NORTHERN BURN CARE OPERATIONAL DELIVERY NETWORK ANNUAL REPORT 2017/18. Page 1 of 27

Transcription

1 NORTHERN BURN CARE OPERATIONAL DELIVERY NETWORK ANNUAL REPORT 2017/18 Page 1 of 27

2 FOREWARD FROM CHAIRPERSON It is with pleasure that I introduce you to our 2017/18 Annual Report for the Northern Burn Care Operational Delivery Network (ODN). I believe the report demonstrates strong collaborative working between and across our clinical and managerial professionals working in our burns services across the ODN. Their passion and commitment to make a real difference for the patients we treat and care for is clearly evident. Although we have faced a number of challenges not least the reduced resources within the ODN central management team we have made significant progress in delivering our key priorities. We will continue to strive to further improve our services for patients. I would like to take this opportunity to applaud the efforts of our staff and thank them for their hard work. I look forward to working with them to realise our key priorities in 2018/19. Diane Wake Northern Burn Care ODN Chair, Chief Executive Dudley Health Group NHSFT Page 2 of 27

3 Northern Burn Care Operational Delivery Network Annual Report 2017/18 Introduction As ODNs Director (Trauma, Burns, Critical Care) I would like to welcome you to the Northern Burn Care Operational Delivery Network (ODN) Annual Report for 2017/18. This report aims to inform you of the work that has been undertaken by the ODN, as a clinical network of Burns Services, during 2017/18, and our key priorities for the coming year. It first outlines the purpose and vision of the ODN and how burns services are delivered across the ODN; the governance and accountability arrangements to which we operate, and thereafter, provides reports from the Network Clinical Lead, Network Lead Nurse, Service Development Group Chairs, and the Burns Services on the key achievements in 207/18 from their respective profession and areas of responsibilities. ODN and Network are one and the same (Northern Burn Care ODN) and may be used interchangeably throughout this report. Northern Burn Care Operational Delivery Network Established in May 2008 the Northern Burn Care ODN is one of four Burns Networks for specialised burn care in England and Wales. In April 2013 it transitioned to function as an Operational Delivery Network (ODN) in line with the National Guidance The Way Forward Operating Delivery Networks (NHSE December 2012), and the National Service Specification for ODNs. We cover the North of England, North Wales and Isle of Man, serving a total population of 15.4 million; 12.5m adults and 2.9 m children. Northern Burn Care ODN s Purpose and Vision Formal standardised processes, structures and agreed working practices are required to continue improving survival rates and quality of life for patients who have sustained a burn injury. Burn Care Services, working collaboratively as Burn Care ODNs, have developed organisational processes to meet the complex needs of these patients while at the same time ensuring care is delivered close to home as soon as possible. The constituent member organisations of the Northern Burn Care ODN operate within an integrated ODN model, providing care and treatment to adult and paediatric burns patients from pre-hospital through to rehabilitation. Our aim and purpose is to optimise the provision of care for burn injured patients as defined in the NHS England Service Specification D06/S/a for Specialised Burn Care (All Ages) by ensuring that all patients that require specialist burn care have access to the right level of burn care at the right time and in the right service. Page 3 of 27

4 ODN s Strategic Objectives Ensure effective clinical flows through the provider system through clinical collaboration for networked provision of services. Take a whole system collaborative provision approach to ensuring delivery of safe and effective services across the patient pathway, adding value for all its stakeholders. Improve cross-organisational multi-professional clinical engagement to improve pathways of care. Stratification of Burn Services In England and Wales burn care is organised using a tiered model of care whereby the most severely injured are cared for in services recognised as Burn Centres and those requiring less intensive clinical support being cared for in either a Burns Unit or Burns Facility. This provides a balance between easy access and care provided closer to home for the majority of patients with highly specialised, centralised services for a much smaller proportion of patients with more severe injuries. The stratification and location of burns services within the Northern Burns Care ODN region are defined in Figure 1 below. (Note: Services listed under Burns Centres have not been formally designated by NHSE Specialised Commissioners). Figure 1 Burns Centres Alder Hey Children s Hospital NHSFT Manchester Children s Hospital NHSFT Manchester Foundation Trust (Wythenshaw Hospital Adult Burn Service) Mid Yorkshire Hospitals NHSFT (Pinderfields Hospital Adult Burn Service) Newcastle Royal Victoria Hospital NHSFT (Adult and Children s Burn Services) St Helen s and Knowsley Hospitals NHSFT (Whiston Adult Burn Service (Mersey Burn Unit)) Burns Units Mid Yorkshire Hospitals NHSFT (Pinderfields Hospital Children s Burn Service) Sheffield Children s Hospital NHSFT Sheffield Teaching Hospitals NHSFT (Northern General Hospital Adult Burn Service) Burns Facilities Middlesbrough Hospitals NHSFT (South Tees Hospital Burns Facility) Lancashire Hospitals NHSFT (Preston Hospital Burns Facility) Northern Burn Care ODN Governance and Accountability Structure The Northern Burn Care ODN is governed by the ODN Board that is made up of Executive/senior managers representing each member Trust, ODNs Director (Trauma, Burns, Critical Care) Network Clinical Lead, Network Lead Nurse, Clinical Chairs of the Network Service Development Groups, and Specialised Commissioners. The Page 4 of 27

