St. Helens and Knowsley Hospitals
NHS Trust
Cancer & Palliative Care
Service Directory
Fourth Edition – April 2007
Produce...
CONTENTS
1. INTRODUCTION.....................................................................................................
6.0 EXTENDED SERVICES........................................................................................................
1. INTRODUCTION
Welcome to the fourth edition of St Helens & Knowsley Hospitals NHS Trust,
Cancer & Palliative Care Servic...
2. CANCER MANAGEMENT TEAM
There is a lead team within St Helens & Knowsley Hospitals, comprising of a
lead clinician and l...
2.1 SUSPECTED CANCER REFERRALS
St Helens & Knowsley Hospitals NHS Trust
Urgent Suspicious Cancer Referral Pro-forma
Patien...
Produced by Cancer Services - Version Four (April 2007)
- 7 -
10
SKIN -Urgent Referral
Melanoma - Pigmented lesion which h...
2.2 MDT POLICY
1.0 Introduction
1.1 As a prerequisite for Cancer Peer Review, the Trust is required to have
an agreed oper...
3.2 The (2004) Cancer Services Standards define the objectives of an MDT
as follows:
 To ensure that designated specialis...
4.6 The core imaging specialist member(s) of the MDT should regularly
report on imaging of the primary cancer site or site...
5.5 Besides the regular meetings to discuss individual patients, the team
should meet at least annually to agree the follo...
8.0 Patient experience
8.1 Each MDT will identify a single named key worker for each individual
patient receiving treatmen...
9.1 The MDT should send a team member as a representative to at least
two thirds of the site-specific clinical network gro...
10.4 The Cancer Support Team will provide each MDT with a monthly report
identifying pre-defined data items including Canc...
12.1 It is a national requirement that an MDT discusses all patients with a
new diagnosis of a cancer. Each MDT must there...
Signed ……… Date ………….. Signed ……...………………….. Date ……………….
MDT Lead Clinician Dr Thind, Cancer Services Lead
Clinician
Appe...
- Managing transitions of care
 In circumstances where the Palliative Care Team (HPCT) are involved, there has
to be an a...
Appendix 3 - Clinical Nurse Specialist Protocol
Initial contact with a newly diagnosed cancer patient
Introduction
As a pr...
2.3 SERIOUS DIAGNOSIS FAX
PRACTICE PROTOCOL
SERIOUS DIAGNOSIS FAX BACK
Introduction
During the baseline assessment of canc...
St. Helens and Knowsley Hospitals
NHS Trust
Produced by Cancer Services - Version Four (April 2007)
- 20 -
NHS
Cancer Diag...
3 ONCOLOGY
3.1 LILAC CENTRE
St Helens & Knowsley Hospitals provides a local outpatient chemotherapy
service for haematolog...
Team Members Role Contact Details
Monday to Friday
9 – 5
Barbara Jost Unit Manager 0151 430 1687
Ruth Jackson Chemotherapy...
3.2 CLINICAL TRIALS TEAM
Team Members Role Contact Details
Monday to Friday
9 – 5
Dr E Marshall Consultant Oncologist 0151...
4. SITE SPECIFIC PATIENT SERVICES
4.1 CANCER SERVICE – Breast
Core Multidisciplinary
Team Members
Role Contact Details
Mon...
OUT OF HOURS CONTACT INFORMATION
Out-patient Advice Via GP/NHS Direct. If urgent local A&E
Department.
G5 Ward if Chemothe...
4.2 CANCER SERVICE – Colorectal
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9-5
Mr R. Kiff Lead C...
OUTPATIENT CLINICS
Consultant Clinic Type Day Site
Mr Kiff Colorectal
Cancer/General
Tuesday AM Whiston
Mr Kiff Colorectal...
4.3 CANCER SERVICE – Gynaecology
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9-5
Mr G. Cawdell Le...
OUTPATIENT CLINICS
Clinic Type Day Site
Gynae-Oncology Alternate Monday AM *Whiston
Rapid Access Pelvic Mass Wednesday AM ...
4.4 CANCER SERVICE – Haematology
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9-5
Dr G. Satchi Lea...
4.5 CANCER SERVICE – Head & Neck
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9-5
Mr Nandapalan Co...
4.6 CANCER SERVICE – Lung
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9 – 5
Dr. J. Hendry Respira...
OUTPATIENT CLINICS
Consultant Clinic Type Day Site
Dr Hendry Lung Shadow
Clinic
Thursday am Whiston Hospital
Dr Stockton L...
4.7 CANCER SERVICE – Skin
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
Mr Green Consultant Plastic...
4.8 CANCER SERVICE – Upper Gastrointestinal
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday 9-5
Mr Kh...
ENDOSCOPY SESSIONS
Dr Francis Monday am
Miss Chagla Alternate Monday p.m.
Paul Madigan Tuesday/Thursday p.m.
Mr Khan Alter...
4.9 CANCER SERVICE – Urology
Multidisciplinary Team
Members
Role Contact Details
Monday to Friday
9-5
Mr Massey Lead Consu...
OUTPATIENT CLINICS
Consultant Clinic Type Day Site
Mr Massey Urology Tuesday pm Whiston Hospital
Mr Massey Urology Thursda...
5. PALLIATIVE CARE
5.1 PALLIATIVE CARE - Hospital Specialist Palliative Care Team
Team Members Role Contact Details
Monday...
Specialist support from diagnosis for the patient and family, psychologically,
spiritually and socially.
Advice on pain an...
PROTOCOL - How do I use the Referral Form?
This 2-sided protocol is to enable Specialist Palliative Care (SPC) Teams withi...
Reasons for referral:
• Please note the guidance at the top of this section and complete as
appropriate.
• Within the ‘Whe...
Reason for Referral Role of the Health Care Team
with Advice and Support from
Specialist Palliative Care Team
as needed
Cr...
ACCESS TO PALLIATIVE CARE OUT-PATIENT CLINICS
WHEN & WHERE?
MONDAY WEDNESDAY THURSDAY FRIDAY
Held at:
WILLOWBRO
OK
HOSPICE...
Referral for Specialist Palliative Care Services
Patient Details Carer Details
NHS Number: Name of Carer:
Hospital ID: Hos...
Referral for Specialist Palliative Care Services 2
NHS Number Hospital ID Hospice ID
Reason(s) for Referral
Please state t...
5.2 PALLIATIVE CARE - Willowbrook Hospice
Willowbrook Hospice
Portico Lane
Prescot
Merseyside
L34 2QT
Telephone: 0151 430 ...
• Complementary Therapies:
 Aromatherapy / Massage / Guided Visionary / Reiki / Reflexology
 Relaxation therapy
 Physio...
Education
Education is a major part of our work. Willowbrook Hospice aims to offer co-
ordinated, multi-professional educa...
Medical Team
Team Members Role
Dr Jenny Wiseman Consultant in Palliative Medicine
Dr Anthony Thompson Assistant Medical Di...
5.3 PALLIATIVE CARE - Macmillan Clinical Nurse Specialist Palliative Care -
Community
Community Clinical Nurse Specialists...
Team Members Role
Dr Jenny Wiseman Consultant in Palliative Medicine
Gillian Harthen Clinical Nurse Specialist Team Leader...
5.4 PALLIATIVE CARE – St Helens Integrated Palliative Home Based Project
Integrated Palliative Home Care Team
The St Helen...
Criteria for Accessing the Integrated Palliative Home Care Team
The patient must be listed on the Palliative Care Register...
5.5 PALLIATIVE CARE - Integrated Palliative Home Care Team – Henrietta Project
Any Health Care Professional Patient/Carer ...
 The patient must be listed on the Palliative Care Register or have a
life expectancy of six months or less (DS 1500)
 T...
6.0 EXTENDED SERVICES
6.1 EXTENDED SERVICES - Hospital Based Pain Team
Medical Team Members Role Contact Details
Monday to...
Description of the service:
Chronic Pain Clinic works in collaboration with Hospital Palliative Care team to
provide a ran...
6.2 EXTENDED SERVICES - Chaplain/Pastoral Care
Spiritual Care Services
The Spiritual Care Team is made up of whole time an...
Chaplaincy Team Denomination Contact details
Sister Susan Molloy Roman Catholic Whiston Hospital Site
Bleep 0042
Sister Ei...
6.3 EXTENDED SERVICES - Department Of Nutrition and Dietetics
REFERRAL PROCEDURE
If a patient meets the following criteria...
DEPARTMENT OF NUTRITION AND DIETETICS
REFERRAL CRITERIA
PATIENTS WHO WILL BE SEEN AS AN IN-PATIENT:
Nutritional risk score...
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
cancer and palliative care directory
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cancer and palliative care directory

  1. 1. St. Helens and Knowsley Hospitals NHS Trust Cancer & Palliative Care Service Directory Fourth Edition – April 2007 Produced by Cancer Services Version Four April 2007 NHS
  2. 2. CONTENTS 1. INTRODUCTION................................................................................................................................4 2. CANCER MANAGEMENT TEAM..................................................................................................5 2.1 SUSPECTED CANCER REFERRALS.............................................................................................6 2.2 MDT POLICY......................................................................................................................................8 2.3 SERIOUS DIAGNOSIS FAX...........................................................................................................19 3 ONCOLOGY.......................................................................................................................................21 3.1 LILAC CENTRE...............................................................................................................................21 3.2 CLINICAL TRIALS TEAM.............................................................................................................23 4. SITE SPECIFIC PATIENT SERVICES.........................................................................................24 4.1 CANCER SERVICE – Breast...........................................................................................................24 4.2 CANCER SERVICE – Colorectal....................................................................................................26 4.3 CANCER SERVICE – Gynaecology................................................................................................28 4.4 CANCER SERVICE – Haematology...............................................................................................30 4.5 CANCER SERVICE – Head & Neck...............................................................................................31 4.6 CANCER SERVICE – Lung.............................................................................................................32 4.7 CANCER SERVICE – Skin..............................................................................................................34 4.8 CANCER SERVICE – Upper Gastrointestinal..............................................................................35 4.9 CANCER SERVICE – Urology........................................................................................................37 5.PALLIATIVE CARE.........................................................................................................................39 5.1 PALLIATIVE CARE - Hospital Specialist Palliative Care Team................................................39 5.2 PALLIATIVE CARE - Willowbrook Hospice................................................................................47 5.3PALLIATIVE CARE - Macmillan Clinical Nurse Specialist Palliative Care - .................51 Community ..............................................................................................................................................51 5.4PALLIATIVE CARE – ST HELENS INTEGRATED PALLIATIVE HOME BASED PROJECT...............................................................................................................................................53 5.5 PALLIATIVE CARE - INTEGRATED PALLIATIVE HOME CARE TEAM – HENRIETTA PROJECT...............................................................................................................................................55 Produced by Cancer Services - Version Four (April 2007) - 2 -
