Enabling patients with learning disabilities to self-manage lower limb lymphoedema

I was employed to develop a lymphoedema service for lower limb primary and secondary non-cancer-related lymphoedema for patients in North Manchester aged 16 years and over in May 2018. This was initially a 2-year pilot that was initiated following a business case made by community nursing, after a huge gap had been identified in service provision for patients with non-cancer-related lymphoedema. The service has now been permanently commissioned.

Those familiar with the demographics of the area will be aware that it has high levels of social deprivation, unemployment and long-term mental and physical health conditions. Therefore, the service had to be developed to be as equitable and accessible as possible, which needed to include seeing patients with wounds, peripheral arterial disease, morbid obesity and those who had been deemed non-concordant with previous attempts at managing their lower limb lymphoedema.

Regular reviews of the caseload were undertaken as the service developed over the pilot period, and it became apparent that 25–30% of patients being referred had either a diagnosed learning disability (LD) or were educationally challenged. Improving access and care outcomes for people with LD is high on the NHS agenda and we needed to ensure that patients with LD and those who were deemed educationally challenged could access services and receive individualised care appropriate to their needs.