• Within each Cancer Network, commissioners and providers (statutory and voluntary) of cancer and palliative care services, working with service users, should oversee the development of services in line with the recommendations of this Guidance. Key personnel will need to be identified to take this forward.
• Assessment and discussion of patients' needs for physical, psychological, social, spiritual, and financial support should be undertaken at key points (such as at diagnosis; at commencement, during, and at the end of treatment; at relapse; and when death is approaching). Cancer Networks should ensure that a unified approach to assessing and recording patients' needs is adopted, and that professionals carry out assessments in partnership with patients and carers.
• Each multidisciplinary team or service should implement processes to ensure effective inter-professional communication within teams and between them and other service providers with whom the patient has contact. Mechanisms should be developed to promote continuity of care, which might include the nomination of a person to take on the role of 'key worker' for individual patients.
• Mechanisms should be in place to ensure the views of patients and carers are taken into account in developing and evaluating cancer and palliative care services. Cancer Partnership Groups provide one potential mechanism. Systems should be devised to support patients and carers to participate in their own care, featuring a range of informal support opportunities such as self-help activities and peer support schemes within community settings.
• Communicating significant news should normally be undertaken by a senior clinician who has received advanced level training and is assessed as being an effective communicator. As this is not always practical, all staff should be able to respond appropriately to patients' and carers' questions in the first instance before referring to a senior colleague.
• The outcome of consultations in which key information is discussed should be recorded in patients' notes and communicated to other professionals involved in their care. Patients should be offered a permanent record of important points relating to the consultation.
• Policies should be developed at local (Cancer Network/provider organization/team) level detailing the information materials to be routinely offered at different stages to patients with particular concerns. These policies should be based on mapping exercises involving service users.
• Commissioners and provider organizations should ensure that patients and carers have easy access to a range of high quality information materials about cancer and cancer services. These materials should be free at the point of delivery and patients should be offered appropriate help to understand them within the context of their own circumstances.
• Commissioners and providers of cancer services, working through Cancer Networks, should ensure that all patients undergo systematic psychological assessment at key points and have access to appropriate psychological support. A four-level model of professional psychological assessment and intervention is suggested to achieve this.
• Explicit partnership arrangements should be agreed between local health and social care services and the voluntary sector to ensure that the needs of patients with cancer and their carers are met in a timely fashion and that different components of social support are accessible from all locations.
• Patients and carers should have access to staff who are sensitive to their spiritual needs. Multidisciplinary teams should have access to suitably qualified, authorized, and appointed spiritual care givers who can act as a resource for patients, carers, and staff. They should also be aware of local community resources for spiritual care.
• Mechanisms need to be implemented within each locality to ensure that medical and nursing services are available for patients with advanced cancer on a 24-hour, 7 days a week basis, and that equipment can be provided without undue delay. Those providing generalist medical and nursing services should have access to specialist advice at all times.
• Primary care teams should institute mechanisms to ensure that the needs of patients with advanced cancer are assessed, and that the information is communicated within the team and with other professionals as appropriate. The Gold Standards Framework provides one mechanism for achieving this.
• In all locations, the particular needs of patients who are dying from cancer should be identified and addressed. The Liverpool Care Pathway for the Dying Patient provides one mechanism for achieving this.
• Commissioners and providers, working through Cancer Networks, should ensure they have an appropriate range and volume of specialist palliative care services to meet the needs of the local population, based on local calculations. These services should, as a minimum, include specialist palliative care inpatient facilities and hospital and community teams. Specialist palliative care advice should be available on a 24-hour, 7 days a week basis. Community teams should be able to provide support to patients in their own homes, community hospitals and care homes.
• Commissioners and providers, working through Cancer Networks, should institute mechanisms to ensure that patients' needs for rehabilitation are recognized and that comprehensive rehabilitation services and suitable equipment are available to patients in all care locations. A four-level model for rehabilitation services is the suggested model for achieving this.
• Commissioners and NHS and voluntary sector providers should work in partnership across a Cancer Network to decide how best to meet the needs of patients for complementary therapies where there is evidence to support their use. As a minimum, high quality information should be made available to patients about complementary therapies and services. Provider organizations should ensure that any practitioner delivering complementary therapies in NHS settings conforms to policies designed to ensure best practice agreed by the Cancer Network.
• Provider organizations should nominate a lead person to oversee the development and implementation of services that specifically focus on the needs of families and carers during the patient's life and in bereavement, and which reflect cultural sensitivities.
• Cancer Networks should work closely with Workforce Development Confederations (the Workforce Development Steering Group in Wales) to determine and meet workforce requirements and to ensure education and training programmes are available.
• Provider organizations should identify staff who may benefit from training and should facilitate their participation in training and ongoing development. Individual practitioners should ensure they have the knowledge and skills required for the roles they undertake.

[NICE, 2004]

• These are the key recommendations of guidance from the National Institute for Health and Clinical Excellence on 'Improving Supportive and Palliative Care for Adults with Cancer' [NICE, 2004].