1. Passing the Baton: Patient Perspective Jillian Pemberton Specialist Oncology Physiotherapist and Hospital Discharge Co-ordinator Velindre Cancer Centre June 2008

2. Content Flow chart of ideal discharge from VCC Case study Impact of individual DToC on other patients

3. Patient flow: Admission to Discharge Medical Plan Admission (EDD established ) Assessment of current status undertaken (UA) Baseline assessment from MDT as to previous performance status ↓ ↓

4. Eligibility meeting Case Conference Funding application sent to LHB if appropriate Inform relevant practitioners with EDD ↓ ↓ ↓

5. Case Study 1 - History Patient with high grade brain tumour admitted due to severe reaction to chemotherapy treatment in Dec 07. 50 year old woman married with husband (suffered from chronic respiratory condition) 2 children and young grandchildren. Home 20 miles from Velindre Cancer Centre

6. Case Study 1 Medical assessment showed disease progression. Palliative RT given over 6wk period Patient and family’s wishes were to go home on completion of treatment. MDT assessments indicated increased level of care at home due to the patient’s deterioration from pre- admission status.

7. Case Study 1 Eligibility meeting held and discharge plan set at case conference. UA form sent to complex care team at LHB for request of continuing Healthcare Funding – criteria agreed between health and social care Forms sent back and returned twice! MDT recognised lack of training but had to wait 6 wks for advice from senior nurse from LHB.

8. Case Study 1 2 nd case conference held resulted in interim plan for pt to be transferred to community hospital nearer to home. Pt waited several wks for available bed. Funding resubmitted and refused. Pt and family extremely distressed, frustrated and planned to take pt home against clinical advice.

9. Sought emergency care to accommodate pt wishes. Pt and family accepted that this option was not sustainable. Family and Pt complained to LHB and Local Authority Accommodation found within 1wk by LA and LHB Case Study 1

10. Case Study 1- Conclusion Dec 07 Patient given aprox 6month prognosis Patient remains in hospital, funding is still not agreed following recent panel Patient and families wishes not met.

11. Impact on patients requiring specialist oncology treatment Due to significant DToC patients are waiting for oncological interventions. E.g. spinal cord compression pts treated as outpatients either from home or other hospital resulting in potentially irreversible reduction in level of function and quality of life.