• Patients with a life threatening illness who have complex physical, psychosocial and/or spiritual needs requiring specialist intervention.
• Relatives or carers of the above patient who have related complex needs themselves and require additional specialist support, preferably with the knowledge of the patient.
• The person being referred is in agreement with the referral.
• The GP is aware of the referral of the patient.

Professionals who require specialist information, support and advice may access Dorothy House independently.

• The Medical Team are available to give advice about any palliative care problems.
• Patients referred for medical consultation can be seen at Dorothy House, at home, nursing home or hospital. Also, patients can be seen as out-patients at the RUH, Chippenham and Paulton Hospitals.
  

• Specialist assessment and treatment of complex symptoms
• Psychological support
• Planned or acute respite
• Readjustment/adaptation to the effects of disease progression, particularly following transfer from an acute hospital setting
• Terminal care, where death is expected within a week
  

• See patients in their own homes, community hospitals and residential/nursing homes.
• Work alongside GPs and District Nurses who remain the patient's primary carers.
• Provide continuing liaison with hospital based professionals, as appropriate.
• Offer advice, information and support to professionals whether or not there is direct contact with the patient.
• Provide on-going visits to patients with specialist palliative care needs.

• To relieve isolation brought on by illness and its associated problems.
• When the carer requires respite because they are in constant attendance.
• For emotional and spiritual support including confidence building and empowerment.
• Where it is possible to transport the patient by volunteer-driven vehicles or disabled taxi.
  

• Breathlessness - non-pharmacological interventions
• Anxiety - relaxation techniques
• Pain - including TENS, TSE
• Mobility and functional activities
• Patient handling
• Patients can be seen at Dorothy House, at home, nursing home or hospital.

• Patients with lymphoedema related to cancer or its treatment.
• Patients should be referred as soon as possible after diagnosis of lymphoedema.
• Both the RUH and Dorothy House accept referrals for complex lymphoedema.
• Offer advice, information and support to professionals whether or not there is direct contact with the patient.
• Palliative care patients are seen initially by a CNS then referred to the local service if their lymphoedema is mild to moderate.
• If patients have mild-moderate lymphoedema, a Key Worker will see them at a local clinic. Patients with more complex needs will come to Dorothy House for clinic appointments.
• Domiciliary visits are made when necessary.
  

• Available within the Dorothy House catchment area.
• For patients who have expressed a wish to remain at home to die (supported by family/carers).
• 1 or 2 nights respite per week if expected prognosis less than 3 months.
• If there is complex need, additional nursing care within the last 4 weeks.
• Up to 24 hour care for patients at a stage in their terminal illness where death is expected within 14 days.
• Flexibility to meet short term emergency cover if unable to be met by another agency.
  

• The Social Worker is available to assess with patients and their carers any practical and emotional needs on the In-patient Assessment Unit, in Day Care and, where appropriate, in the community.
• When appropriate, the Social Worker will refer to, and link closely with, statutory and voluntary services.

• The Chaplain is available to explore spiritual needs with patients and families, particularly if they come into the Assessment Unit or to Day Care.
• The Chaplain will link closely with local clergy as appropriate.
  

• The Children's and Young People's Social Worker supports children and young people up to the age of 18 years old, offering direct support to individuals and families, as well as guidance and advice to other professionals.
• Referrals can be made by members of the Multi-professional Team at Dorothy House, professionals in the community or self-referrals from families known to the hospice.
  

• Creative and diversional therapy is provided for patients in Day Care and the In-patient Assessment Unit.
• Complementary therapies, ie reflexology and aromatherapy, are available for all our patients. Referrals are made through our Complementary Therapy Co-ordinator. When appropriate, carers can be offered complementary therapy.
  

• The Bereavement Service seeks to offer emotional and psychological support to help the bereaved adjust to life without the deceased.
• If Dorothy House has been involved with a patient, bereaved relatives and carers can access a range of services as and when those services are both appropriate and available.
• Referrals can come from professionals, family and friends, or from the bereaved client themselves.
• Bereavement support offered through the service will be contracted with the client(s), and where possible, a planned ending to the work negotiated.

• The initial objectives at time of referral have been achieved.
• There is no longer a need for specialist intervention.
• The person originally referred has declined any further specialist input.
• The GP is aware of the discharge.
  

Winsley, Bradford on Avon, Wiltshire, BA15 2LE | Tel: 01225 722988 | Registered Charity Number 275745