Introduction
Oral suctioning removes saliva and pooled secretions from the mouth using a Yankauer catheter attached to a portable suction machine. It is used when a person cannot clear secretions due to impaired swallowing, neuromuscular weakness or excessive saliva production. Conditions where this is common include MND, Parkinson’s disease, head and neck cancer and people approaching end of life.
Across Greater Manchester, oral suctioning in the community has developed differently in each locality. Some areas have established pathways, others manage requests on a case‑by‑case basis. This variation has created delays in accessing equipment, uncertainty over who should assess and train carers and inconsistent standards of care. There is no GM‑wide commissioned service and no national guidance to support a standard approach. These gaps highlighted the need for coordinated regional work.
About the Project
The issue was first identified through GM neurology pathway work, particularly MND, where delays in providing suction machines and unclear responsibilities affected discharge and community support. Community neurorehabilitation and palliative care teams reported similar problems.
The GM network reviewed the issue and agreed that shared guidance would help reduce variation while still allowing for local flexibility. The network led a piece of project work to understand current practice, gather examples, identify gaps and begin drafting a consistent GM approach.
Project milestones included:
- Regional scoping to map current practice across GM.
- Engagement with community teams, specialist services and equipment providers.
- Identification of inconsistent pathways, training models and equipment processes.
- Consultation with GM neurology and neurorehabilitation consultants to define a medical pathway where none previously existed.
- Development of the GM Oral Suctioning in the Community Guidance document.
- Compilation of supporting resources for a GM toolkit.
Progress to Date
We now have a clearer picture of how oral suctioning is delivered in GM and where improvements are needed. The project has gathered examples of local SOPs, training materials, risk assessment tools, equipment information and service specifications. These have been brought together to support teams developing their own SOPs.
The GM SOP Guidance
A key output is the GM Oral Suctioning in the Community SOP Guidance.
This is not a single GM‑wide SOP, because localities have different staffing models, budgets and equipment pathways. Instead, the guidance outlines the core components that every locality should include when building their own SOP.
The guidance covers:
- Scope of practice
- Medical pathway
- Identification and assessment
- Roles and responsibilities
- Clinical process for oral suctioning
- Equipment and consumables
- Training and competency
- Escalation arrangements, including out of hours
- Financial and procurement responsibilities
Localities can use this guidance as a framework, adapting it to suit their workforce, commissioning arrangements and service structure.
The guidance is intended to support a consistent standard of care across GM while still allowing services to design a pathway that is realistic for their area.
Resource Toolkit (Webpages)
Resource Toolkit (Documents)
Oldham Oral Suctioning in the Community Pathway Documents