1. Planning for care outside the hospital Jean Buchanan, community liaison sister, Weston Park Hospital

2. NICE clinical guideline 75 (2008) Discharge planning and ongoing care, including rehabilitation for patients with MSCC, should start on admission…….It should involve the patient and their families and carers…….

3. Holistic assessment takes time diagnosis of spinal cord compression is a life changing event. “With a one year survival rate of less than 20%,the majority of patients with MSCC must manage both disability and the implications of life limiting illness” Eva G. Paley J, Miller M, Wee B; Palliative Medicine 2009: 23 “Patient’s constructions of disability in metastatic spinal cord compression” It may be the presenting symptom of cancer. Balancing patient’s need for time to adjust to their situation against pressure on inpatient beds.

4. ?????????????? Will I walk again? Will I be able to go home? What happens if I can’t?

5. What options are available on discharge? Transfer back to local hospital Admission to a specialist rehabilitation unit for people who are most likely to benefit (NICE clinical guideline 75) Hospice Nursing home Return home

6. What support may be available at home? Informal carers Social services home care, equipment & adaptations Health services Community & palliative care nurses, night care, “hospice at home”, nursing equipment, home care Third (voluntary) sector services Charities e.g Macmillan, welfare rights advice, day care Services differ between areas –postcode lottery?

7. Will I have to pay for my care? Patients should be assessed against continuing healthcare criteria Depending on level of need either social services, health service or a joint package however The WPH spinal cord compression audit indicates that patients with little or no mobility post treatment are likely to have a poor prognosis and should therefore meet the continuing health care fast track criterion: “A primary health need arising from a rapidly deteriorating condition which may be entering a terminal phase, with an increasing level of dependency” this should help meet the NICE guidelines that “care and equipment is provided in a timely fashion”

8. In conclusion “good communication with the patient cannot happen unless it exists between all members of the MDT” Purdue C. (2004) Nursing Times 21/09/04 “Diagnosis and treatment of malignant spinal cord compression”