  3. 3. 6.0 EXTENDED SERVICES................................................................................................................57 6.1 EXTENDED SERVICES - HOSPITAL BASED PAIN TEAM .................................................57 6.2 EXTENDED SERVICES - Chaplain/Pastoral Care.......................................................................59 6.3 EXTENDED SERVICES - Department Of Nutrition and Dietetics.............................................61 6.4 EXTENDED SERVICES - The Speech & Language Therapy Service........................................68 6.5 EXTENDED SERVICES – SUPPORT Smoking Cessation ........................................................69 S U P P O R T.........................................................................................................................................69 FOR THOSE WHO WANT TO QUIT SMOKING.............................................................................69 ST HELENS (North & South) 01744 755439.......................................................................................71 6.6 EXTENDED SERVICES – ICCP (Integrated Cancer Care Programme)...................................72 7. SUPPORT GROUPS.........................................................................................................................74 7.1 SUPPORT GROUPS - Local Support Groups/Services................................................................74 7.2 SUPPORT GROUPS - Local Bereavement Support......................................................................78 7.3 SUPPORT GROUPS - National Support - General.......................................................................79 7.4 SUPPORT GROUP - National Support – Site-Specific.................................................................84 8. AMENDMENT FORM.....................................................................................................................92 Produced by Cancer Services - Version Four (April 2007) - 3 -
  4. 4. 1. INTRODUCTION Welcome to the fourth edition of St Helens & Knowsley Hospitals NHS Trust, Cancer & Palliative Care Service Directory. This Directory has been produced to build on existing communication links between primary and secondary care. The Directory contains vital information about the multidisciplinary teams responsible for cancer care at St Helens & Knowsley Hospitals. There are seven sections, with the first five giving details of cancer and palliative care services at St Helens & Knowsley Hospitals, Willowbrook Hospice and Primary Care. The sixth section covers a range of extended services, which may be accessed by cancer or palliative care patients. The last gives details of relevant local and national support groups. Inevitably teams change and Directory details become dated and inaccurate. To maintain what we believe is a crucial dialogue between health professionals, the directory will be subject to quarterly amendment to maintain its accuracy, future editions will be available electronically on our Intranet site: nww.sthkhealth.nhs.uk/cancer services. To ensure subsequent editions of the Directory are complete, please inform me of any additions or amendments directly. Your assistance is appreciated. Anita Corrigan Lead Nurse/Manager - Cancer Services 0151 430 1055 Anita.Corrigan@sthk.nhs.uk Produced by Cancer Services - Version Four (April 2007) - 4 -
  5. 5. 2. CANCER MANAGEMENT TEAM There is a lead team within St Helens & Knowsley Hospitals, comprising of a lead clinician and lead nurse/manager, who work in close collaboration to deliver on the strategic and operational agenda for cancer services at a local level. Lead Clinician The lead clinician is responsible for the clinical organisation, development and delivery of cancer care across the cancer unit. The lead clinician is a representative voice for medical colleagues relating to all aspects of cancer service provision. Communication is a fundamental part of this role. Contact details: Dr Rani Thind Tel: 0151 430 1265 Rani.Thind@sthk.nhs.uk Lead Nurse The lead nurse is responsible for providing leadership and direction for all nurses involved in cancer care, to develop cancer-nursing practice in line with local, regional and national priorities. The aim is to facilitate a comprehensive and integrated approach to cancer service delivery and improve the patient’s experience throughout their cancer journey. Contact details: Anita Corrigan Tel: 0151 430 1055 Anita.Corrigan@sthk.nhs.uk Lead Manager The lead manager works closely with individual cancer teams and key stakeholders to develop cancer teams and services to meet national cancer standards and the targets set out in the National Cancer Plan. Contact details: Anita Corrigan Tel: 0151 430 1055 Anita.Corrigan@sthk.nhs.uk Produced by Cancer Services - Version Four (April 2007) - 5 -
  6. 6. 2.1 SUSPECTED CANCER REFERRALS St Helens & Knowsley Hospitals NHS Trust Urgent Suspicious Cancer Referral Pro-forma Patient Details GP Practice Details (stamp) Surname: Practice Name: Address: Postcode: Telephone: Fax: Email: First Name: Age/DOB: Address: Postcode: Contact Number: Evening Telephone: Mobile: Referring GP: New NHS number: Decision to refer date: / / Hospital number (if known): First language: Interpreter required? Y / N Please tick the Speciality for which you are requesting a Two-week wait appointment: 1 Gynaecology 2 Lung (x-ray to be done prior to referral) 3 Haematology 4 Head & Neck 5 Urology 6 Testicular 7 Upper GI 8 Breast 9 Brain 10 Lower GI 11 Skin 12 Sarcoma State clinical reason for suspicion of cancer - See Referral Guidelines – Include any investigation results and any other relevant information. Produced by Cancer Services - Version Four (April 2007) - 6 - FAX THIS FORM WITHIN 24 HOURS OF YOUR DECISION TO REFER TO: UROLOGICAL 0151 430 1901 GYNAECOLOGICAL 0151 430 1043 ENDOSCOPY 0151 430 1892 ALL OTHER CANCER REFERRALS 0151 430 1629
  7. 7. Produced by Cancer Services - Version Four (April 2007) - 7 - 10 SKIN -Urgent Referral Melanoma - Pigmented lesion which have >=1 of the following features: • Growing in size • Changing shape • Irregular outline • Change in colour • Mixed colour • Itch/ bleeding • Inflammation NB Melanomas are usually 5mm or greater at the time of diagnosis, smaller lesions may appear in early melanoma. Squamous Cell Carcinoma (SCC) Slow growing, non-healing lesions with a significant induration on palpation with documented expansion over 1-2 months. • Patients diagnosed SCC from a biopsy undertaken in general practice • immuno suppressed patients following organ transplant have a high incidence of SCC which can be unusually aggressive and metastasize . Strongly recommend referring these patients via two week rule. Characteristics of SCC • Evidence of chronic skin damage eg solar keratosis/old burn scar • Crusting/non healing lesion • Documented expansion • Inflammatory response . 1 GYNAECOLOGY-Urgent Referral  Pelvic mass not obviously fibroids or pregnancy  Post menopausal bleeding not on HRT  Suspicious cervical lesion  Persistent post-coital bleeding  Smear suggesting malignancy 2LUNG-Urgent Referral to a Chest Physician:  Chest x-ray suggestive or suspicious of lung cancer (including pleural effusion and slowly resolving consolidation)  Persistent haemoptysis in smokers/ex-smokers over 40 years of age  Sign of superior vena caval obstruction (swelling of face/neck with fixed elevation of jugular venous pressure)  Stridor (consider emergency referral) 3 HAEMATOLOGICAL – urgent referral  Blood count/film reported as suggestive of acute leukaemia or chronic myeloid leukaemia.  Lymphadenopathy (> 1cm) persisting for 6 weeks NB. Cervical lymphadenopathy/ un- resolving neck masses persisting for > =3weeks, referral to the Head & Neck team is recommended  Hepatosplenomegaly  Bone pain associated with anaemia and a significantly raised ESR (or plasma viscosity)  Bone x-rays reported as being suggestive of myeloma  Constellations of 3 or more of the following symptoms (+/-fatigue) •night sweats •weight loss •itching •breathlessness •bruising •recurrent infections •bone pain. 4 Head & Neck – urgent referral  >=6 weeks hoarseness  any 1 of the following lasting >=3 weeks: ulceration of mucosa, oral swellings, dysphagia, unressolved neck mass  uniltareal nasal obstruction with purulent discharge  unexplained tooth mobility without peridontal disease  cranial neuropathies  orbital masses The level of suspicion is further increased if the patient is a heavy smoker or heavy alcohol drinker and is aged over 45years and male. Other forms of tobacco use (chewing Betel, Gutkha, Pan) should also arouse suspicion 5 UROLOGICAL - Urgent Referral  Macroscopic haematuria in adults  Microscopic haematuria in adults over 50 yrs – excl UTI  Swelling in the body of the testis – refer to consultant  Solid renal masses found on imaging  An elevated age specific PSA in men with a ten year life expectancy  A high PSA (>20ng/ml) in men with a clinically malignant prostate or bone pain  Any suspected penile cancer Recommended that PSA test, in aysmptomatic men should only be performed after full counselling and provision of 6 UPPER GI-Urgent Referral any age  Dysphagia  Dyspepsia with >=1 of the following alarm symptoms: • Weight loss, proven anaemia vomiting  >55 years Dyspepsia >=1 of the following "high risk" features: • Onset of dyspepsia less than one year ago • Continuous symptoms since onset  Dyspepsia combined with >=1 of the following risk factors: • Family history of upper GI cancer in more than 2 first degree relatives • Barrett's oesophagus • Pernicious anaemia • Peptic ulcer surgery over 20 years ago • Known dysplasia, atrophic gastritis, intestinal metaplasia  Jaundice 7 BREAST - Urgent Referrals  Patients with a discrete lump in the appropriate age group (eg age > 30)  Signs which are highly suggestive of cancer such as: ulceration, skin nodule, skin distortion, nipple eczema, recent nipple retraction or distortion (< 3 months 8 Brain tumours – urgent referral  Subacute progressive neurological deficit developing over days to weeks eg weakness, sensory loss, dysphasia, ataxia.  New onset seizures characterised by >=1 of the following: focal seizures, prolonged post ictal focal deficit (>1hr), status epilepticus, associated inter- ictal focal deficit.  Headache, vomiting & papilloedema  Cranial nerve palsy eg diplopia, visual failure incl. Optician defined visual field loss, unilateral sensorineural deafness. Consider urgent referral for: recent onset non-migrainous headaches, present for >=1 month, accompanied by features of raised intra cranial pressure eg woken by headache; vomiting; drowsiness. (Exclude depression and somatisation disorder – brain tumour unlikely) 9 LOWER GI - Signs & Symptoms of predictive value of bowel cancer  Any age • persistent increase in frequency of bowel function or looseness of stools for 6 weeks • definite palpable right sided iliac fossa mass • definite palpable rectal tumour • suspicious barium enema  Aged 40> • bleeding persistently without peri-anal symptoms (eg soreness, discomfort, itching, lumps, prolapse, pain) • dark blood mixed with stools • unexplained iron deficiency anaemia (Hb <11g/dl in men or <10g/dl in postmenopausal women) • abdominal pain only if severe, colicky and in association with weight loss or decreased appetite 10 SKIN -Urgent Referral Melanoma - Pigmented lesion which have >=1 of the following features: • Growing in size • Changing shape • Irregular outline • Change in colour • Mixed colour • Itch/ bleeding • Inflammation NB Melanomas are usually 5mm or greater at the time of diagnosis, smaller lesions may appear in early melanoma. Squamous Cell Carcinoma (SCC) Slow growing, non-healing lesions with a significant induration on palpation with documented expansion over 1-2 months. • Patients diagnosed SCC from a biopsy undertaken in general practice • immuno suppressed patients following organ transplant have a high incidence of SCC which can be unusually aggressive and metastasize . Strongly recommend referring these patients via two week rule. Characteristics of SCC • Evidence of chronic skin damage eg solar keratosis/old burn scar • Crusting/non healing lesion • Documented expansion • Inflammatory response 11 Sarcoma – urgent referral  Soft tissue mass with >=1 of the following: • Size > 5 cms, painful, increasing in size, deep to fascia, recurrence after previous excision.  Radiological suspicion of a primary bone tumour based on evidence of bone destruction, new bone formation, soft tissue swelling and periosteal elevation.
