Article Text

Download PDFPDF

P159 Changing a Lymphoedema Service through Service Redesign
  1. Debbie Murphy
  1. St Catherine’s Hospice, Preston, UK


Background Well established Lymphoedema service facing number of escalating issues:

  • Increasing referrals

  • Over budget

  • Frustrated staff

  • Lack of care pathways and long term management

  • Lack of innovation


  • Reduce financial strain

  • Provide clear care management strategy

  • Introduce self-management strategies

  • Ensure full access for individuals with Lymphoedema.

Approach Used

  • Poor team work - looked at strengths and the weaknesses of each team member as a team

  • Cost reduction – compression garment formulary assessed on cost effectiveness, size of range, availability on FP10, education supplied by the company.

  • Care pathways – patient journey plotted dependent on severity of condition.

  • Discharge policy developed, packs sent to the GP and to patient.

  • Long term self-management - six week education programme combined with fun exercise class (Le Bed), gives patients tools to manage own condition.

  • Following discharge from Le Bed, Lymphoedema Information Fun Event (LIFE) established after feedback from patients - provides ongoing information about service development. Group used as patient reference and involvement group e.g. feedback on leaflets etc.

  • Investment in new technologies (lymph assist machines, lasers, oscillator) - enhances treatments offered, produces quicker results.

  • Kinesio tape introduced

  • Children’s Lymphoedema Service initiated

  • Bra fitting service developed.


  • Greater sense of team - clear lines of reporting, goal setting and monitoring.

  • Expansion of team with a clear mix of skills

    • support worker undertaking more routine work, specialist nurses concentrate on more complex cases

    • part time specialist appointed

    • Lymphoedema physiotherapist (still to be appointed)

    • training and development - manual lymphatic drainage, Le Bed instructor training, bra fitting, wound management, child protection training etc.

  • Number of new patient referrals has increased year on year (see table)

  • Negotiated and secured contracts with three additional CCG’s

  • 2008/2009 = £23k overspend, 2011/2012 break even (including reinvestment in new technologies and education)

  • Number of intensive treatments increased from 27 in 2010/2011 to 119 in 2012/2013

  • Patients self-managing - the discharge pathway and Le Bed class – leading to greater self esteem

  • Lymphoedema manager recognised as Lymphodema nurse of the Year 2013, British Journal of Nursing

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.