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London and South East EnglandSpecialised Burns Project
Stakeholder engagement event20th July 2011
The Hilton Hotel, Gatwick
South East Coast Specialised Commissioning Group
South East Coast Specialised Commissioning Group
London and South East EnglandSpecialised Burns Project
Welcome and introductions
Robert Creighton
Senior Responsible Officer, London and South East England Specialised Burns Project
Former Chief Executive, Ealing, Hillingdon and Hounslow PCTs
Transitional Director, London Public Health
Introduction
• This work is led by the London Specialised Commissioning Group on behalf of the Specialised Commissioning Groups in London and South East England.
• The project is being delivered by London Health Programmes.
• The project’s purpose is to: – establish and sustain high quality burn services, delivering best
practice and meeting all appropriate national standards of care.– deliver equitable access for the population in London and South
East England.– use the available financial resources effectively and efficiently.
The outcome of the review of specialised burns services is intended toensure the sustainable and optimal delivery across London and South East England.
Stakeholders
This event is intended to provide key stakeholders with:• An overview and update on the project’s work to date.
• The opportunity to provide feedback and comment on the case for change.
• The opportunity to contribute to the development of the model of care.
The audience:Invitations to attend today’s stakeholder event were sent a wide range ofNHS organisations, patient groups and charities in London and South EastEngland including:
• All Acute Hospital Trusts• Ambulance services• Royal Colleges (Paediatrics and Child Health, Nursing, Anaesthetists)• Providers of specialised burn services• SHAs and SCGs.
Objectives of the day
• Provide feedback and comments on the draft case for change.
• Contribute to the development of a model of care for specialised burn services in London and South East England.
London and South East EnglandSpecialised Burns Project
The patient perspective
Henrietta Spalding
Patient and Public engagement lead, London and South East England Specialised Burns Project
Head of Policy and Practice, Changing Faces
Why engage with patients?
• Patient engagement forms an integral part of this case for change.
• It is important to ensure that the patient voice is represented when considering how services could be improved.
• It is not possible to identify how services can be improved without seeking input from those with direct experience.
Patient engagement activity to date
The project has sought the views of patients and their families / carers ontheir experiences of specialised burns services, in a variety of waysincluding:
• Two dedicated patient stakeholder events – one in London and one in Aylesbury.
• Facilitated workshops at stakeholder events.
• One to one focussed interviews led by Changing Faces.
All of the feedback received has been used to inform the development ofthe case for change.
Key themes arising from patient feedback
Feedback received at each event was generally consistent with a number of key themes: • The importance of equitable clinical care.
• Support for, and the role of, carers and family members.
• The importance of psychological support.
• The importance of communication and information.
• The importance of relationships with staff.
• The challenges of transition of care from child to adult services.
• Referrals, accessibility and system gaps.
• Variable discharge and availability of aftercare.
What did patients say?
“The options available were excellent… I was
consulted on [the] different types of
painkillers available”
These are some extracts from patients, commenting on their experiencesof specialised burn services in London and South East England
“Aftercare is a bit hit and miss” and “[there is] a “big gulf between hospital and home.”
“Carers [and patients] have to be assertive to get the help they need.”
“Going onto the adult’s ward was like ‘starting
again’ .”
“Knowing that there was a specialist team
was really reassuring – we just assumed that
she would be treated at her local hospital.”
“I really can’t praise the staff enough – you build
relationships with them and start to get to know them.”
“Support with the way I look was poor. I had been an inpatient for a long time and although I had access to a psychologist, what I needed was someone who could take me out (into society) step by step,
just for a coffee or to do some shopping, to make it easier.”
“There was always someone on hand to
provide help or information.”
“The referral system seems to be quite
complicated and difficult to navigate.”
Patient centred care
Nurse
BurnSurgeon
Psychological therapist
Allied Health professionals
Social Care
GP & Primary Care
Other specialities
Summary and findings
• Feedback received during the development of the case for change is presented in full in Specialised burns services project: Patient engagement and feedback summary report.
• Feedback received from patients highlights that there are differences in the care provided at current services and that there remain areas for improvement.
• There was an overwhelming feeling from patients that co-ordination of care, links with other agencies and effective MDT working were very important.
• We are committed to continuing to engage with patients throughout this process.
• Further stakeholder engagement activities will be planned during each phase of the project, to ensure that patients’ needs and views are considered and incorporated into recommendations made.
