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Fatigue ManagementClinical services

Macmillan Step Up Service for Cancer Survivors

We're reloacting these services currently provided from the Mineral Water Hospital site, to a purpose built RNHRD and Therapies Centre on the RUH's Combe Park site in 2019. The new Centre will bring together a number of outpatient services from the RUH and RNHRD which support patients to live independently in the community. 


Why choose us?

The Step Up service is a fatigue and lifestyle management service for adult cancer survivors who are struggling to cope with daily activities due to fatigue related symptoms following completion of their primary cancer treatment.

The service has been set up in partnership with Macmillan Cancer Support and is the first of its kind in the country.  The service aims to support and enable people living with and beyond cancer to engage in daily activities despite experiencing significant fatigue and Step Up to the challenge of learning about and confidently employing self-management strategies. 

The Step Up service is led by Macmillan Consultant Occupational Therapists and comprises an inter professional team of specialist health practitioners.

What we offer

If you meet our referral criteria, you will initially be offered a clinic appointment where you will be able to discuss your health needs and how the Step Up service might be able to help you.  Treatment options are agreed with you based on personal preferences.  This could include 1:1 consultations or attending one of our group lifestyle management programmes or a combination of these options.

Our group programme is held here at the RNHRD in Bath.  Programmes provide in depth information on management strategies for coping better with the effects of post cancer fatigue and aim to help cancer survivors achieve personally acceptable lifestyle changes and maximise their wellbeing. The group also provides an opportunity to discuss experiences of post cancer fatigue with others in a similar position which can be very helpful.

We can also provide specific help and support with work/vocational rehabilitation, including advice and assistance with returning to work following treatment and maintaining work if fatigue is making this difficult.  We can liaise with employers, occupational health practitioners or educational establisments if you need us to do so.

Work Support and Vocational Rehabilitation

We offer work support and vocational rehabilitation for all those referred to the service based on individually assessed needs and employs four specialist Occupational Therapists with expertise in this area of practice two of whom have been involved with setting national standards, guidelines and policies linked to work, vocational rehabilitation and occupational health. This expertise is available for those with CFS/ME, cancer related fatigue and also those with other long term conditions where the person is deemed medically stable. Services are delivered on an individual basis and are risk stratified to meet needs and are based on the following model:

Work Support = Level 1 and Level 2           

Vocational Rehabilitation = Level 3        

  Fatigue Model

How to access our service

You can be referred to the Macmillan Step Up service for cancer survivors by your GP or specialist cancer team.  The service is for those aged 18 and over who have completed their primary treatment for cancer (any type) and are currently in remission or stable, but who are experiencing significant fatigue which makes coping with everyday tasks a challenge.

You are now also able to refer yourself to the team if you meet the criteria above. The Step Up Service Self Referral Form is available in the useful links box to the right of this page or if you would like a hard copy of the form please contact our administrator.

Upon receipt of self referrals, all individuals are assessed by a telephone triage call from a senior member of our specialist team. If the service is suitable for you a face to face appointment with the team will be offered to agree on treatment plans tailored to your needs.

For referral advice or for further information, please contact our team on

Tel.01225 473 456
Fax 01225 473411