  8. 8. 2.2 MDT POLICY 1.0 Introduction 1.1 As a prerequisite for Cancer Peer Review, the Trust is required to have an agreed operational policy in place for each cancer multidisciplinary team (MDT). The policy aims to ensure that the MDT is an integral part of the cancer patient’s management. 1.2 Following consultation with all MDT Lead Clinicians (as documented below), the policy was approved on 14/03/05 at the Trust Cancer Committee Mr G. Cawdell Lead Clinician – Gynaecology Miss L. Chagla Lead Clinician – Breast Mr R. Green Lead Clinician – Skin Dr J. Hendry Lead Clinician – Lung Mr I. Khan Lead Clinician – Upper GI Mr R. Kiff Lead Clinician – Colorectal Dr C. Littlewood Lead Clinician – Palliative Care Mr A. Massey Lead Clinician – Urology Dr G. Satchi Lead Clinician – Haematology 2.0 Scope of Policy 2.1 To describe the process and requirements of an effective MDT, ensuring  All patients with a new diagnosis of cancer have their treatment plan discussed by the appropriate MDT  Prompt effective decision making, to prevent delays in the patients journey  Teams comply with the site-specific quality measures identified within the Cancer Services Manual of Cancer Standards 2004. This is a generic document that applies to all cancer MDT’s in the Trust. It is intended for adjustment by the various MDT’s to reflect their local practices. 3.0 Terminology and definitions 3.1 The Cancer Multidisciplinary Team (MDT) is defined as a group of staff from different health care disciplines, who meet together at a given time (whether physically in one place, or by video/teleconferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient. Produced by Cancer Services - Version Four (April 2007) - 8 -
  9. 9. 3.2 The (2004) Cancer Services Standards define the objectives of an MDT as follows:  To ensure that designated specialists work effectively together in teams such that decisions regarding all aspects of diagnosis, treatment and care of individual patients and decisions regarding the team’s operational policies are multidisciplinary decisions.  To ensure that care is given according to recognised guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision making and to support clinical governance/audit.  To ensure that mechanisms are in place to support entry of eligible patients into clinical trials, subject to patients giving fully informed consent. 4.0 MDT Constitution 4.1 There should be a single named lead clinician for the named MDT who should then be a core team member, agreed by the lead clinician of the Trust. 4.2 The lead clinician of the MDT should have agreed the responsibilities of the position with the lead clinician of the Trust. (Appendix 1) 4.3 The MDT should be listed as part of the services of a named locality of the network. 4.4 The core membership of an MDT will vary between teams and must be adjusted to reflect Cancer Services Standards, NICE guidance and local practice. Membership will generally include:  MDT Lead Clinician  Consultant medically qualified core member(s) other than in imaging and histopathology.  Oncologist(s).  Clinical Nurse Specialist/nurse representative  Radiologist  Histopathologist  Palliative Care representative  MDT Co-ordinator  Any additional members at the discretion of the MDT Lead.  A core team member will be nominated as having specific responsibility for users' issues and information for patients and carers. 4.5 The MDT should agree cover arrangements for each core member, agreed by the lead clinician of the MDT Produced by Cancer Services - Version Four (April 2007) - 9 -
  10. 10. 4.6 The core imaging specialist member(s) of the MDT should regularly report on imaging of the primary cancer site or sites of the MDT. 4.7 The MDT should have at least one core nurse member who should have enrolled in, or be undertaking, or have successfully completed, a programme of study in their specialist area of nursing practice which has been accredited for at least 20 level III CAT points. 4.8 The MDT should have at least one core nurse member who should have enrolled in, be undertaking, or have successfully completed a course/module in communication skills, which is accredited for CAT points. This may be either standalone or as part of specialist programme. 4.9 The lead clinician and the core nurse member/s will have agreed a list of responsibilities. (Appendix 2) 4.10 If applicable, the MDT lead clinician will agree the names of members of the extended team for named roles in the team, if they are not already offered as core team members. 5.0 MDT Terms of Reference 5.1 Meetings should take place as directed by the Cancer Services Standards, or more frequently dependant on workload. As a minimum, fortnightly meetings should take place to ensure the patient’s journey is not adversely affected. A record of core members' attendance will be maintained. 5.2 Core members or their arranged "cover" should attend a minimum of 51% of the meetings. 5.3 The core MDT, at their regular meetings, should agree and record individual patient's treatment plans. A record should be made of the treatment plan. The record should include:  The identity of patients discussed.  The multidisciplinary treatment planning decision (i.e. to which modality(s) of treatment - surgery, radiotherapy, chemotherapy, hormone therapy or supportive care or combinations of the same, they are to be referred for consideration). 5.4 For patients requiring a treatment planning decision before the next scheduled meeting, the consultant lead will discuss the patient with the relevant core/extended team member (i.e. consultant colleague, oncologist , palliative care) and jointly agree a management plan. The agreed management plan will be documented in the case notes. All patients will be discussed retrospectively at the next scheduled meeting. Produced by Cancer Services - Version Four (April 2007) - 10 -
  11. 11. 5.5 Besides the regular meetings to discuss individual patients, the team should meet at least annually to agree the following:  Local protocols and guidelines for practice  Adoption of national/network guidelines  Review MDT compliance with Cancer Services Standards  Agree and ensure representation on the relevant CNG, with regular feedback to the team. 6.0 MDT Co-ordination 6.1 The list of patients to be discussed at a forthcoming meeting is held by the MDT Co-ordinator. Any member of the core or extended MDT may add patients to the list, although this should be discussed with the site- specific surgeon/physician beforehand to ensure responsibility for any clinical decision made by the MDT is agreed. 6.2 The MDT Co-ordinators frequently review all pathology reports to identify cancer patients. If a patient is identified via this route the MDT Co-ordinator has the authority to add these patients to MDT lists. 6.3 The cut-off time for adding patients to the list is as follows:  For a morning meeting - cut-off midday previous working day  For a lunchtime meeting – cut-off close of day previous working day This ensures the MDT Co-ordinators have time to find all notes and x- ray films before a meeting, and for these to be reviewed by MDT members. The Core Team Radiologist and Histopathologist will be informed of those patients on the list, in order to review films/slides in advance of the MDT meeting. 6.4 For patients added to the list after the cut-off time, notes and films must be provided by the ‘adding’ clinician. 6.5 The chair of the meeting will ensure discussions are focused, ensuring all core members of the MDT are able to contribute. 6.6 Following MDT discussion, a core team member will record the management decision be in the patient’s case notes. 7.0 Primary Care Feedback 7.1 The MDT will inform the patient's general practitioner (GP) after a patient is given a diagnosis of cancer. The agreed generic proforma will be completed and faxed to the practice by the end of the following working day. The MDT will audit this process on an annual basis. 7.2 The MDT will provide information to referring general practitioners on the appropriateness of urgent suspected cancer GP referrals. Produced by Cancer Services - Version Four (April 2007) - 11 -
  12. 12. 8.0 Patient experience 8.1 Each MDT will identify a single named key worker for each individual patient receiving treatment/care directly from the team. The name of the current key worker will recorded in the patient's case notes. The responsibility for ensuring that the key worker is identified should be that of the nurse MDT member(s). (Appendix 2 & 3) 8.2 The key worker for each individual patient will ensure that the patients and/or carers receive written contact information to access the MDT to discuss problems or concerns. 8.3 The MDT will offer patients the opportunity of a permanent record or summary of at least a consultation between the patient and the doctor at which the treatment options of their diagnosis were discussed. 8.4 The MDT will undertake an annual survey of its patients' experience of the services offered by the team. The survey should at least ascertain whether patients were offered:  A key worker.  The MDT's information for patients (written or otherwise).  The opportunity of a permanent record or summary of a consultation at which their treatment options were discussed. The survey results will be presented and discussed at an MDT meeting, with at least one action point arising from the survey agreed and implemented. 8.5 The MDT will provide written material for patients and carers which includes:  Information specific to that MDT about local provision of the services offering the treatment for that cancer site.  Information about patient self-help groups if available and complying with the network quality criteria.  Information about the services offering psychological, social and spiritual/cultural support, if available.  Information specific to the MDT's cancer site or group of cancers about the disease and its treatment options. 8.6 There should be a checklist in each patient's case notes addressing whether the patient has been offered:  A key worker.  The MDT's information for patients (written or other formats).  The opportunity of a permanent record or summary of a consultation at which their treatment options were discussed. 9.0 Network requirements Produced by Cancer Services - Version Four (April 2007) - 12 -
  13. 13. 9.1 The MDT should send a team member as a representative to at least two thirds of the site-specific clinical network group (CNG) meetings. The representative should feedback CNG discussions to the MDT on a regular basis. 9.2 The MDT should abide by the agreed specified network-wide clinical guidelines for the cancer site. 9.3 The MDT should abide by the agreed network-wide referral guidelines 9.4 The MDT should abide by the agreed imaging guidelines for the diagnosis and assessment of that cancer site. The guidelines should address:  Imaging modalities.  Their specific indications. 9.5 The MDT should abide by the agreed pathology guidelines for the diagnosis and assessment of that cancer site. The guidelines should address:  Laboratory and histopathology/histochemical investigations.  Their specific indications. 9.6 The MDT should collect the minimum dataset (MDS), as agreed by the site-specific clinical network group (CNG). 9.7 The MDT should participate in at least one network-wide audit project. The MDT should present the results of a completed network-wide audit project to the site-specific clinical network group (CNG) 9.8 The MDT should abide by the agreed network approved list of clinical trials. 10.0 Data Collection 10.1 The MDT should have started to record the MDS in an electronically retrievable form. 10.2 Measured over the complete calendar year prior to the peer review visit, the MDT should ensure that the hospital's number of separate patient returns to the cancer registry for the MDT's cancer site(s) should be at least 95% of the hospital's 'average' return. 10.3 Measured over the complete calendar year prior to the peer review visit, the MDT should ensure that the hospital's number of separate patient returns to the cancer registry for the cancer site(s) of the team should be at least 95% of the new cancer patients discussed by the team in the same period. Produced by Cancer Services - Version Four (April 2007) - 13 -
