“It gets the patients to think about other issues and not just their cancer diagnosis, eHNAs are an excellent tool for looking at patients as a whole person” -  Liz Stones, Macmillan Radiographer Nurse

eHNA screen grab 6What?

EMAHSN’s eHNA (electronic Holistic Needs Assessments) cancer project brings together innovative digital technology and a holistic needs assessment (HNA) tool.  The tool helps to ensure that cancer patients’ physical, practical, emotional, spiritual and social needs are met in a timely and appropriate way. It also helps to target the resources to those who need them most.

The eHNA uses a concerns checklist and feeds into a central online database that supports the creation of an individual patient-centred digital care plan that is shared with healthcare practitioners across secondary and primary care and the patient; empowering them to take an active role in their care and self-management.

Nottingham University Hospitals NHS Trust in partnership with Macmillan Cancer Support and Nottinghamshire primary and community care introduced eHNAs in April 2016; allowing patients to complete the assessment using a tablet and/or at home in their own time.


Increasing numbers of people can now be expected to live with and beyond a cancer diagnosis. There are now 2.5 million people living with cancer in the UK, which is expected to rise to 4 million people by 2030 (Macmillan Cancer Support: Then and Now Report, August 2016). In Nottinghamshire alone, approximately 69,000 people are expected to be living with cancer by 2030; with 17 people newly diagnosed with cancer in Nottinghamshire every day.

Guidance from NICE (2004) and NHS England (2016) recommends a personalised approach to cancer treatment and aftercare, which looks at a person’s full range of emotional, physical and social support needs, by offering all patients with a diagnosis of cancer a Holistic Needs Assessment (HNA).

The National Cancer Survivorship Initiative Report (2013) highlighted that only 25% of cancer patients received an HNA and care plan nationally; with the lack of HNA’s performed potentially contributing to poorer health outcomes for people living with cancer. As a result, the EMAHSN & Nottingham University Hospitals NHS Trust eHNA project are determined that 100% of all eligible newly diagnosed cancer patients will have completed an eHNA assessment and have a personalised care plan developed with them by the end of August 2017.

What's the impact?

  • Between April – June 2016, 454 patients had completed an eHNA assessment and received a personalised care plan at Nottingham University Hospitals NHS Trust.
  • In October 2016 Nottingham University Hospitals NHS Trust were ranked 2nd out of a total of 72 UK NHS Trusts participating in the national Macmillan eHNA project in relation to eHNA/care plan activity.
  • Results of a recent patient survey at Nottingham University Hospitals NHS Trust found that 95% of patients said they would recommend the eHNA and care plan process to someone who has been told they have cancer.
  • 1st UK site to be working with the Chemotherapy Department to integrate eHNA and care plans into the day case unit.
  • Healthcare professionals undertaking the eHNAs strongly believe that patients are highlighting issues and concerns that were not being addressed previously.
  • The project was shortlisted for two prestigious Nursing Times Awards at their annual awards ceremony in October 2016
What's next?
  • The data being collected will provide commissioners with a comprehensive overview of service provision and areas of unmet need/gaps in their regions; addressing their ability to deliver a timely, appropriate and effective range of services to Nottinghamshire cancer patients.
  • Through the Cancer Pathways Re-design Programme at Nottingham University Hospitals NHS Trust, the eHNA project data will help inform the content of local ‘Health & Wellbeing Events’; ensuring information and support is tailored to patient’s needs; allowing patients as far a possible to self-manage their condition and lead a healthy and active lifestyle following a cancer diagnosis.
  • The eHNA project has identified a need to support Clinical Nurse Specialists (CNS’s) in delivering holistic needs assessment outcomes and as such, the project team are currently developing a training needs analysis to fulfil this requirement.
electronic Holistic Needs Assessment (eHNA) video