Lymphoedema Specialist Services

A Message from Lord Pickles and Lord Blunkett, followed by Lymphoedema Specialist Services's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Lymphoedema Specialist Services is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett, MP
Pickles signature Rt Hon The Lord Eric Pickles, MP

www.lymphoedemaspecialist.

THE PARLIAMENTARY REVIEW
Highlighting best practice
36 | LYMPHOEDEMA SPECIALIST SERVICES
Director and Lymphoedema
Consultant Nurse Practitioner
Jane Board
Empowering patients to
effectively self-manage
through clinical excellence
Lymphoedema Specialist Services Ltd deliver specialist
treatment to adults with all types of lymphoedema and
chronic oedema. Founded in 2011, they are owned and
managed by Jane Board, who has over 23 years’ experience
in the provision of lymphoedema care that includes the
development of seven lymphoedema services in southeast
England. Jane explains that their process has helped speed
up the delivery of vital equipment used for the treatment of
lymphoedema and discusses their plans moving forward.
Lymphoedema is a chronic form of oedema, or swelling, occurring in any part
of the body because of a failure of the lymphatic system to drain lymph fluid
from the tissues. In the UK there are at least 240,000 sufferers of lymphoedema.
Causes of the condition include cancer and the effects of treatment, cellulitis
(infection) and genetic malformations. The condition cannot be cured, ensuring
treatment is required for life. The core components of treatment include multi-
layer bandaging, compression garments, manual lymphatic drainage and care of
the skin.
Our key objective is to provide a model of care for the initial prevention and
prompt access to treatment for lymphoedema sufferers residing in East Sussex.
In 2012, we became one of the first independent healthcare providers to gain
and hold a CQC licence in the UK. We were then directly approached and
subsequently commissioned by the NHS to provide a lymphoedema service in
EastSussex.
FACTS ABOUT
LYMPHOEDEMA SPECIALIST
SERVICES
»Director and Lymphoedema
Consultant Nurse Practitioner:
Jane Board
»Founded in 2011
»Based in Eastbourne,
EastSussex
»No. of employees: 2
»Services: Deliver specialist
treatment to adults for all
types of lymphoedema and
chronic oedema
»www.lymphoedemaspecialist.
co.uk
Lymphoedema
Specialist Services
37LYMPHOEDEMA SPECIALIST SERVICES |
BEST PRACTICE REPRESENTATIVE 2019
Patient-centred care
Putting the patient first continues
to underpin our working practice. A
holistic approach to patients and their
clinical treatment needs is integrated
with their personal preference.
Strategies surrounding symptom
control are key in the educating of
patients to self-manage lymphoedema
as a chronic condition, with the aim
of improving quality of life. Results of
consecutive annual patient satisfaction
questionnaires continue to provide
evidence of the effectiveness of our
approach.
In January 2018, all of the 76 out
of 103 patients who responded to
a survey reported that they were
treated with respect and dignity.
Ninety-three per cent also reported
that the treatment they received was
controlling their lymphoedema and
improving their quality of life. Key
performance data collected every
month since 2012 demonstrates our
commitment to seeing every patient
promptly following their referral, and
shows a 100 per cent achievement in
assessing the 1,847 patients referred to
us in fulfilment of our NHS contractual
waiting response times.
Enabling prompt access to
treatment
In line with best practice guidelines,
our policy is to instigate treatment
promptly for each patient to control
and reduce symptoms quickly.
Treatment often includes the
measurement and fitting of hosiery;
however, in February 2014, two
years after the commencement of
an NHS contract, it became evident
that patients were experiencing
delays in receiving hosiery through
the conventional prescription route of
ordering items from GPs. In August
2014, 150 patients were audited
surrounding the process, with 83 per
cent of the 112 who returned the
questionnaire reporting issues with
obtaining hosiery. Sixty-seven per
cent cited the prescription route as
adequate, hard or very hard because
it involved multiple organisations,
with documentation surrounding the
request getting lost, or the wrong
item being received. Forty-six per cent
reported their non-receipt of hosiery
after a period of two weeks or more.
With the support of a compression
hosiery company, we initiated an
alternative process, with the aim
of increasing the speed of hosiery
obtainment and the removal of the
issues faced by patients. The process
enabled the direct purchase and
delivery of hosiery to each patient’s
home, with financial reconciliation
every three months with the NHS. A
post-process audit undertaken two
years later found only two per cent of
the same patients reporting their non-
receipt of hosiery within a two-week
period or more, and with 90 per cent
reporting a stress-free experience.
A lymphoedema affecting
both legs and feet
Putting the
patient first
continues to
underpin our
working
practice
“
“
THE PARLIAMENTARY REVIEW
Highlighting best practice
38 | LYMPHOEDEMA SPECIALIST SERVICES
Supported by NHS commissioners,
my colleague and I continue with the
process and the recommendation
of practice to other lymphoedema
services. My colleague and I were
finalists in the category of innovative
practice at the Health Service Journal
award, in November 2017, and have
further disseminated the information
to lymphoedema services in the UK
through publication in the
Journal of
Lymphoedema
in May 2018.
Reducing the administrative
burden
Since our commencement, we have
been challenged with the undertaking
of administration and balancing
the work with patients’ treatment.
The challenge could not be resolved
with the recruitment of clerical staff.
Instead, we have worked with an IT
company to produce a patient data
management system, specifically
designed for us. Theautomatic
retrieval of data and patient
appointment timetabling has not only
increased our efficiencies but has also
saved approximately seven hours of
administration each month.
Future direction
Over the years, the increasing
number of referrals, along with the
associated need for patients to receive
treatment, has made it very difficult
for my colleague and I to practise
in a proactive way. Consequently,
education and teaching surrounding
lymphoedema prevention for patients
and healthcare professionals – one
of our key objectives – has needed to
be curtailed because of the need to
prioritise patients’ treatment.
In acknowledgement of current
health policy, the need for the
implementation of strategies to
prevent lymphoedema has resulted
in a change in the focus of our
practice. The completion of our
NHS contract has released time
to implement procedures such as
Bioimpedance Spectroscopy (BIS)
Technology. BIS technology detects
small changes in fluid in the tissues
before swelling (lymphoedema) is
visualised. Consequently, surveillance
through data analysis enables the
early detection of lymphoedema in
patients who are at risk of developing
the condition. Early treatment
intervention reduces and resolves
the oedema. Education of patients
in self- management techniques
to minimise lymphoedema, further
reduces the risk of worsening
swelling, cellulitis and impaired
function and mobility. This model
of care is also anticipated to be cost
effective because of the reduction in
the extent of lymphoedema treatment
required by patients, and the
subsequent burden on overstretched
lymphoedemaservices.
Bioimpedance
Spectroscopy
(BIS)
technology
detects small
changes in fluid
before swelling
in the tissues
(lymphoedema)
is visualised
“
“
A lymphoedematous leg
supported with hosiery