  14. 14. 10.4 The Cancer Support Team will provide each MDT with a monthly report identifying pre-defined data items including Cancer Waiting Times Performance. 11.0 Service Improvement 11.1 The lead clinician of the MDT should nominate one of the members of the core or extended team as the person responsible for ensuring that service improvement is integrated into the functions of the MDT. 11.2 The MDT should carry out process mapping covering the key stages of their patients' journey i.e.: a) From the receipt of the referral of a new patient to their point of referral on for each of the possible options for first definitive treatment; and: b) In the case of a surgical, first definitive treatment, to the point of admission for surgery.  From the completed process mapping the MDT should produce a report containing an action plan (AP) for service improvement, which addresses patient waiting times.  The report including the AP should be agreed by the MDT lead clinician, the service improvement lead of the CNG and the network service improvement lead.  From the AP, at least one action point for service improvement addressing patient waiting times should have been agreed with the service improvement lead for the CNG and the network service improvement lead, as being of first priority for implementation, and should then have been implemented.  Data, addressing patient waiting times, from the relevant part of the patient journey should have been collected before and after implementation, and compared.  Following receipt of the MDT's process mapping report, the network service improvement lead should decide whether capacity/demand study is required for any part of the patient journey. If this is required, the MDT should have completed the required study and the results used as a basis for part of the service improvement AP. 11.4 The MDT will offer patients ‘booking’ at three key stages of their cancer journey:-  Booking Two-week wait referrals should be able to choose to pre- book their appointment.  New patients who are suspected of having cancer should be able to choose and pre-book the date of their first diagnostic test.  Patients who require an elective admission/outpatient treatment for first treatment should be able to choose and pre-book their admission date. 12.0 Clinical Governance Produced by Cancer Services - Version Four (April 2007) - 14 -
  15. 15. 12.1 It is a national requirement that an MDT discusses all patients with a new diagnosis of a cancer. Each MDT must therefore ensure the team discusses all patients within their remit at least once, and that treatment decisions are clearly recorded in the patients notes. Appendix 1 – Role and Responsibilities of MDT Lead Clinician Role:  Ensure that all objectives of MDT working (as laid out in Manual of Cancer Service Standards, 2004) are met  Ensure that MDT members work effectively together, such that decisions regarding all aspects of treatment/care of individual patients and decisions regarding the team's operational policies are multidisciplinary decisions  Ensure that care is given according to recognised guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision-making and to support clinical governance/audit.  Ensure mechanisms are in place to support entry if eligible patients into clinical trials, subject to patients giving fully informed consent. Responsibilities:  Overall responsibility for ensuring that MDT meeting and team compliance meet Peer Review Quality Measures.  Ensure attendance levels of core team members are maintained, in line with Quality Measures.  Ensure the target of 100% of cancer patients discussed at MDT is met.  Provide link to Network Site Specific Group (NSSG), either by attendance at meetings or by nominating another team member to attend. Engage in the work of the NSSG in developing cancer services, policies and standards  Lead on, or nominate radiology lead for service improvement.  Organise and chair MDT annual team meeting examining functioning of team and reviewing operational policies, and collate any activities that are requires to ensure optimal functioning of the team (e.g. training for team members).  Ensure MDT’s activities are audited and results documented..  Ensure that the outcomes of the meeting are clearly recorded and clinically validated and that appropriate data collection is supported.  Ensure target for communicating MDT outcomes to primary care is met.  Meet regularly with Cancer Management Team, colleagues from Trust and locality, participating in discussion on trust-wide Cancer Services and Strategy. Produced by Cancer Services - Version Four (April 2007) - 15 -
  16. 16. Signed ……… Date ………….. Signed ……...………………….. Date ………………. MDT Lead Clinician Dr Thind, Cancer Services Lead Clinician Appendix 2 – Role and Responsibilities of MDT Core Nurse Member/s Role:  Contribute to the MDT’s compliance with the quality measures for site-specific teams (as laid out in Manual of Cancer Service Standards, 2004) are met.  Contribute to effective MDT working, such that decisions regarding all aspects of diagnosis, treatment and care of individual patients and decisions regarding the team's operational policies are multidisciplinary decisions.  Ensure that care is given according to recognised guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision-making and to support clinical governance/audit. Responsibilities  Contributing to the MDT discussion and patient assessment/care planning decision of the team at their regular meeting. Ensuring the at MDT meeting and team meet Peer Review Quality Measures.  Providing expert nursing advice and support to other health professionals in the nurse’s specialist area of practice  Utilising research in the nurse’s specialist area of practice.  Involvement in clinical audit  Contributing to the management of the service  Specific responsibility for user issues and information for patient and carers  Lead on patient communication issues and co-ordination of the patients pathway for patients referred to the team – acting as a key worker or responsible for nominating the key worker for the patient’s dealings with the team. Key Worker Role: To promote clinical continuity for patients Key Worker Responsibilities - To orchestrate assessments to ensure patients’ needs are elicited - Ensuring care plans have been agreed with the patient - Ensuring findings from assessments and care plans are communicated to others involved in a patient’s care - Ensuring patients know who to contact when help or advice is needed, whether the ‘key worker’ or other appropriate personnel - Act as an administrative contact (during normal working hours i.e. 09.00- 17.00, Monday-Friday) for patients and professionals. The key worker will ensure that patient’s and those providing care are given contact information in writing (i.e. name and telephone number). Produced by Cancer Services - Version Four (April 2007) - 16 -
  17. 17. - Managing transitions of care  In circumstances where the Palliative Care Team (HPCT) are involved, there has to be an agreement made between the Site-Specific Clinical Nurse Specialist (SS- CNS) and the HPCT member negotiating the' key worker' for that specific episode of care. The individual patient’s current issues and specific problems or concerns need to be taken into account. This will take the form of: - Advice from HPCT to SS-CNS on a particular situation, e.g. on symptom control, where the SS-CNS remains the key worker. - Joint consultation by HPCT and SS-CNS where, on patient's agreement, SS-CNS continues to be the key worker. - Joint consultation by HPCT and SS-CNS where, on patient's agreement, HPCT becomes the key worker. Signed ……………..…………… Date ………….. Signed ……...………………….. Date ………………. MDT Lead Clinician Site Specific – Clinical Nurse Specialist Produced by Cancer Services - Version Four (April 2007) - 17 -
  18. 18. Appendix 3 - Clinical Nurse Specialist Protocol Initial contact with a newly diagnosed cancer patient Introduction As a prerequisite for Cancer Peer Review, the Trust is required to have an agreed operational policy in place for each cancer multidisciplinary team (MDT), ensuring each MDT identifies a single named key worker for each individual patient receiving treatment/care directly from the team. The responsibility for ensuring that the key worker is identified should be that of the nurse MDT member(s). Scope of Protocol To describe the role of the site-specific nurse specialist on Initial contact with a newly diagnosed cancer patient Terminology and Definitions For St Helens & Knowsley Hospitals, the site-specific clinical nurse specialist will perform the role of the ‘key worker’. The Clinical Nurse Specialist title will be used rather than ‘key worker’. Protocol  Initial contact will be made at time of diagnosis in clinic/ward setting or by the end of the next working day by telephone. In the absence of the Nurse Specialist, it is the responsibility of the clinician informing the patient of the diagnosis to provide the Nurse Specialist and patient with contact details.  On contact the patient and/or carer will receive the Nurse Specialist’s name, contact details and hours of work.  The patient and/or carer will receive written/verbal information regarding the role of the Nurse Specialist i.e. - To orchestrate assessments to ensure patients’ needs are elicited - Ensuring care plans have been agreed with the patient - Ensuring findings from assessments and care plans are communicated to others involved in a patient’s care - Ensuring patients know who to contact when help or advice is needed, whether the ‘key worker’ or other appropriate personnel* - Act as an administrative contact (during normal working hours i.e. 09.00- 17.00, Monday-Friday) for patients and professionals. The key worker will ensure that patient’s and those providing care are given contact information in writing (i.e. name and telephone number). - Managing transitions of care  The Nurse Specialist will provide written material for patients and carers which includes: - Information specific to that MDT about local provision of the services offering the treatment for that cancer site. - Information about patient self-help groups if available and complying with the network quality criteria. - Information about the services offering psychological, social and spiritual/cultural support, if available. - Information specific to the MDT's cancer site or group of cancers about the disease and its treatment options. Produced by Cancer Services - Version Four (April 2007) - 18 -
  19. 19. 2.3 SERIOUS DIAGNOSIS FAX PRACTICE PROTOCOL SERIOUS DIAGNOSIS FAX BACK Introduction During the baseline assessment of cancer services in primary care throughout St Helens PCT, it was highlighted that patients were attending surgery following a cancer diagnosis before the GP has been informed of that diagnosis. Developments are being progressed in secondary care to provide GPs with this communication within 24 hours of diagnosis. PROTOCOL This protocol is to be used when a serious diagnosis fax is received within the practice. A named member of the reception staff for each practice should be responsible for dealing with the serious diagnosis fax. A second named member of the Primary Health Care Trust should be identified to cover for holidays and sickness absence etc. The named member of staff should inform the relevant GPs of the diagnosis and treatment plan (registered GP and/or the GP the patient normally sees). Either by showing them the serious diagnosis fax. By informing the GP by telephone. If the GP is unavailable due to sickness absence or holiday then the Locum and/or principle GP of the practice should be informed of the diagnosis and treatment plan. The serious diagnosis fax (or copy) should be placed within the patient’s record/notes. The patient’s record/notes should be Read coded with the appropriate diagnosis (Read codes to be provided). Produced by Cancer Services - Version Four (April 2007) - 19 -
  20. 20. St. Helens and Knowsley Hospitals NHS Trust Produced by Cancer Services - Version Four (April 2007) - 20 - NHS Cancer Diagnosis – 24 hour communication Speciality Dear Doctor ………………………………………… Date …………………… RE: Addressograph Your patient was seen in clinic today by:………………………………………………………. Diagnosis …………………………………………………………………………………………. The patient has been told:……………….……………………………………………………… ………………..…………………………………………………………………………………….. The plan of treatment is as follows: ……………………………………………………………. ……………………………………………………………………………………………………… New medication commenced: ………………………………………………………………….. Investigation / procedures planned ……………………………………………………………. ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Additional information (ie referred to palliative care …………………………………………………………………………………………………………………… Appointment details ……………………………………………………………………………… A detailed letter will be sent to you in the near future. However, if you have any queries in the meantime please do not hesitate to contact me. You will need to update your cancer register with this information. Yours Sincerely, (Name Telephone Number Bleep Number) Whiston Hospital, Warrington Road, Prescot, Merseyside, L35 5DR
  21. 21. 3 ONCOLOGY 3.1 LILAC CENTRE St Helens & Knowsley Hospitals provides a local outpatient chemotherapy service for haematology and oncology patients. In addition to elective chemotherapy the Unit operates an open door access policy for known haematology/oncology patients, with emergency assessment, telephone advice and triage. The Unit also facilitates out-patients procedures including: ♦ Bone marrow biopsy ♦ Hickman/PICC line placement and care ♦ Pleural/ascitic tap ♦ Whole unit venesection ♦ Intravenous infusions including: - iron - immunoglobulin - bisphosphonates - monoclonal antibody - blood and platelet transfusions. The Lilac Nurses are qualified and trained to care for patients with cancer. They aim to make treatment as tolerable as possible and to minimise side effects associated with chemotherapy treatment. They work closely with all team members, to help provide continuity of care. Based within the Lilac Centre is a counselling and complimentary therapy service. This service is open to patients and carers during and post treatment. Both staff and patients can make referrals to the service and all therapies are conducted in a safe and confidential environment. Produced by Cancer Services - Version Four (April 2007) - 21 -
