SMASAC Short Life Working Group on Lymphoedema - Lymphoedema Care in Scotland, Achieving Equity and Quality

A Scottish Medical and Scientific Advisory Committee Report. Providing information on the nature and extent of Lymphoedema. Making recommendations for Scottish Government Health and Social Care Directorate, Health Boards, NHS Education Scotland and Healthcare Improvement Scotland


Appendix 2: Additional Epidemiological Data

Table 1 below shows Scottish hospital data for admissions with lymphoedema as the main diagnosis in calendar years 2002-2010.

Table 1. The number of hospital episodes for lymphoedema by NHS Health Board and Scotland level, calendar year 2002 - 2010

2002 2003 2004 2005 2006 2007 2008 2009 2010
SCOTLAND 498 487 484 621 625 633 633 598 690
NHS Ayrshire & Arran 56 47 45 36 68 52 54 57 68
NHS Borders 8 11 19 19 24 11 11 8 9
NHS Dumfries & Galloway 17 16 19 12 28 12 15 23 38
NHS Fife 50 36 40 55 32 38 80 82 87
NHS Forth Valley 45 21 26 14 13 20 9 24 20
NHS Grampian 59 71 47 33 58 58 80 38 82
NHS Greater Glasgow & Clyde 102 114 101 143 138 121 99 128 112
NHS Highland 38 49 46 51 39 67 59 42 35
NHS Lanarkshire 27 33 37 134 113 90 68 46 73
NHS Lothian 59 68 49 64 79 91 106 77 90
NHS Orkney Islands 2 0 27 28 16 49 30 49 54
NHS Shetland Islands 3 1 5 0 1 0 1 2 0
NHS Tayside 31 16 21 22 13 19 19 20 22
NHS Western Isles 1 4 2 10 3 5 2 2 0

Source: SMR01 (ISD Scotland) discharges from non-obstetric/non-psychiatric NHS hospitals in Scotland.

ICD10 codes for lymphoedema: I89.0, I97.2, Q82.0 in any diagnosis position.

The average length of stay was 8.59 days per person (range 1-287).The admission numbers recorded are considered an underestimate as poor diagnostic coding and poor awareness of the condition may omit many patients from these figures. The current cost per in-patient bed day is calculated at £491. Using this figure an estimate of costs in 2010/11 (1,436 bed days in total) can be calculated at a minimum of £705,076.

Table 2 below demonstrates variation in specialist staffing levels by health board. Some Health Boards provide services only for people with cancer related lymphoedema, whilst others provide a full service for all types of lymphoedema. Clinics range from lone part-time practitioners to small multidisciplinary teams and are based within palliative care centres, cancer clinics, physiotherapy departments, hospital and community based clinics. Referral pathways to services differ between Health Boards as do assessment processes and the co-ordination of treatment pathways.

Table 2. Specialist Lymphoedema Practitioners by Health Board Area

2012 Staff Levels 2012 WTE 2008 WTE ***
NHS Ayrshire and Arran** 1 0.5 0.8
NHS Borders Nil return Nil return Nil
NHS Dumfries and Galloway 1 0.5 0.6
NHS Fife 2 2 0.6
NHS Forth Valley* 2 1.3 0.7
NHS Greater Glasgow and Clyde 5 4.43 3.3
NHS Grampian 4 1.8 1.9
NHS Highland 3 0.4 1.7
NHS Lanarkshire 3 1.4 0.6
NHS Lothian 10 3.43 0.2
NHS Tayside 2 1.35 1.4
NHS Western Isles 3 ns 0.5
Total WTE 17.11 12.3

* Figures supplied for Strathcarron Hospice, Denny.

** In addition, there are two non-funded ad-hoc services identified at Ayr Hospital and Ayr Central Hospital.

*** Obtained from analysis undertaken by Sneddon et al, 2008.

Contact

Email: Diane Dempster

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