The Parliamentary Review Publication, in which this article originally appeared, contained the following foreword from the prime minister.

The Rt Hon Theresa May MP's Foreword For The Parliamentary Review

By The Rt Hon Theresa May MP

British politics provides ample material for analysis in the pages of The Parliamentary Review. For Her Majesty’s Government, our task in the year ahead is clear: to achieve the best Brexit deal for Britain and to carry on our work to build a more prosperous and united country – one that truly works for everyone. 

The right Brexit deal will not be sufficient on its own to secure a more prosperous future for Britain. We also need to ensure that our economy is ready for what tomorrow will bring. Our Modern Industrial Strategy is our plan to do that. It means Government stepping up to secure the foundations of our productivity: providing an education system that delivers the skills our economy needs, improving school standards and transforming technical education; delivering infrastructure for growth; ensuring people have the homes they need in the places they want to live. It is all about taking action for the long-term that will pay dividends in the future.

But it also goes beyond that. Government, the private sector and academia working together as strategic partners achieve far more than we could separately. That is why we have set an ambitious goal of lifting UK public and private research and development investment to 2.4 per cent of GDP by 2027. It is why we are developing four Grand Challenges, the big drivers of social and economic change in the world today: harnessing artificial intelligence and the data revolution; leading in changes to the future of mobility; meeting the challenges of our ageing society; and driving ahead the revolution in clean growth. By focusing our efforts on making the most of these areas of enormous potential, we can develop new exports, grow new industries and create more good jobs in every part of our country.

Years of hard work and sacrifice from the British people have got our deficit down by over three quarters. We are building on this success by taking a balanced approach to public spending. We are continuing to deal with our debts, so that our economy can remain strong and we can protect people’s jobs, and at the same time we are investing in vital public services, like our NHS. We have set out plans to increase NHS funding annually by an average by 3.4 percent in real terms: that is £394 million a week more. In return, the NHS will produce a ten-year plan, led by doctors and nurses, to eliminate waste and improve patient care.

I believe that Britain can look to the future with confidence. We are leaving the EU and setting a new course for prosperity as a global trading nation. We have a Modern Industrial Strategy that is strengthening the foundations of our economy and helping us to seize the opportunities of the future. We are investing in the public services we all rely on and helping them to grow and improve. Building on our country’s great strengths – our world-class universities and researchers, our excellent services sector, our cutting edge manufacturers, our vibrant creative industries, our dedicated public servants – we can look towards a new decade that is ripe with possibility. The government I lead is doing all it can to make that brighter future a reality for everyone in our country. 

British politics provides ample material for analysis in the pages of The Parliamentary Review 
The Rt Hon Theresa May MP
Prime Minister