Ali Batchelor (pictured third from the left), Lead of the Lymphoedema Team at St Margaret's describes her day and the difference she thinks St Margaret’s Hospice Care makes…
What is your role within the hospice?
I lead the Lymphoedema service which is the only fully commissioned service within the hospice. This means we are fully funded by the NHS although we do fundraise for additional equipment we need. We are commissioned to see patients who have a diagnosis of cancer but are in remission, and also people have a non-cancer diagnosis of Lymphoedema or Chronic Oedema, as well as those at high risk of developing lymphoedema. For our service it is not just life-limiting diagnosis.
We have two sites, one in Yeovil and one in Taunton, which are both outpatient clinics and we also have satellite clinics in several community hospitals across Somerset. We treat patients for Chronic Oedema in any part of the body. It is basically a drainage problem where fluid which should go back into the circulation remains in the tissues, causing swelling in the affected part of the body.
Our aim is to reduce the swelling and we do that by promoting good skincare, good exercise and encouraging a good weight management programme and healthy eating as well as using compression garments. We aim to improve people’s mobility, wellbeing, and overall quality of life.
We also run a surveillance programme to identify patients who are at high risk of Lymphoedema and monitor them for two years so we can jump in quickly and treat them before it progresses further. It is amazing the difference you can make to a person’s quality of life if their Lymphoedema is caught early and if they are really committed to self-management. It can make a massive difference.
Can you describe an average day?
There’s no normal day in the Lymphoedema office! Outpatient appointments usually start at around 8.30am. New patients come in and we do a thorough assessment including a medical history, physical assessment, and a social and psychological assessment. We liaise with district nurses, GPs, and nurse specialists at the hospital as well as consultants and physiotherapists. It’s very much a multi-disciplinary team way of working.
We spend a lot of time talking to our patients, which we are all very good at(!) as well as listening to patients and reassuring them. You get to know the patients so you can identify which patients are going to go with what you’re trying to do. Some of them will run with the changes you are suggesting whereas others can be less confident in what to do next. We do more of a step-by-step process with these patients so we might start slowly by introducing changes to their skincare regime and then we will pass them onto our assistant practitioners to make sure they are managing.
Our equipment must be shared between all the lymphoedema therapists so our days have to be planned quite carefully. We all help each other and that’s the beauty of having a combined clinic. If you’ve got a problem, you can just run it by someone else which is also really helpful.
How has the coronavirus pandemic affected the way you work?
In our job you do need to see people face to face and restrictions to this has made it very difficult. During the first lockdown was especially challenging as everything was so new and the change in the way we worked meant we were only able to see a small number of our patients. In the second and third lockdowns it has been much better as we have used technology a lot more to keep in touch and have been able to continue face-to-face appointments when we have needed to for treatment, bandaging or laser treatment.
We do more telephone and video referrals now for patients who are well established in their treatment plan and we get to know the patients who manage with this form of contact. We also do some initial referrals via video call as it can be easier to gather the relevant information and plan who is the best person to see them.
The group who have been affected the most is our surveillance group for our high risk patients because we are monitoring the development of oedema that is not visible to the naked eye. Not being able to catch these oedemas early has meant we are now seeing more people with established oedema, however it has proved the effectiveness of our early detection service.
What difference do you and your team make in the hospice?
We are good at coordinating care. A lot of our patients sort of flit between district nurses, consultants, dieticians, vascular and tissue viability, sometimes it’s not as joined up as we would like, and I like to think we improve this by our coordination.
As well as success of treatment in reducing limb volume and improving mobility I think a lot of it is the psychological support we give to people. People we see can feel isolated, have low self-esteem, and have poor body image. We all work hard to listen to concerns, not just the physical ones and improve our patient’s quality of life. One of our main aims is also to reduce rates of cellulitis, which is one of the side effects of lymphoedema.
What do you love about your job?
I’ve been at the hospice for 20 years and I like two aspects of my job (I like everything but these two spring to mind!). I enjoy being with patients and I like the care that the patients get at the hospice because you know that they are going to get the best possible care. Every single part of the hospice delivers the best possible care because the staff give their all and put their patients first.
I also love the difference we can make to patients. In this job we see our patients for years, some of them have been with this service for more than 20 years so you really get to know them and their families and I enjoy that continuity. When some of them move on some of them stay in contact which is really nice.
I’ve never worked anywhere like St Margaret’s Hospice. Everyone supports each other, it’s a happy place where everyone has a good sense of humour. Everybody is treated with respect and is considered and valued. I always feel that in my team everyone is treated as an equal and I think that is one of the most important things about the hospice. It’s just a lovely place to work and it’s got great atmosphere and patients have a good feeling when they come here.