Older People Living with Cancer

Peer advocates supporting older people affected by cancer

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Calculating the cost/benefit of advocacy

Today, we’re absolutely delighted to be able to bring you the final film from our Older People’s Cancer Voices work.

George, Varun and Carmela from EY (formerly Ernst & Young) explain how it is they came to report that for every £1 invested in our cancer advocacy work, there is a £6.70 social, financial and economic return.

George talks about how working with the real life cancer advocacy stories we provided has opened his eyes to the fact that for those affected by cancer, “everybody’s story is different”. Using the data and stories we provided George and his team sought to “get behind the numbers and got into the detail of what those numbers meant for people’s lives in reality.”  


Varun explains how anything in society that we do has a social return on investment, “because they’re associated with uplifting the welfare of a society.”


Carmela discusses how when looking at issues of Voice Choice and Control, they could see how the support of an advocate gave people the wherewithal to once again make decisions for themselves.


George describes advocacy as a matchmaker, its support “helped people access things that are already there and that’s why it was able to create big returns for a low cost”. 

You can view the film here

and access the EY report via the OPAAL website

Marie McWilliams, OPAAL


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Is a Lasting Power of Attorney still the answer?

Today solicitor Amy Lloyd of leading law firm Wright Hassall explains why she believes a Lasting Power of Attorney remains the answer at a time when the rationale for using them is being questioned:

Denzil Lush, until recently the most senior judge in the UK Court of Protection, stated that he would never sign a Lasting Power of Attorney (LPA) himself.

An LPA allows an individual to choose who they want to make decisions on their behalf should they lack the mental capacity to make those decisions in future. Lush warned the system lacks the necessary safeguards and puts vulnerable people and their assets at risk.

However, Amy believes the risks are overstated:The adverse publicity created by these comments could put even more people at risk if they choose not to make an LPA.

Mental Capacity Act imposes accountability

An attorney’s responsibilities are set out in the Mental Capacity Act which is underpinned by five principles designed to provide the necessary safeguards. Anyone can report attorney financial abuse of a vulnerable person to the safeguarding unit at the Office of the Public Guardian.

Although Lush appears to favour Deputyship Orders, there are drawbacks to them, starting with their cost as they require the provision of annual accounts to the Court, and the purchase of a security bond to cover financial losses.

They also require a full list of assets, which an individual may not want disclosed, particularly if they have fluctuating mental health problems, rather than a deteriorating health condition. If you suddenly became incapable of managing your finances, even a trusted relative or friend would struggle to help you without an LPA. Remember, your bank will not deal with anyone other than you, the account holder.

Amy Lloyd

Adding clauses to an LPA for peace of mind

An LPA ensures that your affairs are managed by someone you choose, rather than someone chosen by the Court of Protection. With a solicitor’s help, you can add clauses to the standard LPA form to help avoid potential abuse, such as insisting your attorney provides annual accounts to three named family members and your accountant.

Is this better or worse than providing annual accounts to the Court? The family members or accountant could report any concerns to the safeguarding unit.

Including such a condition in your LPA would answer Lush’s concerns that the LPAs “lack of transparency, causes suspicions and concerns which tend to rise in a crescendo and eventually explode”.

Alternatively, you could appoint several attorneys to monitor each other. But that opens your finances to greater scrutiny within the family which you may not welcome.

Retired Judge Denzil Lush’s statement that he would never make an LPA, was an endorsement of a Court Deputyship Order. If you want to retain some control beyond incapacity, the LPA is still the right choice, together with some carefully worded conditions.”

About Amy: Amy Lloyd specialises in estate and succession planning including drafting Wills, inheritance tax planning, Trusts (formation and administration), guarding estates against care fees or potential claims by estranged family members, mental capacity issues including powers of attorney and deputyship orders.

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Lost in transition?

Today Rhonda Oliver, Project Manager from Barnet Macmillan Cancer Advocacy & Advocacy in Barnet, discusses the issues facing older people, especially in transition from hospital and what Advocacy in Barnet is doing to help:

The National Health Service (NHS) is bursting at the seams and struggling to cope with record levels of demand. Services are stretched to the limit and if that is not bad enough, hospital and GPS are being affected by one of the worst flu outbreaks in recent years

We have all seen the pictures of ambulances queuing outside A&E and patients are facing long delays to find an available bed.

Yet, according to the King’s Fund the total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients being treated has soared. The UK currently has fewer acute beds relative to the size of its population than almost any other comparable health system. It is a tribute to the dedication and phenomenal hard work of NHS staff that they are able to deliver the high quality care and support that patients require in the face of such challenges.

The King’s Fund further report that the number of general and acute beds has reduced by 43 per cent since 1987/8. Most of this fall is owing to closures of beds for the long-term care of older people. Innovations in medicine, including an increase in day surgery, has also had an impact by reducing the time that many patients spend in hospital.