  22. 22. Team Members Role Contact Details Monday to Friday 9 – 5 Barbara Jost Unit Manager 0151 430 1687 Ruth Jackson Chemotherapy Sister 0151 430 1687 Karen Pocock Chemotherapy Nurse 0151 430 1687 Holly Donaghy Chemotherapy Nurse 0151 430 1687 Philip Walker Chemotherapy Nurse 0151 430 1687 Maureen Scotton Chemotherapy Nurse 0151 430 1687 Janet Davies Receptionist 0151 430 1614 Deborah Kilshaw Receptionist 0151 430 1614 Janice Ashton Health Care Assistant 0151 430 1687 Gill Levey Counselling Manager 0151 430 1687 Shirlie Deveney Assistant Counselling Manager 0151 430 1687 Dawn Porter Research Practitioner 0151 430 1147 Bleep 1148 Jeanette Ribton Oncology Nurse Specialist 0151 430 2269 Bleep 0014 Raphael Kawonga Haematology Staff Grade 0151 430 1825 Bleep 1826 Dr M Abbas Oncology Staff Grade 0151 430 1995 Bleep 0227 Peter Smith Oncology/Haematology Pharmacist 0151 430 1514 Bleep 1514 Laura Evans Oncology Dietician 0151 430 1201 Bleep 0208 Elaine Smith Haematology Secretary 0151 430 1825 Denise Ambage Haematology Secretary 0151 430 1825 Lisa Ryan Haematology Secretary 0151 430 1825 Sandra Clegg Oncology Secretary 0151 430 1910 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Ward G5 – 0151 430 1560 In-patient Advice Surgical/ Medical On Call Team. Produced by Cancer Services - Version Four (April 2007) - 22 -
  23. 23. 3.2 CLINICAL TRIALS TEAM Team Members Role Contact Details Monday to Friday 9 – 5 Dr E Marshall Consultant Oncologist 0151 430 1910 Jenny Almond Merseyside & Cheshire Cancer Research Network Manager 0151 482 7804 Dawn Porter Research Practitioner 0151 430 1147 Bleep 1148 Sarah Simpkin Clinical Trials Nurse 0151 430 1147 Bleep 1147 Michelle Harvey Clinical Trials Data Clerk 0151 430 1147 Jeanette Ribton Oncology Nurse Specialist 0151 430 2269 Bleep 0014 Produced by Cancer Services - Version Four (April 2007) - 23 -
  24. 24. 4. SITE SPECIFIC PATIENT SERVICES 4.1 CANCER SERVICE – Breast Core Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Miss L. Chagla Lead Consultant 0151 430 1607 Mr R. Audiso Consultant Breast Surgeon 0151 430 1079 Dr S. Desmond Consultant Radiologist 0151 426 1600 Ex2491 Dr O. Harris Consultant Radiologist 0151 430 1185 Dr E. Gradwell Consultant Pathologist 0151 430 1827 Dr S. Kelly Consultant Pathologist 0151 430 1839 Dr H Innes Dr R Sripadam Clinical Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Sue McNicholas Breast Care Specialist Nurse 0151 430 1908 Chris Bebb Breast Care Specialist Nurse 0151 430 1908 Louisa Mahon Breast Care Nurse 0151 430 1908 Jill Atherton MDT Co-ordinator 0151 430 1061 Extended Multidisciplinary Team Member Role Contact Details Monday to Friday 9-5 Colette Murray Palliative Care Cancer Nurse Specialist 0151 430 1953 Chris Jonkers Breast radiographer 0151 430 1185 Rob Rosser Clinical Psychologist 0151 430 1654 Mr K. Graham Consultant Plastic Surgeon 0151 430 1262 Mr R. Alvi Consultant Plastic Surgeon 0151 430 1401 Dr Lynn Greenhough (Alder Hey Hospital) Clinical genetic/genetics counsellor Marie Curie centre Physiotherapist/ Lymphoedema Mr A. Ray Associate Specialist 0151 430 1528 Dr R. Thind Consultant Radiologist 0151 430 1265 Dr M. Pinto Consultant Pathologist 0151 430 1731 Dr N. Hasan Consultant Pathologist 0151 430 1190 Sarah Simpkin Trials Nurse 0151 430 1147 Nina Agnew Warrington Screening 01925 230923 Produced by Cancer Services - Version Four (April 2007) - 24 -
  25. 25. OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. G5 Ward if Chemotherapy related. In-patient Advice Ward H4 or via Surgical On Call Team. G5 Ward if Chemotherapy related. Non-urgent Advice Breast Care Nurses Answer Phone Service. OUTPATIENT CLINICS Consultant Clinic Type Day Site Miss Chagla Breast New patients Wednesday AM Burney Breast Unit Miss Chagla Breast Revisits Wednesday PM Burney Breast Unit Mr Audisio Breast New patients Tuesday PM Burney Breast Unit Mr Audisio Breast Revisits & new non-urgent Thursday PM Burney Breast Unit Mr Audisio Breast Revisits Friday AM Stephenson House Mr Ray Breast New patients Monday AM Burney Breast Unit Mr Ray Breast Revisits Friday PM Burney Breast Unit Dr Innes Breast New patients and Revisits. Friday AM Wednesday PM Alternate Monday AM Stephenson House Dr Innes Breast New patients and Revisits. Tuesday PM St Helens OUTPATIENT CLINICS Nurse Specialist Clinic Type Day Site Sue McNicholas Or Chris Bebb Breast Prosthetic Clinic Tuesday PM Whiston BREAST SCREENING/RECALL Dr R. Thind Breast Screening Assessment Monday AM Whiston Dr O. Harris Breast Screening Assessment Monday AM Whiston Dr S. Desmond Breast Screening Assessment Monday AM Whiston Multidisciplinary Team Meeting held, every Friday at 13.00 Venue: Post Graduate Centre Produced by Cancer Services - Version Four (April 2007) - 25 -
  26. 26. 4.2 CANCER SERVICE – Colorectal Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Mr R. Kiff Lead Clinician 0151 430 1529 Mr D. Maitra Colorectal Surgeon 0151 426 1600 Ext. 2339 Mr M. Scott Colorectal Surgeon 0151 430 1911 Dr J McLindon Physician Gastroenterologist 0151 430 1281 Dr E Marshall Medical Oncologist 0151 430 1910 Dr Whitmarsh Clinical Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Dr A. Evans Consultant Radiologist 0151 430 1265 Dr. S. Kelly Consultant Pathologist 0151 430 1839 Helen Carroll Colorectal Nurse Specialist 0151 430 1078 Angela Fitzgerald-Smith Colorectal Nurse Specialist 0151 430 1685 Paul Ratcliffe MDT Co-ordinator 0151 430 1061 Extended Multidisciplinary Team Role Contact Details Monday to Friday 9-5 Carolyn Swash Stoma Nurse Specialist 0151 430 1221 Debbie Maddox Specialist Palliative Care CNS 0151 430 1274 Laura Evans Dietitian /nutritionist 0151 430 1201 Tony Ellis Clinical geneticist / genetics counsellor Social Worker 0151 430 1201 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. G5 Ward if Chemotherapy related. In-patient Advice D2 Ward or Via Surgical On Call Team. G5 Ward if Chemotherapy related. Non-urgent Advice Colorectal Nurse Specialists’ Answer Phone Service. Produced by Cancer Services - Version Four (April 2007) - 26 -
  27. 27. OUTPATIENT CLINICS Consultant Clinic Type Day Site Mr Kiff Colorectal Cancer/General Tuesday AM Whiston Mr Kiff Colorectal Cancer/General Friday AM St Helens Mr Maitra Colorectal Cancer/General Wednesday AM Whiston Mr Maitra Colorectal Cancer/General Thursday AM St Helens Mr Scott Colorectal Cancer/General Thursday AM Whiston Mr Scott Colorectal Cancer/General Friday PM St Helens Dr Marshall Oncology (Chemotherapy) Monday AM Whiston Dr Marshall Oncology (Chemotherapy) Thursday AM Whiston Dr Whitmarsh Oncology (Radiology) Monday AM Whiston ENDOSCOPY SESSIONS Mr Kiff Wednesday PM Mr Maitra Alternate Friday PM Rapid Access Friday PM Multidisciplinary Team Meeting held, every Monday at 13.00 Venue: X-ray Seminar Room Produced by Cancer Services - Version Four (April 2007) - 27 -
  28. 28. 4.3 CANCER SERVICE – Gynaecology Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Mr G. Cawdell Lead Clinician 0151 430 1663 Vacant Medical Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Dr J Zekri Clinical Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Dr J. Kirwan Gynaecology Oncologist Women’s Hospital 0151 702 4265 Dr N. Hasan Consultant Histopathologist 0151 430 1824 Dr O. Harris Consultant Radiologist 0151 426 1600 Ext.2491 Diane Dearden Clinical Nurse Specialist 0151 426 1600 Ext. 2348 Jill Atherton MDT Co-ordinator 0151 430 1061 Extended Multidisciplinary Team Role Contact details Monday to Friday 9-5 Colette Murray Specialist Palliative Care CNS 0151 430 1274 Sarah Simpkin Clinical Trials Nurse 0151 430 1147 Dr M. Abass Oncology Staff Grade 0151 430 1910 Gill Levey Psychosocial / psychosexual counsellor 0151 430 1687 Maria Embleton Staff Nurse 0151 426 1600 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. In-patient Advice H4 or Via Gynaecology On Call Team. G5 if chemotherapy related. Non-urgent Advice Gynaecology Oncology Nurse Answer Phone Service. Produced by Cancer Services - Version Four (April 2007) - 28 -
  29. 29. OUTPATIENT CLINICS Clinic Type Day Site Gynae-Oncology Alternate Monday AM *Whiston Rapid Access Pelvic Mass Wednesday AM *Whiston Rapid Access Post-Menopausal Bleeding Tuesday PM H1, Whiston Rapid Access Post-Menopausal Bleeding Wednesday PM H1, Whiston Rapid Access Post-Menopausal Bleeding Friday PM H1, Whiston Vulvoscopy Alternate Wednesday PM HI, Whiston *Clinics take place in Maternity and Gynaecology Unit COLPOSCOPY SESSIONS Colposcopy Monday am/p.m. H1, Whiston Colposcopy Tuesday am/p.m. H1, Whiston Colposcopy Thursday am/p.m. H1, Whiston Colposcopy Thursday am/p.m. H1, Whiston Colposcopy Friday am/p.m. H1, Whiston Multidisciplinary Team Meeting held alternate Mondays at 09.15 prior to Oncology Clinic Venue: X-Ray Seminar Room Produced by Cancer Services - Version Four (April 2007) - 29 -
  30. 30. 4.4 CANCER SERVICE – Haematology Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Dr G. Satchi Lead Clinician 0151 430 1887 Dr J. Tappin Consultant Haematologist 0151 430 1292 Dr T. Nicholson Consultant Haematologist 0151 430 1825 Dr R. Kawonga Staff Grade – Haematology 0151 426 1600 Ex 2473 Bleep 1826 Jeanette Ribton Oncology Nurse Specialist 0151 430 1687 Bleep 0014 Angela Madigan Haematology/Oncology Macmillan CancerNurse Specialist 0151 430 4111 Bleep 4111 Sr. I Kearney Ward Manager – G5 0151 430 1560 Sr. B. Jost Unit Manager – Lilac Centre 0151 430 1687 Dawn Porter Trials Practitioner 0151 430 1147 Bleep 1148 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via Switchboard to Consultant on-call In-patient Advice G5 Ward OUTPATIENT CLINICS Consultant Clinic Type Day Site Dr G. Satchi Anti- coagulation Monday AM St Helens Dr G. Satchi Anti- coagulation Tuesday PM Whiston Dr G. Satchi Haematology Wednesday AM Whiston Dr G. Satchi Haematology Thursday AM St Helens Dr J. Tappin Haematology Wednesday AM Whiston Dr J. Tappin Haematology Friday AM Whiston Dr T. Nicholson Haematology Wednesday AM Whiston Dr T. Nicholson Haematology Friday AM Whiston Multidisciplinary Team Meeting held weekly on Wednesday at 14.00 Venue: X-ray Seminar Room. Joint MDT with North Cheshire Hospitals 1st Wednesday of the month 15.00 Venue: X-ray Seminar Room. Produced by Cancer Services - Version Four (April 2007) - 30 -
  31. 31. 4.5 CANCER SERVICE – Head & Neck Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Mr Nandapalan Consultant Otolaryngologist 0151 430 1598 Mr Daud Consultant Otolaryngologist 0151 430 1573 Mr Jones Consultant Otolaryngologist 0151 529 5248 Dr Husband Medical Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Dr Hasan Consultant Histopathologist 0151 430 1190 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. In-patient Advice D2 Ward OUTPATIENT CLINICS Consultant Clinic Type Day Site Mr Daud ENT Monday AM Whiston Hospital Mr Daud ENT Friday PM Whiston Hospital Mr Nandapalan ENT Tuesday AM Whiston Hospital Mr Nandapalan ENT Thursday PM Whiston Hospital Mr Jones ENT Tuesday PM 2nd , 4th & 5th Whiston Hospital Dr Husband Mr Jones Head & Neck Tuesday PM 1st & 3rd Whiston Hospital Multidisciplinary Team Meeting held at University Hospital Aintree Produced by Cancer Services - Version Four (April 2007) - 31 -
  32. 32. 4.6 CANCER SERVICE – Lung Multidisciplinary Team Members Role Contact Details Monday to Friday 9 – 5 Dr. J. Hendry Respiratory Physician – Clinical lead for Lung Cancer 0151 430 1899 Dr. P. Stockton Respiratory Physician 0151 426 1600 Ex 2638 Dr S Twite Respiratory Consultant 0151 426 1600 Ex 2638 Joanne Brown Lung Cancer Clinical Nurse Specialist 0151 430 1367 Pauline Murphy Lung Cancer Clinical Nurse Specialist 0151 430 2326 Carol Dawson Lung Cancer Clinical Nurse Specialist 0151 430 2326 Robert Case Specialist Palliative Care CNS 0151 430 1274 Dr. J. Wide Consultant Radiologist 0151 426 1600 Ex 2485 Dr N. Mohsin Consultant Radiologist 0151 426 1600 Ex 2485 Dr A. Dar Consultant Histopathologist 0151 430 1827 Dr E. Marshall Consultant Oncologist 0151 430 1910 Mr. Shackcloth Thoracic Surgeon 0151 228 1616 Dr. Z. Malik Consultant Oncologist Clatterbridge Centre for Oncology 0151 334 4000 Lorraine Price MDT Co-ordinator 0151 430 1061 Extended Multidisciplinary Team Members Role Contact details Monday to Friday 9-5 Dr Littlewood Palliative Care physician 0151 430 1347 Pool member Social Worker Rob Rosser Clinical Psychologist 0151 430 1634 Jane Shepherd Chaplain/ pastoral care worker 0151 430 1657 Willowbrook Hospice Bereavement care worker 0151 430 8736 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. In-patient Advice Ward F2, G16, C1 or Via Medical On Call Team. Non-urgent Advice Lung Cancer Nurse Answer Phone Service. Produced by Cancer Services - Version Four (April 2007) - 32 -
