The Challenge: Reactive care and operational processes limiting consistent patient oversight

Prior to June 2025, Lloyd's Clinical faced a core challenge in delivering proactive SACT (Systemic Anti-Cancer Therapy) consistently across their entire patient population. Without a consistent, scalable way to monitor patients between appointments, clinical teams had limited visibility of how patients were feeling day to day, symptom deterioration was often identified reactively, rather than caught early through routine monitoring.

Compounding this, the operational processes around patient care were more manual and time-intensive than they needed to be. Introducing patients to Careology involved several touchpoints across Patient Services, Oncology Nurse Advisors (ONAs) and homecare nurses, meaning not all patients were consistently onboarded. Pre-visit wellness checks were conducted entirely by phone, with field nurses spending an estimated 11.5 hours per week on calls ahead of appointments. And the Risk and Needs Assessment, conducted during the install visit, was dominated by non-clinical questions (such as whether a patient has a fridge at home or how many flights of stairs they have) that did not require a nurse to ask in person, leaving less time for the clinical conversations that matter most.

The Solution: Making Proactive Symptom Monitoring the Standard, and Building the Infrastructure Around It

The core shift at Lloyd's Clinical was making proactive, day-to-day symptom monitoring a routine part of care for all SACT patients, not an optional extra. By embedding Careology into the ONA workflow from June 2025, patients now begin logging symptoms from the start of treatment as a standard, opt-out part of their care. ONAs review symptoms as part of their daily work, identifying red and amber presentations early and intervening before patients deteriorate to the point of needing emergency care. Hospital avoidance is no longer an occasional outcome; it is a recurring result of routine clinical activity.

Three operational changes were made to sustain and scale this model:

1. A new patient invitation pathway ONAs now invite all new SACT patients to Careology during the onboarding call, ensuring that from day one, every patient is part of the monitoring pathway. This shifted Careology from a tool some patients used to a core component of care for all.

2. A digital pre-visit wellness check Rather than relying on nurse-led phone calls the evening before each appointment, patients now complete a digital wellness check via Careology ahead of their visit. ONAs triage responses and call only where clinically necessary, reducing unnecessary contact and freeing up nursing time for higher-complexity work.

3. A digital Risk and Needs Assessment The Risk and Needs Assessment has been embedded as a questionnaire on Careology and sent directly to patients to complete at home before the install visit. By moving non-clinical questions out of the visit and into a form patients complete themselves, nurses can focus their time on clinical discussion from the very first contact.

Patient Journey: Careology's Role Alongside the Patient Pathway

These changes work together across the patient pathway, from first contact through to ongoing treatment monitoring. 

The new invitation pathway brought significantly more patients into the platform, with the invitation rate rising from 30% to 121% in H2 2025. Engagement has remained strong and consistent, at 85% in H1 2025 and 82% in H2 2025, while the number of patients actively logging symptoms rose by 32%.

Note: invitation rates can exceed 100% in a given period where the team catches up on patients not invited in previous months; while the rate may appear above 100% within a single half, it normalises across the full year. 

The Impact: Recurring Hospital Avoidance as a Result of Routine Monitoring

With more patients consistently logging symptoms, ONAs have been able to identify and respond to clinical needs early, on a recurring basis.

Between July and December 2025, a substantial level of clinical need was recorded within the cohort. Of symptoms logged, 45.7% were red, while 42.9% were amber, typically presenting in combination as either double-amber or amber-red cases. A smaller proportion (11.4%) were green symptoms, occurring alongside higher-risk presentations such as red-green or double-amber-green combinations. The most frequently reported symptoms were fatigue (18.6%), fever (14.3%), and pain (12.9%).

Crucially, 71.1% of patients who reported a red or double-amber symptom avoided A&E. Rather than attending emergency services, 50% were advised over the telephone, 18.4% were called proactively but did not answer, 7.9% were assessed in person, and 5.3% were advised to contact their GP. Based on avoided A&E attendance and overnight stay (assuming an average length of stay of 8.5 days), an estimated cost saving of £238,750 was achieved across the period.

The digital pre-visit wellness check has the potential to save an estimated 11.5 hours of nurse time per week currently spent on pre-treatment phone calls, time that can be redirected to higher-complexity clinical activity. The digital Risk and Needs Assessment further reduces time spent on non-clinical data collection during install visits, allowing nurses to focus on clinical discussion from the first point of contact.

Nurses and patients highlight the value of proactive monitoring

"Well, it's been brilliant. When you have a cancer diagnosis or a diagnosis with anything nasty, it's just really good because for every step, it's like having someone there (with you)." Patient

"The value comes from the actual control the patient has... it gives them control over the medications that they're taking and over what's going on in their life by documenting it. I think psychologically that's helpful. You can't underestimate the benefit from that side." Nurse

"I've certainly picked up on needs of patients and I've certainly picked up the things that I've needed to call patients about." Nurse

Why it matters: a model that catches problems early and keeps patients out of A&E

The distribution of red, amber, and green symptoms reflects how Careology supports a structured, end-to-end care pathway, moving patients from self-management through to acute prevention. Green symptoms represent opportunities for patients to safely self-manage with confidence, reducing unnecessary clinical contact. Amber symptoms demonstrate where guided care and timely input can prevent deterioration, while red symptoms reflect cases where urgent intervention was required. The presence of amber and green symptoms alongside higher-risk presentations suggests that earlier identification creates meaningful opportunities to manage escalation more effectively, and in some cases avoid it altogether.

What makes this sustainable is the operational foundation underneath it. More patients on the platform means more consistent symptom data for ONAs to act on. The pre-visit wellness check builds engagement habits that support ongoing questionnaire completion. And a higher-engagement cohort makes every clinical intervention more informed and more timely. Together, these elements do not just enable proactive care in a given month; they make it the default mode of working.

For clinical teams, this means a more targeted workload, with attention directed toward higher-risk patients rather than routine or avoidable contacts. For the organisation, it translates into reduced demand on acute services, freed-up hospital capacity, and measurable cost savings.

The Big Picture: Proactive Care, Every Day, at Scale

The story at Lloyd's Clinical is not just about one period of avoided A&E attendances. It is about building a model where ONAs identify and respond to patient need as a matter of routine, supported by a platform that keeps patients engaged and surfaces risk early. By embedding Careology across the patient pathway, from onboarding through to day-to-day symptom monitoring, Lloyd's Clinical has shifted from reactive to proactive care in a way that is measurable, repeatable, and scalable. The result is better outcomes for patients, a more sustainable workload for clinical teams, and meaningful operational savings for the organisation.