The rate of decrease in bed numbers may have slowed in recent years, but avoidable admissions may be prevented by making better use of existing bed stock, reducing variations in length of stay and improving the discharge of patients.

The focus should be on older patients who stay in hospital a long time, but this depends on there being enough capacity to provide appropriate care outside of hospital. Evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care.

The need for efficient discharge planning has never been so pressing.

Advocacy in Barnet has found that 78% of older people in Barnet experience isolation, helplessness and despair as they move from hospital to home or into residential care, often without proper care, food, money, possessions or treatment plans and many without family to support them. Only 55% had plans explained to them and 100% said the plans did not provide the support they need after discharge.

Rhonda Oliver

Hospital discharge planning should consider the patient’s needs after a hospital stay and they should not be discharged from hospital until:

  • They are medically fit
  • They have received an assessment to look at the support they need
  • They have been given a written care plan that sets out the support they will receive to meet their assessed needs 
  • The support described in their care plan has been put in place and it is safe for them to be discharged.

Advocacy in Barnet has received funding to champion the rights of disadvantaged people 50 years old and over and we aim to support lone older people in hospital to make informed choices and decisions about their treatment and future care especially in relation to discharge arrangements.

We will provide independent advocacy to support people to access the services and information they need to improve their stay in hospital and to avoid re-admission once they have been discharged.

We are grateful to our funders: the Mercer’s Company, the Garfield Weston Foundation  and the B’nai Birth Leo Baeck Lodge (London) Limited for providing support to enable us to provide this essential service to the residents of Barnet.

Rhonda Oliver, Project Manager, Advocacy in Barnet

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An exciting night at the HSJ Awards

OPAAL was absolutely delighted some weeks ago to find out that the Cancer, Older People and Advocacy programme was shortlisted for an HSJ Awards (Health Service Journal) in the Supported Self Care category.

Wednesday last week, November 22nd, saw the awards evening in the Intercontinental Hotel at the O2 in London. I attended along with Bob and Maddy Smith, peer volunteer advocates and Kathleen Gillett, Macmillan project coordinator, all of Dorset Macmillan Advocacy. Also attending as a guest of NHS England was OPAAL Trustee and Vice Chair, Catherine Wood. NHS England, as sponsors of the Supported Self Care category award, hosted two tables and Catherine was seated at one of these and was very well placed centrally, near to the stage.

The night began with a bit of trauma for myself, Bob, Maddy and Kathleen. The Blackwall Tunnel near to the venue had been closed due to a road traffic accident. This led to major disruption on the roads for miles around the area. After an hour and fifty minutes in our cab for a journey which should have taken thirty, we arrived late and having missed the opening speeches. Fortunately after wolfing down our starters we caught up with every one else at our table. All had been nominated for awards although not in the same category as us.

Catherine, Maddy, Marie and Kathleen

Marie, Kathleen at the back with Bob and Maddy in front

Sir Lenny Henry










After a lovely meal the awards started in earnest. Hosted by the wonderful Sir Lenny Henry, the excitement for us mounted and mounted. Our category was midway through the programme so we had a bit of time to wait to find out the result.

I was so hopeful that our name would be called out as winner. Being nominated and shortlisted was a real achievement but at OPAAL we were so keen that our wonderful peer volunteers and cancer champions be nationally recognised by this award.

Unfortunately it wasn’t to be. First Steps Derbyshire’s Online Befriending Service was the name called out rather than ours. Whilst disappointed, we applauded the winner and consoled ourselves that it genuinely was a massive achievement to be shortlisted and had gone a long way to raising the profile of advocacy on the national stage.

Here at OPAAL we see everyone involved in the Cancer, Older People and Advocacy programme as winners and we thank each and every one. All have made a difference to the lives of older people affected by cancer.

Marie McWilliams, Operations Manager, OPAAL

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Widening the skill mix in Dorset’s cancer care

Macmillan Cancer Support has created a role of Cancer Support Worker and posts are currently being filled at the three Trusts in Dorset.  Deborah-Lynn Wilkinson is helping patients at Royal Bournemouth Hospital with accessing information and support based on an assessment of their needs using the electronic Holistic Needs Assessment (eHNA). If that sounds like a bit of a mouthful then it’s worth noting that Deborah-Lynn is very careful to avoid jargon when speaking with patients.   What the patient experiences is a friendly and informal conversation focused on their wellbeing.