  33. 33. OUTPATIENT CLINICS Consultant Clinic Type Day Site Dr Hendry Lung Shadow Clinic Thursday am Whiston Hospital Dr Stockton Lung Shadow Clinic Thursday am Whiston Hospital Dr Marshall Cancer Clinic Monday am Whiston Hospital Dr Marshall Cancer Clinic Thursday am Whiston Hospital Mr Soorae Thoracic Surgery Clinic 1st and 3rd Tuesday p.m. Whiston Hospital Dr Z Malik Oncologist Radiotherapy Thursday am Whiston Hospital BRONCHOSCOPY SESSIONS Alternate Monday p.m. Dr Stockton H2, Endoscopy Unit Tuesday am Dr Ridyard H2, Endoscopy Unit Wednesday p.m. Dr Hendry/Dr Corless H2, Endoscopy Unit Multidisciplinary Team Meeting held every Thursday morning, at 08.30 Venue: Brandreth Suite Pre-thoracic Surgery MDT Meeting alternate Tuesdays, at 14.00. Venue: Hackworh Suite X Ray MDT Wednesday 12.30 – 14.00 Venue: X-Ray Seminar Room Produced by Cancer Services - Version Four (April 2007) - 33 -
  34. 34. 4.7 CANCER SERVICE – Skin Multidisciplinary Team Members Role Contact Details Monday to Friday Mr Green Consultant Plastic Surgeon 0151 430 1664 Mr Hancock Consultant Plastic Surgeon 0151 430 1044 Dr Curley Consultant Dermatologist 0151 430 1507 Dr Herbert Consultant Radiologist 0151 426 1600 Ext. 2265 Dr Marshall Consultant Oncologist 0151 430 1910 Dawn Porter Clinical Trials/Research Practitioner 0151 430 1147 Bleep 1148 Tom Crowe Dermatology Nurse Specialist 0151 430 1953 Chris Hunt Dermatology Nurse Specialist 0151 430 1482 Dr Gradwell Consultant Pathologist 0151 430 1827 Dr Husband Consultant Oncologist Clatterbridge Centre for Oncology 0151 334 4000 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. In-patient Advice Holbrook Unit Non-urgent Advice Dermatology Nurse Specialist Answer Phone Service OUTPATIENT CLINICS Consultant Clinic Type Day Site Mr Green *Skin Cancer Tuesday PM Whiston Hospital Dr Curley Skin Cancer Tuesday PM Whiston Hospital Dr Marshall Skin Cancer – Oncology Tuesday PM 1st & 3rd Whiston Hospital *Note – although patient’s with Skin Cancer are mainly seen at this clinic they can be seen by other consultants at clinics in Whiston & St Helens Multidisciplinary Team Meeting held 1st & 3rd Tuesday in the month at 12.30 Venue: Burns & Plastics Seminar Room Produced by Cancer Services - Version Four (April 2007) - 34 -
  35. 35. 4.8 CANCER SERVICE – Upper Gastrointestinal Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Mr Khan Lead Clinician 0151 430 1239 Mr A. Li UGI Surgeon 0151 430 1528 Ms Chagla UGI Surgeon 0151 430 1607 Mr Kanwar UGI Surgeon 0151 430 1528 Dr Preistley Physician Gastroenterologist 0151 430 1252 Dr Marshall Medical Oncologist 0151 430 1910 Dr Meek Consultant Radiologist 0151 430 1589 Dr Kelly Consultant Histopathologist 0151 430 1824 Paul Madigan Nurse Consultant Gastroenterology 0151 430 1599 Laura Evans Oncology Dietician 0151 430 1381 Kathy McDermott Chest Physiotherapist Bleep 1188 Barbara Ashall Upper GI Nurse Specialist 0151 290 4143 Bleep 2600 Peter Smith MDT Co-ordinator 0151 430 1061 Dr Littlewood Consultant in Palliative Care Medicine 0151 430 1347 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A+E Department Lilac Centre 0151 430 1687 In-patient Advice Ward D3 0151 430 1440 Ward G5 – if chemotherapy related Non-urgent Barbara Ashall CNS Answer Phone service 0151 290 4143 Produced by Cancer Services - Version Four (April 2007) - 35 -
  36. 36. ENDOSCOPY SESSIONS Dr Francis Monday am Miss Chagla Alternate Monday p.m. Paul Madigan Tuesday/Thursday p.m. Mr Khan Alternate Wednesday p.m. Mr Kanwar Alternate Monday a.m. and every Friday a.m Mr Memon Alternate Wednesday p.m. Dr Turner OUTPATIENT CLINICS Consultant Clinic Day Site Ms Chagla UGI/GEN Alternate Monday am Whiston Mr Li General Monday am St Helens Mr Li UGI/Gen Tuesday pm Whiston Mr Khan UGI/Gen Wednesday am Whiston Mr Khan General Friday pm St Helens Dr Francis Gastro Tues/Thurs pm Whiston 2 week rule Rapid Access Friday pm Whiston Multidisciplinary Team Meeting held every Thursday 08.30 Venue: X-Ray Seminar Room Produced by Cancer Services - Version Four (April 2007) - 36 -
  37. 37. 4.9 CANCER SERVICE – Urology Multidisciplinary Team Members Role Contact Details Monday to Friday 9-5 Mr Massey Lead Consultant Urologist 0151 430 1976 Mr Gana Consultant Urologist 0151 430 1907 Mr Khattak Consultant Urologist 0151 430 1907 Dr Marshall Medical Oncologist 0151 430 1910 Dr Malik Clinical Oncologist Clatterbridge Centre for Oncolgy 0151 334 4000 Dr Meek Lead Radiologist 0151 426 1600 Ex 2492 Dr M. Pinto Lead Histopathologist 0151 430 1731 Sue Charles Nurse Specialist 0151 430 1076 Nancy Chisholm Nurse Specialist 0151 430 1898 Nerys Williams Nurse Specialist 0151 430 1076 Julie Keith MDT Co-ordinator 0151 430 1061 Extended Multidisciplinary Team Role Contact Details Monday to Friday 9-5 Claire Littlewood Consultant in Palliative Care 0151 430 1058 Dennis McComas Senior Nurse Specialist 0151 430 1898 Lorna Evans Dietitian 0151 430 1201 Mary McBirnie Urology Sister 0151 426 1600 Ex 2528 Ann Caton Urology Sister 0151 426 1600 Ex 2528 Carolyn Swash Stoma Nurse 0151 430 1221 Dr Clark Clinical Oncologist (testes patients + bladder patients who required chemotherapy treatment only) Shirlie Deveney Assistant Counselling Manager 0151 430 1687 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP/NHS Direct. If urgent local A&E Department. In-patient Advice A1 Ward / D1 Ward or Via Urology Surgical On Call Team. Non-urgent Advice A1 Ward / D1 Ward Monday – Friday 9 am – 4pm Urology Nurse Specialist Answer Phone Service. Produced by Cancer Services - Version Four (April 2007) - 37 -
  38. 38. OUTPATIENT CLINICS Consultant Clinic Type Day Site Mr Massey Urology Tuesday pm Whiston Hospital Mr Massey Urology Thursday pm St Helens Hospital Mr Gana Urology Wednesday am St Helens Hospital Mr Gana Urology Friday am Whiston Hospital Mr Gana Urology 1st Wednesday pm Newton Hosptial Mr Khattak Urology Monday AM Whiston Hospital Mr Khattak Urology Thursday PM Whiston Hospital Nursing Team Rapid Access Haematuria Clinic Monday am & Alternate Thursday pm A1 Ward Nursing Team Prostate Assessment Clinics Monday pm Wednesday am & Alternate Thursday pm A1 Ward Mr Gana Flexible Cystoscopy Lists Thursday am A1 Ward Mr Massey Flexible Cystoscopy Friday am A1 Ward Dennis McComas Flexible Cystoscopy Tuesday am A1 Ward Dennis McComas Flexible Cystoscopy Wednesday pm A1 Ward Sue Charles Stable Prostate Cancer Clinics Monday pm St Helens Hospital Sue Charles Stable Prostate Cancer Clinics Thursday am Whiston Hospital Sue Charles Chemotherapy Intravesical Immunotherapy Friday pm On the district Multidisciplinary Team Meeting held weekly on a Monday at 11.45 – 12.15 Venue: X-Ray Seminar Room Produced by Cancer Services - Version Four (April 2007) - 38 -
  39. 39. 5. PALLIATIVE CARE 5.1 PALLIATIVE CARE - Hospital Specialist Palliative Care Team Team Members Role Contact Details Monday to Friday 9-5 Dr C Littlewood Consultant in Palliative Medicine 0151 430 1347 Dr J Wiseman Consultant in Palliative Medicine 0151 430 1347 S.P.R. (Rotational every 12 months) Dr Jenny Smith Mrs Jan Leatherbarrow Team Leader, Specialist Palliative Care CNS 0151 430 1347 Robert Case Specialist Palliative Care CNS 0151 430 1274 Mrs Collette Murray Specialist Palliative Care CNS 0151 430 1953 Ms Debbie Maddox Specialist Palliative Care CNS 0151 430 1274 Miss Claire Johnston CNS – Heart Failure/ FCP Facilitator 0151 430 1274 Mr Andrew Dickman Pharmacist Pager: 07654661703 Or 0151 430 1274 Mrs Jackie Bruce P.A. to Dr Littlewood 0151 430 1058 Mrs Josie Dold Team Secretary 0151 430 1274 Mrs Denise Delaney Team Secretary 0151 430 1274 Mrs Simone Taylor Data Entry Clerk/ Admin Assistant 0151 430 1274 OUT OF HOURS CONTACT INFORMATION Out-patient Advice Via GP or Community Nurse In-patient Advice Via Willowbrook Hospice Nurse in Charge 0151 430 8736. Non-urgent Advice Answer Phone Service. Multidisciplinary Team Meeting held weekly, every Wednesday, at 14.00 Venue: Palliative Care Office The Hospital Specialist Palliative Care Service adopts the concept of shared care with other health professionals, aiming to ensure a quality of service and improved quality of life for patients within St Helens & Knowsley Hospitals. The service is aimed at patients with specialist needs relating to life limiting disease and is based on need and not diagnosis. The service provides: Produced by Cancer Services - Version Four (April 2007) - 39 -
  40. 40. Specialist support from diagnosis for the patient and family, psychologically, spiritually and socially. Advice on pain and symptom control for patients, relatives and staff. Liaison between hospital and hospice and regular contact with the Specialist Palliative Care Community Nursing Team is maintained. Education is provided both formally and informally, and is available to hospital staff. Support and advice for staff, in their difficult and sometimes complex role of caring for patients with advanced disease. Referrals Referrals to the Specialist Palliative Care Team should be made with: The full agreement of the patient. The full knowledge of the doctor and nurse undertaking the patients care and management. Referral forms can be found in Web Communities under Specialist Groups ‘Specialist Palliative Care http://nww.sthkhealth.nhs.uk/palliative_care. Fax referral 0151 430 1925, or contact direct. A Secretary/answer phone will take messages until a Team member is available to return your call. Produced by Cancer Services - Version Four (April 2007) - 40 -
  41. 41. PROTOCOL - How do I use the Referral Form? This 2-sided protocol is to enable Specialist Palliative Care (SPC) Teams within St Helens & Knowsley to standardise and unify practice with respect to (SPC) patient referrals. This protocol was designed and developed collaboratively by the St Helens & Knowsley Integrated Care Network. The aim of the (SPC) referral form is to enhance and develop the exchange of patient referral information across Hospital, Community and Hospice settings. Please note the revised (SPC) referral forma replaces all previous referral forms as at 5th April 2004. To this end please note the following points as well as the ‘Reasons for Referral’ table on side-2, as they apply within each of the (SPC) referral form headings: Patient Details: • Please provide at least one of the following as they relate to your SPC team NHS number, Hospital ID and Hospice ID • At the D.O.B (Date of Birth) please complete as follows: 2 digits to represent day of month; 2 digits to represent month and 4 digits to represent year of birth. e.g If Patient born on the 12 June 1967 this would be 12 06 1967.Plaese note this convention is applicable to all date data-fields within the (SPC) referral form. • Please provide were possible Ethnicity/Religion – if this is unavailable insert NA at appropriate data-field Carer Details: • Within the ‘Is the Patient Living Alone’ data-field please tick  at the appropriate box. (N = No, Y = Yes and NK = Not Known). Involved Professional Details: Community Contact: • Within the PCT data-field please tick  at the appropriate PCT. • Within the ‘DN’ (District Nurse) data-field please insert the name of the DN involved with the patient. This will aid communication between SPC & Community professionals. History of illness: • Within ‘Disease Stage’ please tick  at the appropriate box • Within ‘Disease Management’ please tick  at the appropriate box • Within ‘Is Patient Aware of Referral’ please tick  at the appropriate box Details of Understanding and Medication: • Please use free-text were appropriate. Produced by Cancer Services - Version Four (April 2007) - 41 - Page 1
  42. 42. Reasons for referral: • Please note the guidance at the top of this section and complete as appropriate. • Within the ‘Where is Patient Presently?’ data-field please tick as appropriate Except at Hospital (Ward) – please insert hospital name and ward as appropriate. Service Required: • Tick  as appropriate for the (SPC) required • Tick as appropriate which patient service is required at Willowbrook Hospice Referrer Details: • Please state your designation i.e. Consultant, Community Nurse Specialist, Hospital Doctor etc... • Your signature shall confirm approval of patient’s GP or Consultant. If (SPC) Referral is More Urgent: • Please contact relevant service by telephone Produced by Cancer Services - Version Four (April 2007) - 42 - Page 2
  43. 43. Reason for Referral Role of the Health Care Team with Advice and Support from Specialist Palliative Care Team as needed Criteria for Direct Patient Contact by Specialist Palliative Care Team in conjunction with Ward Team Pain Control Assessment, investigation, diagnosis. Initiate treatment according to Trust formulary. World Health Organisation pain ladder. Monitor and document effect of treatment (at least daily) Uncontrolled/escalating pain Any Other Symptoms Assessment, investigations, diagnosis. Initiate treatment, evaluate and document outcome (at least daily) Incomplete symptom control. Unacceptable side effects. Complex multiple problems. Psychological Support for Patient +/- Family Basic psychological support. Review and document outcome. Complex psychological and spiritual support. Patient Dying Identify the patient is dying. Assess and address symptom, psychological and spiritual distress. Use of Care Pathway for the Dying Patient. Specialist support to achieve symptom control, psychological and spiritual support. Information/ Communication Provide information about diagnosis and current condition, patient/family needs. Up-date as necessary. Document discussions. Difficult communication issues. i.e. denial, collusion, complex family dynamics. Discharge/ Placement Discharge planning to commence at time of admission as per Hospital Policy. Facilitate rapid discharge to enable patient to die at home. Initiate Hospice Transfer. (Adapted from Referral Criteria RLUH Palliative Care Team, March 2002) Produced by Cancer Services - Version Four (April 2007) - 43 - Reasons for Referral Table
