• Microsurgical free flap reconstruction should be the primary reconstructive option for most defects of the head and neck that need tissue transfer. (R)

• Free flaps should be offered as first choice of reconstruction for all patients needing circumferential pharyngoesophageal reconstruction. (R)

• Free flap reconstruction should be offered for patients with class III or higher defects of the maxilla. (R)

• Composite free tissue transfer should be offered as first choice to all patients needing mandibular reconstruction. (R)

• Patients undergoing salvage total laryngectomy should be offered vascularised flap reconstruction to reduce pharyngocutaneous fistula rates. (R)

• Palliative and supportive care must be multidisciplinary. (G)

• All core team members should have training in advanced communication skills. (G)

• Palliative surgery should be considered in selected cases. (R)

• Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R)

• All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G)

• Pain relief should be based on the World Health Organization pain ladder. (R)

• Specialist pain management service involvement should be considered early for those with refractory pain. (G)

• Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G)

• Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G)

• Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R)

• Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R)

• ‘Do not attempt cardiopulmonary resuscitation’ orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G)

• Patients should be followed up to a minimum of five years with a prolonged follow-up for selected patients. (G)

• Patients should be followed up at least two monthly in the first two years and three to six monthly in the subsequent years. (G)

• Patients should be seen in dedicated multidisciplinary head and neck oncology clinics. (G)

• Patients should be followed up by dedicated multidisciplinary clinical teams. (G)

• The multidisciplinary follow-up team should include clinical nurse specialists, speech and language therapists, dietitians and other allied health professionals in the role of key workers. (G)

• Clinical assessment should include adequate clinical examination including fibre-optic rigid or flexible nasopharyngolaryngoscopy. (R)

• Magnetic resonance imaging and positron emission tomography combined with computed tomography imaging should be used when recurrence is suspected. (R)

• Narrow band imaging can be used in the follow-up in selected sites. (R)

• Second primary tumours should be part of rationale of follow-up and therefore adequate screening strategies should be used to detect them. (G)

• Patients should be educated with regard to the appearance and detection of recurrences. (G)

• Patients with persistent pain should be investigated to exclude recurrent disease. (R)

• Patients should be offered support with tobacco and alcohol cessation services. (R)

• All cancer patients should meet a clinical nurse specialist at the point of diagnosis. (R)

• Clinical nurse specialists must act as gate keeper to the patients' cancer pathway to provide a seamless journey. (R)

• Holistic needs assessment should be completed at different stages of the patient's pathway to reflect the changes of the patients' needs. (R)

• Clinical nurse specialists to be part of local and national initiatives for health promotion and raising awareness in the public domain. (G)

• Clinical nurse specialists should lead in redesigning of services and policies to ensure they are responsive to patient's needs for the future. (G)

• Treatment summaries should become part of practice to provide good communication between primary and secondary care to enable continuity of care for the patient. (G)

• Trainees applying for head and neck surgical oncology consultant posts should have completed additional training in the subspecialty.