A 13-year-old boy with neurofibromatosis type 1 presented to the emergency department twice in a fortnight with moderate intermittent abdominal pain, radiating to the back and associated with nausea and vomiting. He examined as a well child with a soft abdomen and minimal tenderness. A history of constipation was identified but he failed to respond to a trial of laxatives. Subsequent ultrasound abdomen demonstrated a large mass surrounding the porta hepatis. MRI further characterised a focal, non-aggressive lesion extending from his liver, encapsulating his pancreas, portal vessels and laterally displacing his spleen and left kidney. Biopsy performed at a specialist cancer treatment hospital of our reference later confirmed this to be a benign neurofibroma of a size not previously reported in the literature. He will be managed conservatively with surveillance imaging and the potential for chemotherapy should the lesion continue to grow.

Aims In August 2005 the National Institute for Health and Clinical Excellence (NICE) produced a guidance document, Improving outcomes in children and young people with cancer. In our area it was suggested that there should only be one Level 1 POSCU due to the population size. Having only one Unit would have meant that some children would have needed to travel to receive the service. It was therefore decided to have one POSCU operating on two sites. This paper describes the service model and how this was achieved. Method It was agreed: To operate as one team caring for the children on both sites. That the community team should be located on the acute hospital sites. To deliver a family-centred service. To have one Multi-disciplinary Team (MDT) meeting attended by the staff on both sites. To have clear MDT documentation and copies of the records in both the hospital and the community records. To have an information leaflet so that families knew and could easily identify the members of the team. To carry out Patients Satisfaction Survey. Results The service was started in August 2009 and was internally validated by the Trust in July 2010. Compliance was 97.8% (44/45) confirming that a safe and effective service was being delivered on both sites with a single MDT. As part of the National Cancer Peer Review Programme the service was reviewed in November 2011. This confirmed that the service model was appropriate, the approach to palliative care, the family centred policies, the MDT documentation, and the record keeping were excellent. A patient satisfaction survey has shown that communication between the community team and other POSCU members is excellent. Conclusion The model of having one POSCU operating on two Sites is workable and is compliant with NICE Guidance. This model delivers a safe effective service close to patient's homes and could be used for the management of other long-term conditions.