by the Policy Research Unit for Cancer Screening, Awareness and Early Diagnosis.
    This qualitative element of the evaluation used a realist methodology to describe the development and implementation of MDCs a six pilot sites, by considering the contexts, mechanisms and outcomes that operated at each site and then drawing together the key themes that emerged across all six sites. The underlying programme theory for ACE Wave 2 was that pilots would be successfully implemented by being part of a national programme (ACE) that provided support, funding and opportunities for shared learning.
    One hundred and twenty-eight interviews were conducted over three rounds between February 2017 and June 2018. All sites successfully implemented their chosen MDC model and the support from the ACE programme was a key factor in enabling this. A transformational style of leadership, together with stable project management were key factors in ensuring a smooth and successful result. MDCs required clinicians and Clinical Nurse Specialists to work in different ways, in particular the CNS role needed to be redefined. The need for a patient navigation function emerged as important in all sites and was explicitly addressed by the appointment of a navigator at some of these.
    There remain some concerns about the longer term sustainability of MDCs. In most cases this is due to their success being dependent on one or two highly motivated individuals. It was also apparent that in most cases the MDC had not been fully normalised within the operational systems and staffing capacity of the host Trust, though diagnostic test capacity was not generally a challenge. Further roll-out of MDCs will require comparable resourcing to become established and in all cases Trusts will need to plan in detail the resources required to ensure long-term viability.
    Original languageEnglish
    PublisherCancer Research UK
    Publication statusPublished - 2018

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    Ablett-Spence, I., Howse, J., & Rubin, GP. (2018). Implementation of the ACE programme, Wave 2 2017-18 Realist Evaluation. Cancer Research UK.