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

Aim

• 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.

Outcomes

• 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