Making a referral

To make a referral, you can either download a referral form or alternatively you can complete a referral form online.  If you choose to complete the referral form online, this should take approximately 10 minutes to complete but please note, progress cannot be saved.  Following completion of the form, you will receive an e mail requesting an e signature agreeing to Demelza’s Confidentiality, Data Protection & Consent Statement, please therefore read this document carefully before signing.

Make an online referral Download our referral form

Who can use our services?

Demelza’s services are available for children and young people, aged 0-18, with serious or life-limiting conditions (see below for definitions). There is no definitive list of conditions or illnesses which may or may not meet the criteria, the following information outlines Demelza’s eligibility criteria:

  • Live in the Demelza catchment area of Kent & Medway, East Sussex and South London, specifically the boroughs of Bexley, Bromley, Lewisham, Lambeth, Southwark, Greenwich and Croydon
  • Have written consent for a referral from a person with parental responsibility

Categories

Category One - Serious or life-limiting conditions for which curative treatment may fail e.g. cancer, irreversible organ failure

Category Two - Conditions where premature death is anticipated but intensive treatment may prolong life e.g. complicated cystic fibrosis, Duchenne muscular dystrophy 

Category Three - Progressive conditions without curative treatment options where treatment is exclusively palliative e.g. Battens disease, mucopolysaccharidoses

Category Four - Conditions causing severe neurological disability leading to susceptibility of health complications and likelihood of premature death e.g. severe cerebral palsy, multiple disabilities following brain or spinal cord injury

Category Four further assessment

Demelza aims to be there for serious or life-limited babies, children, young people and their families within our region, as and when they need us. With this in mind, it may be necessary to complete a short, further assessment for those referred with conditions defined under Category Four, to establish that they meet the criteria.

Emergency referrals

If there is an identified need for immediate or short notice support from Demelza, please contact the local Lead Nurse by telephone first. This will enable key information to be gathered and support a prompt assessment and admission, should we be able to assist. Such referrals may relate to end of life care, bereavement suite use, symptom management or crisis intervention.

In Kent and Medway - Lead Nurse: 01795 845200
In South East London - Lead Nurse: 0208 859 9800
In East Sussex - Lead Nurse: 01323 446474