London and South East EnglandSpecialised Burns Project
The case for change
Ken Dunn
Chair of the Clinical Expert Panel, London and South East England, Specialised Burns Project
Consultant Plastic Surgeon, University Hospital South Manchester
Background
National Burns Care Review (NBCR) and injury referral guidelinespublished
National Burn Care Group (NBCG) established to take forwardrecommendations made by the National Burn Care Review
National Burn Care Standards published
London & South East of England Burn Network (LSEBN)establishedInterim configuration of services agreed
Peer review assessments conducted at 3 of the 4 specialised burn
services in London and the South East
2001
2003
2004
2006
2009
• Burn facilities (BF) caring for people with minor burns linked with local plastic surgery services.
• Burn units (BU) providing regional level services caring for patients with a burn of moderate size and/or moderate complexity.
• Burn centres (BC) supra-regional services caring for patients with the most complex injuries.
Specialised burn services structure
Current service provision
Challenges in London and South East England
• Accessibility for the population served.
• Gaps in service provision.
• Capacity – total capacity is adequate, but is not necessarily located in the right place.
• Non compliance with national standards.
• Lack of key onsite support services.
• Lack of outreach services.
• Lack of recognised services to manage less severe burn injury.
• Risk of inability to cope with infection outbreak or major incident.
Demand and capacity
• Evidence shows that the incidence and prevalence of burn injury increases in line with increasing levels of deprivation.
• Current services are not positioned in areas of greatest need.
• Data shows a high number of hospital admissions to non specialised burn services.
• This may be attributable to the current distances between specialised burn services and gaps in the north eastern part of the network.
• It is likely that some patients may not be receiving optimal care as a result.
Gaps in service provision
0
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100
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Activity at non specialised burn services over a 5 year period
• Evidence shows that prevalence of burn injury increases with increasing population density.
• Currently, three out of four providers take a significant proportion of their patients from London.
Patient flows
Clinical co-dependencies (1)
• Purple (E1) – essential requirement (essential onsite co-location to deliver a minimum and safe service.
• Lilac (E2) – essential requirement (desirable onsite co-location, otherwise must be provided through outreach).
• White (O) – optimal (onsite co-location to deliver an optimal service).
• A clinically agreed statement of the co-dependencies and co-location requirements for each tier of specialised burn services
a b c d e f g h i j k l m n o p q r s
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3Adult Burn Unit N E1 E1 E1 E1 E1 E1 O O N N N
4Paed Burn Unit N E1 O O E1 E1 E1 O O N E1 N
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2
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3Adult Burn Unit N E1 E1 E1 E1 E1 E1 E2 O E2 E2 E2 E2 E2 E2 E1 E1 E1 E1 E2
4Paed Burn Unit N E1 O E1 E1 E1 O E2 O E2 E2 E2 E2 E2 E2 E1 E1 E1 E1 E2
5
Adult Burn Facility
N N N E1 E1 E1 E1 E2 O E2 E2 E2 E2 E2 E2 E1 E1 E1 E1 E2
6
Paed Burn Facility
N N N E1 E1 E2 E2 O E2 E2 E2 E2 E2 E2 E1 E1 E1 E1 E2
Emer
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• A model of care for specialised burn services: Co-dependencies framework will be published alongside the case for change, and is available upon request.
Key components:
• Workforce– Evidence suggests that consultant led services improve outcomes.– Current services do not meet national recommendations for
consultant cover.– Lack of specialised burns nurses.– Lack of provision for surgical training in specialised burn care.
• Network working– Lack of support for local hospitals and emergency departments.– Lack of outreach services to improve access to care.– Links with other agencies to need to be improved to ensure good
follow up care and care of patients with long term health needs.
• Major incident planning and infection outbreak– Capacity is potentially in the wrong place to cope with a major
incident.– Limited capacity to cope with outbreaks of infection.
Supporting the delivery of care
Financial sustainabilityThe NHS has a responsibility to ensure that services are financiallysustainable, deliver high quality care and provide value for money.
Challenges in ensuring the financial sustainability of specialised burnservices:
• Disparity in cost of care at different services.
• Variances in cost of care across PCTs.
• Lack of quality measures to audit quality of care provided.
• Lack of national tariff for specialised burn care.
