We highlight examples of best practice from health settings around the UK

Good Practices

Cleft Lip and/or Palate Care at Addenbrooke’s Hospital, Cambridge

When a baby is diagnosed with a cleft condition there will be an immediate referral to the Cleft Team. The specialist team at Addenbrooke’s take referrals from a wide region, across six counties in East Anglia. All members of this multi-disciplinary team have a shared responsibility to recognise and respond to psycho-social needs of patients and parents from day one right the way through the child’s development up to the age of 20.

Anxieties or fears about hospital procedures are common and it is the job of the clinical psychologist to support children and young people when the Cleft Team asks for help. Advice for parents and behavioural assessment and therapy for children can be invaluable. Talking things through, including help with decision making about plastic or oral surgery in late adolescence or adulthood, and thinking about solutions really helps, individually or in groups. The psychologist also assesses other aspects of the child’s psycho-social wellbeing in education settings, public places and making friends.

General plastic surgery at the Royal Free Hospital, London

The plastic and reconstructive surgery department is concerned with the diagnosis and treatment of skin cancers, the management of trauma, burns surgery and specialised cosmetic procedures and is frequently involved in patients’ care when a multi-disciplinary approach is essential.

The department, for example, plays a role in the skin cancer multi-disciplinary team which naturally includes a clinical psychologist, together with dermatology, radiology, oncology, nuclear medicine and radiotherapy team members, providing an excellent, highly integrated service that fully meets the psycho-social needs of patients. In elective plastic surgery too, psychologists are first-line in assessing the patient’s needs and wishes, and ensuring that appropriate surgical and/or psycho-social interventions are chosen.

Sussex Cancer Centre, Brighton

This Cancer Centre’s multi-disciplinary team has not included psychological therapists but frequently refers patients to health professionals outside the team. The psycho-social needs are recognised and responded to as a matter of course by all members of the team, in particular by the clinical nurse specialist. It is the awareness that psycho-social support is best given from the point of diagnosis, which guarantees a high quality holistic service.

Patients are often referred to the Department of Psychological Therapy at the Queen Victoria Hospital. East Grinstead, West Sussex where, at assessment, an individualised treatment plan is developed. A range of treatment options is available especially for people with disfigurements, including body image focused CBT, social interaction skills training, and psychological therapy to process thoughts and feelings about diagnosis. The support is also extended to relatives and carers to enable them to optimise the support they can provide to the person receiving the treatment.

Outlook, Frenchay Hospital, North Bristol NHS Trust

Outlook is an NHS psychological support service, originally funded by Changing Faces and later converted into a statutory service, for anyone affected by a disfigurement or visible difference from any cause. Outlook offers support and help for people of all ages who are coming to terms with a different or unusual appearance or a disfigurement. It is a confidential service for children, adolescents and adults who experience emotional or psychological problems linked to their disfigurement or visible difference. It also provides information, support and training to health professionals.

St. Johns Hospital, London’s Institute of Dermatology

Dr. David Fenton, consultant dermatologist at St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospital in London, is an advocate of psycho-social support as a standard part of the care offered to patients as a routine adjunct to regular investigations, diagnosis and treatments. He fully acknowledges the positive difference it can make to patients with emotional needs and he has therefore initiated training for all members of the team: to raise awareness, to establish a smooth referral system and to increase disfigurement confidence amongst patients and staff.

Setting National Standards for Burn Care

The care of burn-injured patients in England and Wales has been subjected to a major review since 2003 under the auspices of the National Burn Care Group (NBCG) – see www.nbcg.nhs.uk.  Changing Faces has been much involved in the whole process with a particular focus on the development of improved psycho-social services. In December 2008, the NBCG approved a set of new Standards of Psycho-social Care and Rehabilitation which are to be applied across all the burn care networks covering all aspects of care including the training of staff at all levels and the provision of appropriate psycho-social support throughout the patient’s journey, from day one for many years.