“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 Information and Support Radiotherapist 

eHNA screen grab 6What?

Our eHNA (electronic Holistic Needs Assessments) cancer project brings together innovative digital technology with a ‘holistic needs assessment’ (HNA) tool. It aims to ensure cancer patients’ physical, practical, emotional, spiritual and social needs are met, and targets support at those who need it most.

Patients complete the assessment using a smart device, e.g. a tablet (which can be done at home). It is based on a concerns checklist that feeds into an online database to create an individual care plan. These are shared with healthcare practitioners across secondary and primary care, and they empower patients to take an active role in managing their care. HNAs were introduced in Nottinghamshire in 2015 and EMAHSN has worked in partnership with Nottingham University Hospitals NHS Trust, Macmillan Cancer Support  and Nottinghamshire primary and community care partners to introduce the electronic version and increase uptake.


More people are living with and beyond a cancer diagnosis, there are 2.5m people living with cancer in the UK, expected to rise to 4m by 2030; in Nottinghamshire alone 69,000 people will be living with cancer by 2030 with 17 new diagnoses every day.

Guidance recommends a personalised Holistic Needs Assessment (HNA) for all patients with a diagnosis of cancer, as a key part of effective treatment and aftercare – but only 25% of patients receive one. We are committed to ensuring that 100% of all eligible newly diagnosed cancer patients in Nottinghamshire have an eHNA and a personalised care plan by the end of August 2017.

What's the impact?

  • Between January and December 2016, 1449 patients (compared with 299 for the same period in 2015) 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. 67% of nurses said eHNA has enabled them to take more effective action to address patients’ concerns
  • Healthcare professionals undertaking the eHNAs strongly believe that patients are highlighting issues and concerns that were not being addressed previously.
  • The project has been shortlisted for 2 prestigious Nursing Times Awards during 2016, and was shortlisted for a HSJ Value in Healthcare Award 2017
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.

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.

Useful links and resources

pdfView the implementation case study 

A summary of the eHNA project in 30 seconds:

eHNA - nurses' experience video: