Rehabilitation Pathways

Transcription

1 Rehabilitation Pathways MCCN Allied Health Professionals Cross Cutting Group (CCG) Author: Allied Health Professionals CCG Date Approved: 15 November 2010 Version: 1.1 Supersedes : N/A Review Date: November 2011 MCCN Rehabilitation Pathways Page 1 of 29

2 INDEX PAGE 1.0 Introduction Section One: Site Specific Rehabilitation Pathways Brain/CNS 6 Breast 7 Colorectal 8 Gynaecology 9 Head & Neck 10 Haematology 11 Lung 12 Skin 13 Upper GI 14 Urology 15 Sarcoma.to follow 2.0 Section Two: Locality Rehabilitation Directory Eastern Sector 17 Liverpool 21 Sefton 23 Western Cheshire 25 Wirral 27 MCCN Rehabilitation Pathways Page 2 of 29

3 1.0 Introduction The development of tumour site specific Allied Health Professional (AHP) Cancer Rehabilitation care pathways is a requirement for Peer Review as part of the implementation of the Rehabilitation measures (2008). The aim of these pathways is to guide best practice and ensure appropriate service provision. Each care pathway should: cover all stages of the patient s journey from diagnosis through active treatment to survivorship and on to palliative/end of life care. specify particular clinical indications for referral to each relevant rehabilitation service - describe the relevant intervention / procedure /therapy required from any or all of the four relevant AHP professional groups, i.e. Dietetics Occupational link to the National AHP care pathways - the nine site specific pathways are: - Breast - Head & Neck - Upper GI - oesophago-gastric - Upper GI - hepatobiliary pancreas - Colorectal - Urology - Lung - Brain CNS Each of these has a drop down menu of appropriate common symptom pathways: - breathlessness - Pain - Lymphoedema - Spinal Cord Compression - Continence - Fatique and energy management - Anorexia/cachexia/weight loss - Dysphagia - Communication difficulies NB: for further information visit the National Cancer Action Team website or follow this link MCCN Rehabilitation Pathways Page 3 of 29

4 When a rehabilitation need is identified - consider the level of intervention required: Is the symptom of little concern or already self adapted? YES NO Encourage self management & offer supportive written information Is the symptom impacting on function or quality of life? NO YES Is the symptom likely to impact treatment options or become more debilitating over time? YES NO Refer to Specialist Cancer AHP services who can offer expert advice, an integrated care plan and ongoing support for future potential problems Refer to symptom care pathway & consider referral to generic AHP services for assessment and advice To make a referral to an AHP: Please see your Local Cancer Rehabilitation Directory (see Section 2.0) MCCN Rehabilitation Pathways Page 4 of 29

5 Section One: Site Specific Rehabilitation Pathways - Brain & CNS - Breast - Colorectal - Head & Neck - Haematology - Lung - Skin - Upper GI - Urology - Sarcoma.to follow MCCN Rehabilitation Pathways Page 5 of 29

6 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Brain and CNS Tumour Rehabilitation Pathway: CNS.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative Consider level of intervention required: Information support General rehabilitation services Specialist oncology, neurology and palliative rehabilitation. Provision of information to support timely future access to rehabilitation services (see local cancer services directory: rehabilitation services). End of life Difficulties with function, movement and symptom control: Difficulty with walking and getting around Upper and Lower Limb/Trunk weakness Changes with muscle tone, movement patterns and advice regarding positioning Breathing difficulties/cough Pain Sensory changes Impaired balance and manual handling risk assessment Occupational Difficulties with activities of daily living (work productivity & leisure): Functional impact of physical symptoms Functional impact of sensory changes Weakness upper / lower limb or trunk Difficulty with functional mobility Functional impact of anxiety and behavioural changes Cognitive and perceptual impairment Dietitian Nutrition and diet: Altered appetite Nausea and vomiting Weight loss/weight management Difficulties swallowing Information needs Speech & Language Therapist Communication & Eating/Drinking: Food sticking in the throat Aspiration related chest infections Weak or hoarse voice/loss of volume Weak cough Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 6 of 29

7 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Breast Cancer Rehabilitation Pathway: Breast.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Physiotherap y Difficulties with function, movement and symptom control: Upper Limb/Trunk movement disorder (especially post surgery/pre radiotherapy) Difficulty walking and getting around Pain Breathing difficulties/cough Sensory changes Body image concerns Weakness (focal or generalized) Impaired Balance Lymphoedema Specialist Lymphoedema: of upper limb, trunk or neck Occupational Difficulties with activities of daily living, leisure and work resulting from: Physical symptoms and changes in sensation Upper limb functional impairment Fatigue or tiredness Difficulty walking and getting around Impaired balance Weakness Anxiety Role and function change Body image concerns Cognitive impairment Dietician Nutrition and diet: Reduced appetite Weight loss/weight management/weight gain Fatigue/tiredness Difficulties swallowing Nausea and vomiting Information needs Speech & Language Therapist Impaired communication, eating and drinking: Coughing/choking on eating or drinking Aspiration related chest infections Food sticking in the throat Weak or hoarse voice/loss of volume Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 7 of 29

8 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Colo-Rectal Cancer Rehabilitation Pathway: olorectal.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Difficulties with function, movement and symptom control: Trunk movement disorder (especially post surgery/pre radiotherapy) Difficulty walking and getting around Breathing difficulties/cough Pain Sensory changes Body image concerns Weakness (focal or generalized) Impaired Balance Occupational Difficulties with activities of daily living, leisure and work resulting from: Physical symptoms and changes in sensation Functional impairment, (especially post surgery) Fatigue Impaired balance Weakness Difficulty walking and getting around Anxiety Adjustment to role and function change Body image concerns Cognitive impairment Dietician Impaired or risk of impaired communication, eating and drinking: Food sticking in the throat Recurrent chest infections? Aspiration relate Weight loss/weight management/weight gain Difficulties swallowing Information needs Therapist Nutrition and diet: Reduced appetite Nausea and vomiting Weak cough Weak or hoarse voice/loss of volume Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 8 of 29

9 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Gynae Cancer Rehabilitation Pathway: ynae.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Difficulties with function, movement and symptom control: Lower Limb/Trunk movement impairment (especially post surgery/pre radiotherapy) Difficulty walking and getting around Incontinence Breathing difficulties/cough Pain Body image concerns Incontinence Weakness (focal or generalized) Impaired Balance Sensory changes Lymphoedema Specialist Lymphoedema: of lower limb or trunk Occupational Difficulties with activities of daily living, leisure and work resulting from: Physical symptoms/ sensory changes Lower limb functional impairment Difficulty walking or getting around Impaired balance or weakness Incontinence Adjustment to role and function change Concerns re: body image Anxiety or cognitive impairment Dietician Nutrition and diet: Reduced appetite Nausea and vomiting Weight loss/weight management/weight gain Difficulties swallowing Information needs Speech & Language Therapist Impaired or risk of impaired communication, eating and drinking: Food sticking in the throat Aspiration related chest infections Weak or hoarse voice/loss of volume Weak cough Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 9 of 29

10 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Head and Neck Cancer Rehabilitation Pathway eadandneck.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Occupational Difficulties with function, movement and symptom control: Difficulty walking and getting around Breathing difficulties/cough Tingling in hands and feet Weakness and loss of muscle strength (focal or generalized) Difficulties with functional activities of daily living, leisure and work: Difficulty walking and getting around Breathing difficulties Fatigue/Tiredness Impaired balance/weakness Pain Sensory changes Body image concerns Impaired Balance Painful / stiff shoulder post op Management of secretions/tracheostomy e.g. post laryngectomy Recurrent chest infection Anxiety/Depression/loss of motivation/isolation Adjustment to role and function change Body image/ Facial disfigurement Cognitive impairment Tingling in hands and feet Pain management Dietician Nutrition and diet: Reduced appetite (anorexia) Malnutrition Weight loss/weight management (cachexia) Nausea and vomiting Difficulties swallowing Information needs Speech & Language Therapist Impaired communication, eating and drinking: Coughing/choking on eating or drinking Food sticking in the throat Aspiration related chest infections Weak or hoarse voice/loss of volume Weak cough Difficulty understanding or speaking Poor intelligibility/sounding nasal Stridor related to vocal cord problems Dry mouth Laryngectomy care including surgical voice restoration, stoma care, heat moisture exchangers, use of or maintenance of artificial larynx MCCN Rehabilitation Pathways Page 10 of 29

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12 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Lung Cancer Rehabilitation Pathway ung.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Difficulties with function, movement and symptom control: Difficulty walking and getting around Breathing difficulties/cough Weakness and loss of muscle strength (focal or generalized) Pain Impaired Balance Sensory changes Body image concerns Occupational Difficulties with functional activities of daily living, leisure and work resulting from: Difficulty walking and getting around Breathing difficulties Fatigue/Tiredness Impaired balance/weakness Anxiety Adjustment to role and function change Body image concerns Cognitive impairment Equipment/environmental/information needs Dietician Nutrition and diet: Reduced appetite (anorexia) Malnutrition Weight loss/weight management (cachexia) Nausea and vomiting Difficulties swallowing Information needs Speech & Language Therapist Impaired communication, eating and drinking: Coughing/choking on eating or drinking Weak cough Aspiration related chest infections Food sticking in the throat Weak or hoarse voice/loss of volume Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 12 of 29

13 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Skin Cancer Rehabilitation Pathway: (web address will be the MCCN location where the pathway is uploaded) Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required. Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory: rehabilitation services). Difficulties with function, movement and symptom control: Limb/Trunk/Neck movement disorder (especially post surgery/pre radiotherapy/consequent to scarring) Difficulty walking and getting around Breathing difficulties/cough Pain/sensory changes Weakness (specific focal or generalized) Impaired Balance Occupational Difficulties with activities of daily living, leisure and work resulting from: Physical symptoms and changes in sensation Limb/Trunk/Neck functional impairment Visual impairment /impaired balance Weakness (focal or generalized) Difficulty walking and getting around Anxiety/Cognitive impairment Adjustment to role and function change Dietician Nutrition and diet: Reduced appetite Nausea and vomiting Weight loss/weight management Difficulties swallowing Information needs Speech & Language Therapist Communication & Eating/Drinking: Food sticking in the throat Aspiration related chest infections Weak or hoarse voice/loss of volume Weak cough Difficulty understanding or speaking Dry mouth Lymphoedema Specialist Lymphoedema of limb / trunk / head / neck MCCN Rehabilitation Pathways Page 13 of 29

14 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Upper GI Cancer Rehabilitation Pathway: Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Difficulties with function, movement and symptom control: Upper Limb/Trunk movement Breathing difficulties/cough Disorder (especially post surgery/pre radiotherapy) Difficulty walking and getting around Pain Weakness (focal or generalized) Impaired Balance Sensory changes Body Image Concerns Equipment Information needs Occupational Difficulties with activities of daily living, leisure and work: Physical Symptoms Sensory Changes Upper limb/trunk functional impairment, (especially post surgery) Impaired balance Weakness Difficulty walking and getting around Anxiety Role and function change Body image concerns Cognitive impairment Equipment needs Information needs Dietician Impaired Nutrition & Diet: Reduced appetite Nausea and vomiting Weight loss Weight management/weight gain Difficulties swallowing Information needs Therapist Impaired communication, eating and drinking: Impaired communication, eating and drinking: Coughing/choking on eating or drinking Weak cough Aspiration related chest infections Food sticking in the throat Weak or hoarse voice/loss of volume Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 14 of 29

15 Merseyside and Cheshire Cancer Network Clinical Indicators for Referral to Urological Cancer Rehabilitation Pathway logical.pdf Patients are at risk of developing or experiencing the following clinical indicators and should be assessed for referral to rehabilitation pathway interventions at all stages in the cancer care pathway as described below: Diagnosis & Planning Post Monitoring/ Survivorship Palliative End of life Consider level of intervention required: Information support General rehabilitation services Specialist oncology/palliative rehabilitation. Ensure patient has contact details for timely future access to rehabilitation services (see local cancer services directory-rehabilitation services). Lymphoedema Specialist Lymphoedema: of lower limb or trunk Difficulties with function, movement and symptom control: Occupational Difficulties with functional activities of daily living, leisure and work: Difficulty walking and getting around Impaired Balance Breathing difficulties/cough Movement impairment/loss of function Pain Difficulty walking and getting around Breathing difficulties Fatigue/Tiredness Impaired balance/weakness Adjustment to role and function change Pain management Weakness and loss of muscle strength (focal or generalized) Incontinence Tingling in hands and feet Sensory changes Body image concerns Anxiety/Depression/loss of motivation/isolation Body image/ Facial disfigurement Cognitive impairment Tingling in hands and feet Incontinence Dietician: Nutrition and diet: Reduced appetite (anorexia) Malnutrition Weight loss/weight management (cachexia) Nausea and vomiting Difficulties swallowing Information needs Speech & Language Therapist: Impaired communication, eating and drinking: Coughing/choking on eating or drinking Aspiration related chest infections Food sticking in the throat Weak or hoarse voice/loss of volume Weak cough Difficulty understanding or speaking Dry mouth MCCN Rehabilitation Pathways Page 15 of 29

16 Section Two: Locality Rehabilitation Directory - Eastern Sector - Liverpool - Sefton - Western Cheshire - Wirral Locality PCT Acute Trust/s Hospices Eastern Sector o Halton & St Helens o Warrington o Knowsley o St Helens & Knowsley o Warrington & o Halton Haven o ST Rocco s o Willowbrook Halton Liverpool o Liverpool o Royal Liverpool & Broadgreen o Alder Hey* o Liverpool Womens o Liverpool Heart & Chest o Marie Curie Sefton o Sefton o Aintree o The Walton Centre o Southport & Ormskirk Western Cheshire o Western Cheshire o Countess of Chester Wirral o Wirral o Wirral Hospital o Clatterbridge * Paediatric s not included in this Directory o Woodlands o Queenscourt o Hospice of the Good Shepherd o St Johns o Claire House* MCCN Rehabilitation Pathways Page 16 of 29

17 EASTERN SECTOR LOCALITY NHS Halton & St Helens (Halton ) Clinic Patients Telephone Fax appointments available Yes Yes Occupational Halton Haven Yes & visits Nutrition & Dietetics Yes Yes Yes Rapid Response In & Out patients Respiratory Team and home visits Social s OT Yes NHS Knowsley (Knowsley & St Helens s) Clinic Patients Telephone Fax appointments available - No Yes mobility: Knowsley - No Yes mobility: St Helens Occupational : No Yes Knowsley Occupational : St Helens Musculo- skeletal Knowsley and St Helens No Yes- rapid reponse & reenablement Yes No Nutrition & Dietetics Yes Yes Yes Yes Social s OT No Yes NHS Warrington Orthopaedic Clinical Assessment and service Community Falls & Rehabilitation Community neuro team (physio & OT) Clinic appointments available Patients Telephone Fax Yes No Yes (falls clinic) Yes No Yes Nutrition & Dietetics Yes No MCCN Rehabilitation Pathways Page 17 of 29

18 Yes Yes Social s OT Yes St Helens & Knowsley NHS Trust: Whiston Hospital In-patient service available Telephone Occupational Nutrition & Dietetics: Southport NHS Foundation Trust. YES for admitted patients. St Helens & Knowsley NHS Trust: St Helens Hospital This is a DTC Facility only Out-patient Occupational service available No No Fax Telephone Fax Nutrition & Dietetics: No No * St Helens and Knowsley NHS Trust Contracts In Patient services only (from NHS Knowlsey). Out Patient services are provided by NHS Knowsley for Knowsley and St Helens patients see NHS Knowsley above. Warrington & Halton NHS Foundation Trust: Warrington Hospital Out-patient Telephone Fax service available Yes In-pts: Out-pts: In-pts: Occupational Yes In-pts: Out-pts: Nutrition & Dietetics Yes Yes Warrington & Halton NHS Foundation Trust: Halton Hospital Yes None available Occupational Yes In-pts: Out-pts: In-pts: Out-pts: Nutrition & Dietetics Yes Yes Rapid Response Respiratory Team In-patients, outpatients and home MCCN Rehabilitation Pathways Page 18 of 29

19 (physiotherapy) visits Halton Haven, Runcorn Visits Out- Patients & Day Telephone Yes Yes Yes Occupational No services available Nutrition & Dietetics St Rocco s, Warrington Visits Out- Patients & Day Telephone Yes Yes Yes Occupational No services available Nutrition & Dietetics Willowbrook, St Helens Visits Inpatients Inpatients Inpatients Out- Patients & Day Telephone No Yes Yes Occupational Yes Yes Yes Nutrition & Dietetics No services available Wheelchair s: Telephone Fax St Helens Halton Warrington Equipment s: Telephone Fax Halton & St Helens Knowsley /7537 Warrington Lymphoedema s: Locality Base Telephone Fax Eastern St Helens & Knowsley Liverpool Marie Curie Hospice Fax Fax Fax MCCN Rehabilitation Pathways Page 19 of 29

20 Eastern Halton & Warrington Lymphoedema Warrington & Halton Hospitals NHS Foundation Trust MCCN Rehabilitation Pathways Page 20 of 29

21 LIVERPOOL LOCALITY Liverpool PCT Clinic appointments available Patients Telephone No Yes Occupational No Yes Nutrition & No Yes Dietetics Speech & Language No service available for patients with cancer. Palliative non-malignancy related neurological conditions can be referred. Contact details as above. Falls No Yes Social s No Yes OT Royal Liverpool & Broadgreen Hospitals NHS Trust: Royal Liverpool Hospital Out-patient service Telephone Fax available : Yes Occupational : No Nutrition & Dietetics: Yes Yes (head & neck : cancer only) Royal Liverpool & Broadgreen Hospitals NHS Trust: Broadgreen Hospital : Yes Occupational : No Nutrition & Dietetics: No : No Liverpool Heart and Chest Hospital. Out-patient service Telephone Fax available No Occupational Yes and home visits Nutrition & Dietetics Fax No Liverpool Women s Hospital Out-patient service Telephone Fax available No Occupational No service available Nutrition & Dietetics As part of joint clinic No available Marie Curie Hospice, Liverpool Visits Inpatients Out- Patients & Telephone Fax MCCN Rehabilitation Pathways Page 21 of 29

22 Day Yes Yes Yes Occupational Yes Yes Yes Nutrition & Dietetics No services available Wheelchair s: Telephone Fax Liverpool Equipment s: Telephone Fax Liverpool / Lymphoedema s: Locality Base Telephone Fax Liverpool Liverpool Marie Curie Hospice Lymphoedema MCCN Rehabilitation Pathways Page 22 of 29

23 SEFTON LOCALITY NHS Sefton: South Sefton Clinic Patients Telephone Fax appointments available No Yes Occupational No Yes Nutrition & Yes Yes Dietetics Speech & Yes Yes Language Social s No Yes OT NHS Sefton: North Sefton Clinic Patients Telephone Fax appointments available Yes Yes Occupational Yes Yes Nutrition & Yes Yes Dietetics Speech & Yes Yes Language Social s OT No Yes Aintree Hospitals NHS Foundation Trust Out-patient Telephone Fax service available Yes- Musculoskeletal Occupational No Nutrition & Dietetics Some clinics supported Yes (head & neck cancer only) Southport & Ormskirk Hospital NHS Trust Out-patient Telephone Fax service available Yes-musculoskeletal only. Occupational Splinting and acute musculo-skeletal Nutrition & Dietetics: No Southport NHS Foundation Trust. No Walton Centre for Neurology Out-patient service Telephone Fax MCCN Rehabilitation Pathways Page 23 of 29