Summary
• Issues and challenges facing current services need to be considered in line with the national and local strategic context
• Current services do not comply with appropriate care standards and national recommendations
• The network of care does not work as effectively as it could do
• There are gaps in service provision in some areas of the network and a lack of provision for the treatment of minor burn injuries
• Some patients are travelling too far to access the care they need
• The way that specialised burn care in London and South East England is delivered must change in order to improve services for patients
London and South East EnglandSpecialised Burns Project
The case for change: Q&A session
Robert Creighton
Senior Responsible Officer, London and South East England Specialised Burns Project
Former Chief Executive, Ealing, Hillingdon and Hounslow PCTs
Transitional Director, London Public Health
London and South East EnglandSpecialised Burns Project
Stakeholder engagement event20th July 2011
The Hilton Hotel, Gatwick
South East Coast Specialised Commissioning Group
South East Coast Specialised Commissioning Group
London and South East EnglandSpecialised Burns Project
The national perspective
Nathan Hall
National Burn Care Programme Lead
NHS Specialised Services
Background
• The National Network for Burn Care (NNBC) aims to improve the quality of burn care services in England and Wales.
• A key objective of the NNBC is to implement recommendations of the National Burn Care Review (2001).
• The membership reflects the interests of several groups involved in burn care including: 4 regional burn care networks, NHS specialised commissioners, patient and carer representatives.
• Several members of the NNBC are involved in the London and South East England specialised burn project: Ken Dunn, Teresa Warr, Becky Martin, Greg Williams, Pete Saggers, Sean Overett, Nathan Hall.
• We aim for joined up working and co-production.
Specialised burn care – England and Wales
NNBC work (1)
1. National Burn Care Standards
The national burn care standards have been updated and are currently available for comment.
The nationally agreed standards describe the clinical processes and structures that will deliver optimal outcomes.
Key deliverables:
• Burn Care Standards and assessment process (October 2011)
• Agreed outcome measures, used alongside the Burn Care Standards, to measure service quality.
• National service specification (November 2011).
NNBC work (2)
2. Information to Improve Quality
Key deliverables:
• National clinical dataset for all patients receiving burn care (including in plastic surgery services).
• Data analysed and reported to inform effective commissioning and quality improvement.
• Develop nationally consistent contract currencies.
• National Audit.
NNBC work (3)
3. Major incident planning
• NHS Emergency Planning Guidance: Planning for the Management of burn injured patients in the event of a major incident.
• Burn Network & Burn Service Burn Major Incident Plans
4. Other relevant projects
• Burn Care Guidance for Major Trauma Networks (to be finalised late summer).
• National Severity Thresholds.
• National Patient Experience Survey.
Contact details
For further information:
www.specialisedservices.nhs.uk/burncare
London and South East EnglandSpecialised Burns Project
Developing a model of care
Ken Dunn
Chair of the Clinical Expert Panel, London and South East England, Specialised Burns Project
Consultant Plastic Surgeon, University Hospital South Manchester
Introduction
The purpose of this session is to introduce the concept of a model of
care and to invite discussion and feedback on the development of a
model of care for specialised burn services in London and South East
England.
There will be three parts to this session:
1. Overview and background.
2. Discussion sessions.
3. Feedback from groups and further opportunity for questions.
Key themes from the case for change• Capacity – total capacity is adequate, but is not necessarily located
in the right place.
• Gaps in service provision in some areas.
• Accessibility and travel times for patients.
• Lack of recognised services for the treatment of minor burn injuries.
• Current services do not comply with national standards and the requirements identified by the co-dependencies framework.
• Lack of adequate provision of training in specialised burn care.
• Lack of outreach services and links with other agencies.
Components of the Model of Care
The model of care will be comprised of the following:
• Review and evaluation of existing national and international service models to determine the most appropriate service model.
• Recommendations for improvements to service delivery.
• A range of potential configuration options (non site specific/ no geographical locations).
• Care pathway aligned to the agreed service model.
Existing service models
• Reviews of existing service models in other healthcare systems:– Europe– United States– Australasia– Other developing countries
• Conclusions drawn from literature on existing service models:– need for a regional and integrated approach for patients with serious
burn injury– centralisation of burn injury services to improve expertise and
ensure good clinical outcomes– service delivery through formal clinical networks – integration with trauma systems/ networks– access should be optimised for populations where need is greatest
Proposed service model
• Burn facilities (BF) caring for people with minor burns linked with local plastic surgery services.