  44. 44. ACCESS TO PALLIATIVE CARE OUT-PATIENT CLINICS WHEN & WHERE? MONDAY WEDNESDAY THURSDAY FRIDAY Held at: WILLOWBRO OK HOSPICE (p.m.) WHISTON (p.m.) COPD – Monthly (commencing 19.04.04) WILLOWBROOK HOSPICE (p.m.) Community linked NEWTON COTTAGE (alternate Wednesdays) WHISTON (a.m.) Stephenson House Brandreth Suite Parallel clinic to Dr. E. Marshall Oncology/Lung Cancer WHISTON (a.m.) Stephenson House Brandreth Suite Parallel clinic to Dr. A. Flavin Oncology/Breast Cancer Dr C.M. Littlewood Dr. J. Wiseman Dr. C.M. Littlewood Dr. C.M. Littlewood HOW TO REFER?  Referrals for WHISTON clinics - by formal letter to Dr C.M Littlewood, c/o Palliative Care Team, Whiston Hospital Tel: 0151-430-1058 Jackie Bruce, P.A/Supervisor Fax: 0151-430-1925 General Office  Referrals for HOSPICE clinics – by formal letter. Referrals will be put into next available clinic with Dr. C.M. Littlewood or D. J. Wiseman. Tel: 0151-430-8736 Paula Younger, Medical Co-ordinator Fax: 0151-493-1006 General Office NOTE: Patients initially attending Whiston clinics may be linked into Hospice services, as felt appropriate. Produced by Cancer Services - Version Four (April 2007) - 44 - Draft Version 2.0 - Page 1 SPC Referral Form March 2004
  45. 45. Referral for Specialist Palliative Care Services Patient Details Carer Details NHS Number: Name of Carer: Hospital ID: Hospice ID: Relationship to Patient: Title: Forename(s): Carer Tel: Gender: Surname: Is Patient Living Alone? Y N Address: Involved Professional Community Contact PCT: GP Name: GP Surgery: GP Tel: Postcode: DN Name: Tel: Hospital Contact Details Age: D.O.B Hospital Consultant: Ethnicity: Religion: Hospital Dept: History of Illness (Please include Diagnosis. Secondary Site – Relevant Treatment) Diagnosis: Date of Diagnosis: Spread/Complications: Disease Stage EARLY ADVANCED Disease mang’t CURATIVE NON- CURATIVE Current Treatments: Past Treatment: Is Patient Aware of Referral: Y N Details of Understanding for Patient/Carer Patients Understanding of Diagnosis: Carers Understanding of Diagnosis: Current Medication Previous Medication (State Reaction/Poor response) 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. 6. 6. 7. 7. 8. 8. 9. 9. 10. 10. Produced by Cancer Services - Version Four (April 2007) - 45 -
  46. 46. Referral for Specialist Palliative Care Services 2 NHS Number Hospital ID Hospice ID Reason(s) for Referral Please state the main problems that have led to the request for SPC assessment. Include relevant information on physical symptoms (including mobility), carer’s needs, psycho-social/spiritual issues and different ethical needs as appropriate: ……………………………………………………………………………………………………….. ………………………………………………………………………………………………………. ………………………………………………………………………………………………………. ………………………………………………………………………………………………………. ………………………………………………………………………………………………………. Where is Patient Presently? Home Hospital (Ward) N/Home R/Home Service Required ( Please FAX referral to appropriate number) Hospital Palliative Care Team Fax (0151) 430 1925 Referral to MEDICAL OUT- PATIENT CLINIC FORMAL LETTER ONLY TO: Dr Littlewood Consultant in Palliative Care Medicine, Whiston Hospital Prescot L35 5DR Tel: 0151 430 1274 Referral to MEDICAL OUT- PATIENT CLINIC FORMAL LETTER ONLY TO: Dr Wiseman Consultant in Palliative Care Medicine Willowbrook Hospice Prescot L34 2QT Tel: 0151 430 8736 Community Palliative Care Team Fax (0151) 289 8776 Willowbrook Hospice Fax (0151) 493 1006 If you think this Referral requires ‘OUT-OF HOURS’ Service – Please see details below Referrer Details Print Name Designation: Date of Referral Signature: Referrer Tel No: (Signature Confirms Approval of Patient’s GP or Consultant). If More Urgent: 9.00 am – 5.00 pm Monday to Friday WILLOWBROOK Office Use Only: DATE REFERRAL Received …………….. DATE of INTIAL CONTACT ……………….. DATE of INTIAL ASSESSMENT …………… DATE of ACCEPTANCE ……………………. TO BE COMPLTED ON ORGINAL FORM ACCEPTED REFUSED on OTHER GROUNDS (e.g. too unwell) CANCELLED (e.g. died) Date ………….. Signature ………………….. Hospital Palliative Care Team: Tel: 0151 430 1274 Community Palliative Care Team: Tel: 0151 431 0156 OUT-OF-HOURS SERVICE Willowbrook Hospice Tel: 0151 430 8736 All referral will be reviewed within 24-48 HOURS Produced by Cancer Services - Version Four (April 2007) - 46 -
  47. 47. 5.2 PALLIATIVE CARE - Willowbrook Hospice Willowbrook Hospice Portico Lane Prescot Merseyside L34 2QT Telephone: 0151 430 8736 Fax: 0151 493 1006 Willowbrook Hospice is an independent charitable organisation providing specialist palliative care services for the adult population of St Helens and Knowsley Boroughs. Willowbrook Hospice aim to enhance the quality of life, and relieve the suffering of patients with cancer, and other life threatening illness, by providing quality Specialist Palliative Care for those in need, and support for their carers. We are a NO smoking hospice. Specialist Palliative Care In-Patient Service Currently we have nine In-Patient beds. There is no restriction on visiting times and families are encouraged to take an active part in the care of their loved ones if they wish. Staff at the Hospice are always available to offer advice and support whenever it is needed. Referral Criteria • For patients with advanced, progressive, incurable, malignant and non- malignant disease who have complex physical, psychological, spiritual, and social or carer needs. • Where the above patient and / or family needs are unable to be met by health professionals in the current care setting and may be met by a specialist palliative care service. • Where the current health professionals require the support and advice of the specialist palliative care service. Discharge Procedure Preparation for the discharge of our patients begins on their admission. Willowbrook Hospice is for short periods of treatment only. Patient care is reviewed regularly and future care planned as necessary. Services provided include: - In-patient care 9 beds for assessments, symptom control, rehabilitation and terminal care. Outreach Services Day therapy providing up to 10 places on a given day and time. Services offered include: • Key worker system - each patient is allocated a key worker to ensure consistency of care. Produced by Cancer Services - Version Four (April 2007) - 47 -
  48. 48. • Complementary Therapies:  Aromatherapy / Massage / Guided Visionary / Reiki / Reflexology  Relaxation therapy  Physiotherapy / Exercise Programmes /Breathlessness Groups / Anxiety Management  Group activity  Craft classes  Bereavement support  Medical review The Day Therapy Team consists of: Team Leader – responsible for Complementary and Creative Therapies Sister Staff Nurse Senior Physiotherapist Therapy Assistant Chaplaincy Team Out patient Service Patients who require initial or follow up appointments can be seen within the out patient facilities at Willowbrook Hospice. Medical Clinics are held at the Hospice weekly, in addition to medical clinics at Whiston Hospital and Newton Community Hospital. Request for appointments are received from Hospital Consultants, General Practitioners or Nurse Specialists via a letter or referral form. Physiotherapy and complementary therapy may be accessed via the outpatient service. Also referrals are accepted from any member of the multi-professional team. Individual or family visits can be arranged to offer a consultation with a doctor. Carers Support Service – Family Support Co-ordinator A Carers’ Support Service is offered at Willowbrook Hospice, as part of our Philosophy of Care. The service aims to provide personal advice, comfort, empathy and support to patients’ carers and relatives including: • Offering comfort and support to carer's and relatives of patients attending the Hospice in the anticipatory and post bereavement stages. • Trying to ensure the current physical, psychological, social and spiritual needs are met in order to minimise any future harmful effects on health. • Facilitating expressions of grief and discuss the grieving process. • Advising on available resources and provide practical help when needed. • Aiding recovery and assist in resolution. Produced by Cancer Services - Version Four (April 2007) - 48 -
  49. 49. Education Education is a major part of our work. Willowbrook Hospice aims to offer co- ordinated, multi-professional educational programmes, to all members of staff providing Palliative and Specialist Palliative care within Knowsley and St Helens. The Hospice is committed to supporting education and training. Services available include: • Raising awareness of the role of Willowbrook Hospice and Hospice services. • Involvement within, local organisations, societies, clubs and other groups in the local community. • Clinical placements for medical under-graduates, student nurses’, other staff undertaking specialist courses, and overseas visitors, as appropriate. • A resource centre on specialist palliative care for multi-professional staff and carers. • Providing speakers to inform, educate local organisation – societies, clubs, schools and other community organisations. • Committed to the on going development of staff in-house training. Referral The Hospice accepts referrals from the patients’ General Practitioner, Hospital Consultant, or any member of the multi-professional team. In no case will contact be made with the patient without the express prior permission of the patient’s General Practitioner nor without the patient being aware of their diagnosis and that Hospice involvement has been requested. Referrals should be made on the Hospice Referral Form by letter or fully completed single assessment documentation. Produced by Cancer Services - Version Four (April 2007) - 49 -
  50. 50. Medical Team Team Members Role Dr Jenny Wiseman Consultant in Palliative Medicine Dr Anthony Thompson Assistant Medical Director Clinical Team Mrs Chris Haywood Head of Clinical Services Mrs Margaret McConaghy Team Leader for In-Patient Services Lucy Scriven Team Leader for Outreach Services Chief Executive Neil Wright Produced by Cancer Services - Version Four (April 2007) - 50 -
  51. 51. 5.3 PALLIATIVE CARE - Macmillan Clinical Nurse Specialist Palliative Care - Community Community Clinical Nurse Specialists Palliative Care Willowbrook Hospice Portico Lane Prescot Merseyside L34 1QT Telephone: 0151 431 0156 Fax: 0151 289 8776 The service compliments those services provided by the Primary Health Care Team and other providers/agencies. A key principle is that the specialist nurse seeks to work with these other teams/professionals equipping them with the required skills and knowledge. Referral Criteria The Community Macmillan Clinical Nurse Specialists (CNS) within Knowsley PCT and St Helens PCT operate an open referral system. Anyone may refer themselves, or someone else for assessment. Any patient with a malignant disease or life-limiting condition will be accepted to the service. Referrals will be with the full knowledge of the doctor and the nurse-in-charge of the team undertaking the patient’s care and management. The Macmillan CNS will assist the District Nurse Team Leader in assessing the needs of patients and relatives. The Macmillan CNS will not take over care but act as a specialist resource. Patients requiring nursing care should be referred directly to the District Nurse. Not all patients with malignant disease or life-limiting conditions will require intervention from a Macmillan CNS. Referrals should be made with the patient’s agreement and for: Patients who have problematic pain or other symptoms. Patients or their relatives requiring informed support at time of diagnosis/recurrence. Relatives or carers requiring support over and above what Primary Carers provide, and where there are complex needs. Staff requiring support in order to continue caring effectively for the above patient group. Bereavement problems in families known to the Macmillan Service. Referrals can be made by: Completing a referral form Telephone, if urgent, followed by a completed referral form. Contact from the Macmillan CNS, and frequency of visits, will be determined by the Macmillan CNS on an individual basis. Produced by Cancer Services - Version Four (April 2007) - 51 -
  52. 52. Team Members Role Dr Jenny Wiseman Consultant in Palliative Medicine Gillian Harthen Clinical Nurse Specialist Team Leader Amanda Watson Macmillan CNS Helen Mack Macmillan CNS Geoff Prince Macmillan CNS Julie Parr Macmillan CNS Zoe Keating Macmillan CNS Maggie Cooke Macmillan CNS Out of hours service Willowbrook Hospice Tel 0151 430 0156 MDT Meeting Clinical Meeting every Monday 9.30 am at Willowbrook Hospice Produced by Cancer Services - Version Four (April 2007) - 52 -
  53. 53. 5.4 PALLIATIVE CARE – St Helens Integrated Palliative Home Based Project Integrated Palliative Home Care Team The St Helens PCT and Integrated Palliative Home-Based Project aims to enhance it’s home-based services to those with life threatening conditions. The project will compliment existing health and social care input to enable patients, carers and families to continue with their everyday lives during this time. Referral to this service can be made by any Health Care Profession, patient/carer as long as the patient has been assessed by a District Nurse or Senior Hospital Staff. As care and support is provided according to the needs of the patient and carer, referrals should whenever possible be pre planned so that the service can respond quickly to an urgent situation. Aims of the service. To enable terminally ill patients to be cared for and die at home, where that is their identified wish. To provide nursing care which is supplementary to the existing District Nursing Service. To offer a combination of psychological and practical support to the patient and family. To support the patients with palliative needs from hospital or hospice. To provide support during times of crisis for patient or carer and to prevent unnecessary admission to hospital or hospice. To increase the overall provision of home based Palliative Care. To increase the availability of care for longer periods of the day. To extend community palliative care services to people with cancer and other life threatening conditions. Produced by Cancer Services - Version Four (April 2007) - 53 -
  54. 54. Criteria for Accessing the Integrated Palliative Home Care Team The patient must be listed on the Palliative Care Register or have a life expectancy of six months or less [DS1500]. This service is available to any patient who is in the terminal stage of their illness [registered with a St Helens GP], and aims to increase the availability of care for longer periods of the day and night. To access 24 hour round the clock care patients need to be commenced on an Integrated Care Pathway. All patients who are referred and are living at home must have been assessed by the District Nursing Service. All patients must be aged eighteen and over. All patients in hospital who are referred must have been assessed by the ward manager or DN Liaison. The DN Service must be made aware of any referrals of patients being discharged with any of the services. All patients referred to the service must be referred with the full knowledge of the GP These services are here to enhance the District Nursing Services and not to replace them. They will give families added support and security in difficult times. It is very important that families are aware that these services are available to allow patients to choose where they wish to spend their final days. Please try to plan ahead and refer to the service as soon as you have identified the need. Produced by Cancer Services - Version Four (April 2007) - 54 -
  55. 55. 5.5 PALLIATIVE CARE - Integrated Palliative Home Care Team – Henrietta Project Any Health Care Professional Patient/Carer can make referral to this service as long as a District Nurse or Senior Hospital Staff has assessed the patient As care and support is provided accordingly to the needs of the patient and carer, referrals should whenever possible be pre planned so that the service can respond quickly to an urgent situation Aims of the service  To enable terminally ill patients to be cared for or die at home, where that is their identified wish  To provide nursing care which is supplementary to the existing District Nursing Service  To offer a combination of psychological and practical support to the patient and family  To support the patients with palliative needs from hospital or hospice  To provide support during times of crisis for patient and carer and to prevent unnecessary admission to hospital or hospice  To increase the overall provision of home based Palliative Care  To increase availability of care for longer periods of the day  To extend community palliative services to people with cancer or other life threatening conditions Criteria for Assessing the Integrated Home Care Team Produced by Cancer Services - Version Four (April 2007) - 55 -
  56. 56.  The patient must be listed on the Palliative Care Register or have a life expectancy of six months or less (DS 1500)  This service is available to any patient who is in the terminal stage of their illness (Registered with a Knowsley GP) and aims to increase availability of care for longer periods of the day  The District Nursing Service must have assessed all patients who are referred and are living at home  The patients must be aged eighteen and over  The Ward Manager or DN Liaison must have assessed all patients in hospital who are referred. The DN Service must be made aware of any referrals of patients being discharged with any of the services  All patients referred to the service must be referred with the full knowledge of the GP These services are here to enhance the District Nursing Service and not to replace them. They will give families added support and security in difficult times It is very important that families are aware that these services are available to allow patients to choose where they wish to spend their final days Please try to plan ahead and refer to the service as soon as you have identified the need Produced by Cancer Services - Version Four (April 2007) - 56 -
  57. 57. 6.0 EXTENDED SERVICES 6.1 EXTENDED SERVICES - Hospital Based Pain Team Medical Team Members Role Contact Details Monday to Friday 9-17 Dr Konstantin Levshankov Consultant Anaesthetist 0151 430 1455 Dr Mike Forsyth Staff Grade Anaesthetist Mrs Mary Doolan Theatre/Chronic Pain Nurse Mrs Eileen O’Neil Theatre/Chronic Pain Nurse Mrs Anne Roberts Secretary 0151 430 1455 OUT OF HOURS-CONTACT INFORMATION Outpatient advice 0151 430 1455 (answer machine) Inpatient advice 0151 430 1455 (answer machine) Anaesthetist on call via switchboard for urgent advice OUTPATIENT CLINICS Consultant Clinic Type Day Site Dr K Levshankov Multidisciplinary Spinal Clinic Monday pm Whiston Dr K Levshankov Multidisciplinary Spinal Clinic Tuesday pm St Helens Dr K Levshankov Theatre session (invasive procedures/TENS/a cupuncture) Thursday am Whiston Dr K Levshankov Dr M Forsyth Outpatient Pain Clinic Thursday pm Whiston Dr K Levshankov Pain Management Programme Friday am Whiston Produced by Cancer Services - Version Four (April 2007) - 57 -
  58. 58. Description of the service: Chronic Pain Clinic works in collaboration with Hospital Palliative Care team to provide a range of services aimed at alleviating pain, enhancing the quality of life and functioning of the patients with chronic pain. We aim at improving pain control and addressing pain-modifying issues in the multidisciplinary context. We offer: • Initial assessment of pain and pain related issues in the context of its multifactorial and multidimensional nature. • Assessment and modification of the treatment regime according to individual needs. • Formulation of the pain management approach based on specific needs of the patient in collaboration with Hospital Palliative Care team. • Non pharmacological interventions – transcutaneous electrical nerve stimulation, acupuncture. • Interventional therapies – neuromodulation, specific neuroablative procedures, systemic and regional drug infusions, somatic and autonomic blocks. • Reassessment of the patient’s progress at appropriate and regular intervals and modification of the treatment regime according to individual response. • Education of the patient and those involved in the care of the patient. Produced by Cancer Services - Version Four (April 2007) - 58 -
  59. 59. 6.2 EXTENDED SERVICES - Chaplain/Pastoral Care Spiritual Care Services The Spiritual Care Team is made up of whole time and part time chaplains representing the different Christian denominations; we also have a Secretary and a large group of carefully selected and trained volunteers. We are here to make provision for the spiritual and religious needs of patients, relatives, and staff of all faiths and none. We are available at all times of the day and night, either through the department (0151 430 1657) or, in emergency and out of hours, by calling the switchboard and asking for the on call chaplain. If you need to contact a religious leader of a non-Christian faith for yourself or a patient in your care we can give details of names and telephone numbers. We can also liase with local churches. Services are held at St Helens and in the Chapel at Whiston at Christmas and Easter and to mark particular events. Our regular services at Whiston Chapel are as follows: Every Sunday there is a Mass at 11 am and Holy Communion at 2 pm On Wednesdays 1.30 – 2 pm Exposition and Quiet Prayer Every Friday staff of the Islamic faith, meet in the Chapel at lunchtime to pray. The Chapel at Whiston is open at all times for prayer or reflection. The Prayer Room at St Helens can also be made available by request. NB For more information please refer to our Patient Information Leaflet and our Staff Support leaflet. We also have a Spiritual Care page on the Intranet. How to Contact the Chaplains: - The Spiritual Care Department at Whiston is our main base and Ann Wright, Spiritual Care Secretary, works in the Office on weekday mornings. Our Direct Line is (0151) 430 1657, this can be used for all routine calls. Alternatively please use the bleeps or long range pagers via switchboard. Produced by Cancer Services - Version Four (April 2007) - 59 -
  60. 60. Chaplaincy Team Denomination Contact details Sister Susan Molloy Roman Catholic Whiston Hospital Site Bleep 0042 Sister Eileen O’Riordan (Part-time) Roman Catholic St Helens & Peasley Cross Sites Bleep via switchboard Revd. Jayne Shepherd Head of Department Church of England All sites – Bleep 0041 Revd. Jamie Hartwell Free Church All sites – Bleep 0041 Contact details for other Faiths & Special Needs Jehovah’s Witness 0151 430 3296 Church of Jesus Christ Latter Day Saints (Mormon) 01744 811077 Unitarian 0151 263 4899 Jewish Othodox Reformed Progressive Lay Visitor 0151 722 2079 0151 722 5438 0151 733 5871 0151 722 1810 Islam/Moslim/Muslim 0151 709 2560 Hindu/Sikh 0151 263 7965 Ba’hai 0151 733 8614 Buddist 0151 727 0108 Seventh Day Adventist 0151 226 4385 Produced by Cancer Services - Version Four (April 2007) - 60 -
  61. 61. 6.3 EXTENDED SERVICES - Department Of Nutrition and Dietetics REFERRAL PROCEDURE If a patient meets the following criteria, please complete a Dietetic referral request form in full. REFERRALS: A doctor or registered nurse (D grade or above) must sign all referrals. PATIENTS WILL NOT BE SEEN IF A REFERRAL REQUEST FORM IS NOT COMPLETED & SIGNED. NUTRITION RISK SCORE MUST BE CALCULATED AND DOCUMENTED ON THE REFERRAL REQUEST FORM. Phone the Dietetic Department on Ext 1201 or 1474 to inform your ward Dietitian that you have a referral. Indicate reason for referral. A referral request form must still be completed, which will be collected when the Dietitian attends the ward. Alternatively the form can be faxed to the Dietetic Department on 1461. The Dietitian aims to see referrals for Enteral and Parenteral Nutrition within one working day (applicable Whiston only). The Dietitian aims to see all other referrals within 2 working days of receiving the referral (applicable Whiston only). Refer as early as possible. Patients referred on day of discharge will NOT be seen as an inpatient. Referrals received after 12.00 noon on Fridays may not be seen until the following Monday. Produced by Cancer Services - Version Four (April 2007) - 61 -
  62. 62. DEPARTMENT OF NUTRITION AND DIETETICS REFERRAL CRITERIA PATIENTS WHO WILL BE SEEN AS AN IN-PATIENT: Nutritional risk score High (> 10). Nutritional risk score Moderate (5-9) after review. Patients requiring Parenteral Nutrition (PN). Patients requiring Enteral Nutrition i.e. nasogastric (NG), nasojejunal (NJ), Percutaneous Endoscopic Gastrostomy (PEG), jejunostomy (JEJ) feeding. N.B. Starter feeding regimen available on all wards. Diabetes if: Newly diagnosed New to insulin therapy Poor appetite, weight loss or REGULAR hypos. If patients do not fit one of the categories stated above, give the diet sheet ‘Food and Diabetes’. All newly diagnosed individuals should also be given this booklet to give them basic information until they see the Dietitian. Ulcerative Colitis All newly diagnosed. Patients with previously diagnosed Ulcerative Colitis experiencing weight loss and diarrhoea. Crohn’s Disease All newly diagnosed. Patients with previously diagnosed Crohn’s disease experiencing weight loss and diarrhoea. Coeliac Disease All newly diagnosed. N.B. Gluten free diet available from Catering. Gluten free bread and biscuits available from Pharmacy. Dysphagic patients with a poor oral intake. Patients presenting with cancer cachexia. Oesophagogastrectomy / oesophageal stent. Colostomy / Ileostomy Refer if indicated by nutritional risk score. Produced by Cancer Services - Version Four (April 2007) - 62 -

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