24 available No Occupational No Nutrition & Dietetics Nutrition & dietetics and speech & language therapy services are provided for in-patients only by the departments at Aintree Hospitals NHS Foundation Trust. Queenscourt Hospice, Southport Visits In-patients Outpatients & Day Telephone Yes Yes Yes Occupational Yes Yes Yes Nutrition & Dietetics No services available Fax Woodlands Hospice, Aintree Visits Inpatients Out- Telephone Fax & Community Outreach Patients & Day Yes Yes Yes Occupational Yes Yes Yes Nutrition & No services available Dietetics Speech & Language Wheelchair s: Telephone Fax Sefton (includes Kirkby) Equipment s: Telephone Fax Sefton Lymphoedema s: Locality Base Telephone Fax South Sefton Woodlands Hospice Lymphoedema North Sefton Ainsdale Centre for Health & Well- Being (mark for attention of Lymphoedema Nurse) MCCN Rehabilitation Pathways Page 24 of 29

25 WESTERN CHESHIRE LOCALITY NHS Western Cheshire Clinic appointments available Patients Telephone No Yes Occupational No Yes Nutrition & Dietetics Yes Yes Specialist Palliative Team (Physio/OT) No Yes Fax Countess of Chester NHS Hospital Trust Out-patient service available Yes- consultant referrals only Occupational Yes- consultant referrals only Nutrition & Dietetics Yes- GP & cons referral Yes- GP & cons referral Telephone Fax Hospice of the Good Shepherd, Chester Visits Inpatients Out- Patients & Day Telephone Yes Yes Yes Occupational Yes Yes Yes Nutrition & Dietetics No services available Wheelchair s: Telephone Fax Western Cheshire Equipment s: Telephone Fax Western Cheshire: Prescription service only Choicequip: Lymphoedema s: Locality Base Telephone Fax Fax MCCN Rehabilitation Pathways Page 25 of 29

26 Western Cheshire Clatterbridge Centre for Oncology: Lymphoedema x MCCN Rehabilitation Pathways Page 26 of 29

27 WIRRAL LOCALITY NHS Wirral Community ( & OT) Clinic appointments available Patients Telephone No Yes Fax Nutrition & Dietetics Yes Yes Yes Yes Specialist Palliative Team: (physio, OT, dietitian) No Yes Social s OT-: Birkenhead: Wallasey: Bebington & West Wirral: No Yes Clatterbridge Centre for Oncology (in & out-patient services available for patients receiving oncology treatments) Telephone FAX ext Occupational ext Dietetics ext ext Wirral University Teaching Hospitals NHS Trust: Arrowe Park Out-patient Telephone Fax service available Yes Occupational No x8478 Nutrition & Dietetics Yes x8145 Yes Wirral University Teaching Hospitals NHS Trust: Clatterbridge Hospital Out-patient Telephone Fax service available Yes Occupational No x4730 Nutrition & Dietetics Yes x St Johns Hospice, Wirral Visits Inpatients Out- Patients & Day Yes Yes Day therapy=yes Out-patients= no Telephone Fax Occupational Yes Yes Day MCCN Rehabilitation Pathways Page 27 of 29

28 Nutrition & Dietetics No services available therapy=yes Out-patients= no Wheelchair s: Telephone Fax Wirral Equipment s: Telephone Fax Wirral Lymphoedema s: Locality Base Telephone Fax Wirral Clatterbridge Centre for Oncology: Lymphoedema x MCCN Rehabilitation Pathways Page 28 of 29

29 8.0 OUT OF AREA CONTACTS 8.1 Betsi Cadwaladr University NHS Trust Hospital Contact Details Lymphoedema Central: West: East: Occupational Central: West: East: in-patients social services Central (Glan Clwyd): West (Ysbyty Gwynedd) : East: (Wrexham) reception rehab unit community Central: West: East: Dietician Central: West: East: Christie NHS Foundation Trust Contact Details Lymphoedema Occupational Department Department Dietician MCCN Rehabilitation Pathways Page 29 of 29