Deborah-Lynn Wilkinson

Deborah-Lynn visited Jo Lee at Help and Care to get an understanding of independent advocacy support from Dorset Macmillan Advocacy and find out what else the organisation can offer locally.  Then Kathleen Gillett visited Deborah-Lynn at the hospital to hear more about the scope of the Support Worker role. Patients can complete the eHNA questionnaire in clinic on a tablet or at home via a web-link and the results form the basis of a care plan.  At present Deborah-Lynn is working on one cancer pathway and will contact patients at three points in their cancer journey to ensure to pick up changing needs.

The Support Worker posts will enable the Clinical Nurse Specialists to use their clinical knowledge and time to best effect and widen the skill mix in the department.  Macmillan Cancer Support’s latest report on workforce From the Frontline includes recommendations to do just this.   We are hopeful that the eHNAs will spotlight where there is a need for advocacy support and that the Support Workers will refer to the advocacy service.

Kathleen Gillett, Macmillan Project Coordinator, Dorset Macmillan Advocacy

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Trick or Treat?

Today Rhonda Oliver of Advocacy in Barnet provides us with food for thought:

Halloween is looming – rooted in the ancient Celtic festival of Samhain, it marks the end of Summer and the harvest, and the beginning of the cold dark winter associated with human death, when the boundary between the living and the dead becomes blurred.

According to the Office of National Statistics more people die in winter than in summer and the Grim Reaper pays most house calls in December, January and February. So, if you do not want to think about death and dying, look away now!

Is there a right time to have an advance care plan? Who should have one? What should it cover?

A care plan is for anyone, with increasing relevance for older people who are likely to be nearing the end of their lives. However, it could be for someone who has particular health needs or someone who just wants to record their choices and preferences for their care and treatment for any other reason.

It is a good idea not to leave this until a crisis happens when you may not be able to participate in making choices. In an emergency health professional may have to make rapid decisions about your treatment and a care plan can help to ensure that you get the treatment that is best for you and that you would have wanted.

A care plan is created through conversations with your family and carers, your health professionals and you. You keep the plan with you and ensure that it will be available immediately in an emergency, say to ambulance crews, out-of-hours doctors, accident & emergency and other hospital staff if you are admitted. Some people keep their care plan displayed on their fridge door; others leave it inside the fridge in a plastic bag! This is often the first place an ambulance crew will look.

The plan will guide clinicians to balance the priorities for your care, i.e. would you want them to focus on treatment to prolong life or to focus mainly on providing comfort? The plan should include your choices regarding  treatments that you would want to be considered for or those you would not want, for example would you want cardiopulmonary resuscitation (CPR)? If the answer to this is no then you should flag an advance decision to refuse treatment (DNR) or any other important planning documents in the plan. It is very important that your understand the parameters and implications of an advance decision to refuse treatment and that you discuss this with your GP and family.

Talk to your local advocacy organisation if you are thinking about your future care. It will support you to make your choices and preferences heard.

Once you care plan is made it is not set in stone and should be reviewed on a regular basis. It should, however, provide you with peace of mind so you can cuddle up on the sofa with your loved ones, with a cup of tea (or something stronger), watch the telly and wait for spring.


Rhonda Oliver, Project Manager, Barnet Macmillan Cancer Advocacy & Advocacy in Barnet

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The many benefits of volunteering at any age

Last year Tessa Watts described what she was learning from her first experience as a peer volunteer advocate with Dorset Macmillan Advocacy.   Since then Tessa has supported several more advocacy partners but she has also continued to develop her skills with two other related roles.  Tessa described her studies and her interest in health coaching at interview so when opportunities arose we ensured that Tessa heard about them.  As a result Tessa is now a trained lay facilitator with the Macmillan HOPE course.  HOPE (Helping to Overcome Problems Effectively) is a licensed programme developed by Coventry University and Macmillan Cancer Support to help people who have had/or have cancer to get on with their lives.   More recently Tessa has begun a part time role at Help and Care as a Health Coach with My Health My Way which provides personalised support to people with long term conditions.

Tessa Watts


Through her initial link with us Tessa is now involved in three different approaches to self management; independent advocacy, group peer support and one to one coaching. Tessa says, ‘I decided to volunteer with Dorset Macmillan Advocacy because I believe I have the skills to support people during difficult times.  When the coaching opportunity arose it felt like a very natural next step to use these skills so support people with long term health conditions.’

NHS Health Education England has a consultation open at the moment on a new volunteering strategy.  It is aimed at developing the future workforce and focuses on bringing young people into Health and Social care.  I think it’s a great idea and particularly like the emphasis on removing inequalities in volunteering but it did make me think of Tessa and how volunteering has been a way for her to kick-start a new career to which she brings her wealth of accumulated knowledge and experience. Tessa agreed, ‘I had no idea that volunteering would open up a new world for me.  I am enjoying the work immensely and I feel like it does make a difference.’

Kathleen Gillett, Macmillan Project Coordinator, Dorset Macmillan Advocacy