One Voice: A Domiciliary Service for People After Laryngectomy

The Speech and Language Therapy (SLT) department at North East London NHS Foundation Trust (NELFT) offers specialist laryngectomy rehabilitation in North East London. This region is diverse with areas of high social deprivation. The service includes care of the permanent neck stoma & management of surgically placed voice prostheses.

Historically, clinics were offered at a local acute hospital. In March 2020, outpatient clinics were closed. Initially, another hospital provided emergency support, however this was unsustainable and some patients, concerned about travelling and covid exposure, declined appointments. Waiting times rose to 83 days, increasing the risk of avoidable medical complications.

An alternative, innovative model of community-based provision was introduced to reduce waiting times, limit covid exposure, and re-establish local care, whilst maintaining patient safety. We present our outcomes from this project, including environmental and financial benefits.

Conclusions

- Delivery of a domiciliary service to people after laryngectomy is feasible, safe, popular and more accessible that hospital-based care.

- We believe that this fully fledged domiciliary model is the first of its kind for people following laryngectomy.

- Domiciliary models of care can deliver environmental and financial efficiencies, whilst reducing the burden of care experienced by patients and their loved ones

- We will continue to develop the service through our co-design project and will monitor other sustainability factors, e.g. use of supplies/equipment