• Burn units (BU) providing regional level services caring for patients with a burn of moderate size and/or moderate complexity.
• Burn centres (BC) supra-regional services caring for patients with the most complex injuries.
Model of care discussion session 1In this session we would like you to consider answers to the following:
• What are the key elements of an effective network of care for specialised burn services?
• How could/ should an effective network of care for specialised burn services be supported?
• What are the potential challenges to the development/ delivery of an effective network of care for specialised burn services?
Specifically, tell us
• How patients should move through the system.• Which teams should be involved in on going and follow up care.• The role of technology in supporting the care pathway.• How should communication with patients work?• At which points will the model differ for adults and children?
London and South East EnglandSpecialised Burns Project
Group feedback:Model of care discussion session 1
Developing the configuration optionsA process will be designed to decide how many services will be needed at each level.
Part of the model of care will outline the range of
potential configuration options, based on the three tier model
(non site specific and no geographical locations).
Example A: 2 centres: 1 adult and paediatric centre (co-located) and 1
adult centre (no paediatrics)
Example B: 3 centres: 2 adult only centres. 1 adult and paediatric centre
(co-located)
• The number of centres will dictate the number of units and facility level services required.
• A number of options will assessed in order to identify an appropriate range.
Evaluating factors We have identified some factors which will influence the range and suitability of potential configuration options.
Clinical factors:– Ideal patient throughput (minimum and maximum).– Size of population served.
This will give us the optimum number of centres.
Additional factors:– Provision of services for adults and children?– Resilience in the event of a major incident.– Value for money.– Access – to the specialised service at the time of injury.– Access – for follow up and ongoing care. – Workforce considerations
The configuration of specialised burn services is one that should
ensure it meets the health needs and requirements of the population.
Model of care discussion session 2
1. Do you agree with these factors?
2. Are there are any additional factors that you think are important to consider?
3. Do any factors stand out as being particularly important.
London and South East EnglandSpecialised Burns Project
Group feedback:Model of care discussion session 2
London and South East EnglandSpecialised Burns Project
Next steps
Robert Creighton
Senior Responsible Officer, London and South East England, Specialised Burns Project
Former Chief Executive, Ealing, Hillingdon and Hounslow PCTs
Transitional Director, London Public Health
Phase 1
Case for Change• The case for change (full document & summary) will be presented for
sign-off to Specialised Commissioning Board meetings in September 2011 (South Central, South East Coast, East of England & London).
• Following their sign-off the documents will be published (Autumn 2011).
Co-dependencies Framework• The framework has been distributed today.
• The full technical paper will be published alongside the case for change.
Patient & Public Engagement report• This will be presented to the project Steering Group for sign-off in July.
• The report will be published alongside the case for change.
Phase 1 (2)
Model of care
This will be further developed with the Clinical Expert Panel following feedback from the stakeholder event today. This will be published late Autumn.
If you have any feedback or comments on the draft case for change or model of care development please e-mail the project team [email protected] by 5th August.
We will keep you updated about publications through our project update bulletin. Please let us know if you do not want to be on the distribution list.
Next steps
• Implementation of the model of care. This is likely to include:
– A network approach to implementation.
– Formal process to select providers based on their ability to deliver services in line with the model of care.
• A proposal about Phase 2 of the project will be presented to Specialised Commissioning Group Board meetings in September 2011 (South Central, South East Coast, East of England & London).
We will continue to keep you updated about Phase 2 of the project through our project update bulletin.
Please let us know if you do not want to be on the distribution list.
London and South East EnglandSpecialised Burns Project
Feedback and Q&A session
Robert Creighton
Senior Responsible Officer, London and South East England Specialised Burns Project
Former Chief Executive, Ealing, Hillingdon and Hounslow PCTs
Transitional Director, London Public Health
Further information
Thank you for attending today’s event.
Further comments:If you have any feedback or comments on the draft case for change or model of care development please e-mail the project team:[email protected] by 5th August.
Project update bulletin:We will keep you updated about publications through our project update bulletin. Please let us know if you do not want to be on the distribution list.
Key contact details:Project team: [email protected] or 0207 685 6947
London Health Programmes: www.londonhp.nhs.uk
National Network for Burn Care (NNBC): www.specialisedservices.nhs.uk/burncare