5 ODN management team is accountable to the ODN Board and NHS England Specialised Commissioners. Its member organisations and the ODN host adhere to the ODN s Memorandum of Understanding. The infrastructure and running costs of the ODN is funded by NHSE from the national CQUIN. Our ODN Board meets quarterly and its purpose is to oversee the development and modernisation of burns services across the Network in line with national and local priorities. Its aim is to provide senior management and executive leadership, and clinical leadership; make strategic decisions, approve key planning issues, and hold member organisations to account for delivering national clinical standards and, national and local priorities. The ODN Board is responsible for and oversees the work of the Network Multi-disciplinary Clinical Audit & Advisory Group, and the Network Nurses, Therapies and Psychologists Services Development Groups (SDGs) that are established as part of the Network s structure. The ODNs Management Team Diane Wake, Chief Executive for Dudley Healthcare Group, has been Chair of the ODN since 2014We have a small dedicated central management team that manages three ODNs; North Trent Adult Critical Care ODN, South Yorkshire Major Trauma ODN and Northern Burn Care ODN. Between April 2017 to May 2018 two vacancies have arisen in the ODN central management team: Maria McGonnell (nee Price), ODNs Administrator/Secretary, and Kennedy Hindle-May, ODNs Audit & Information Officer. In addition, Baljit Kaur, ODNs Quality Improvement Manager, completed a fixed term contract. A further vacancy will arise at the end of August 2018 when Lorraine Rogers, ODNs Quality Improvement Manager, leaves to take up the post of Business Manager in NHSE Y&H Hub. Recruitment to team posts is in abeyance as the hosting arrangements for the ODNs is under review. This has resulted in significant challenges for the team to ensure continuity of business across the three ODNs. The current team comprising 2.5 WTE reducing to 1.5 WTE : Jayne Andrew, ODNs Director (Trauma, Critical Care, Burns) Caroline Burgin ODNs Quality Improvement Managers Lorraine Rogers ODNs Quality Improvement Manager Our thanks go to Chris, Maria, Kenny and Baljit for all their hard work in the ODN and we wish them well for the future. Page 5 of 27

6 In addition to the central ODNs team, we have a Burns Network Clinical Lead and Burns Network Lead Nurse to support the Northern Burn Care Network, and elected Clinical Chairs for the Nurses, Therapies and Psychologist SDGs. Caroline and Lorraine support the SDGs and have overall management responsibility for ensuring their respective group s work programme is achieved within the agreed timescales. The leads and SDG Chairs have a place on the ODN Board to provide clinical leadership at a strategic level. Key Achievements 2017/18 Firstly, I would to thank my colleagues in the ODNs management team, the clinical leads, SDG Chairs and all our stakeholders for their continued commitment and contribution to the work of the ODN. Over the last year we have been very busy working on a number of key areas and projects at both ODN and national level. This has been challenging at times due to the lack of staff resources and staff sickness but nonetheless we have achieved a great deal. Projects such as the workforce and training and education surveys, currently being undertaken, will provide a more accurate picture of the capacity and capability of our workforce across the ODN and give us a baseline on which to develop our Network Strategies for workforce development and training and education. Later, the Network Clinical Lead and the Service Development Groups Chairs report on the work undertaken during the last year by their respective groups and the key areas they will be focusing on in 2018/19. ODN Website The new ODN website has been up and running for over year and now. There many useful resources available for both burns specialists and non-specialist staff Collaborative Working The four Burn Networks within England and Wales have always recognised the need to work collaboratively at a national level. This year we have developed a robust structure to support collaborative working and agreed a National Work Programme of common priorities with each ODN taking the lead on one or more of the projects. In 2017 to-date we have worked on the following projects. Data and Information The need for accurate, meaningful and timely data and information is a priority for the four ODNs. We will work with NHS England to improve the accuracy of data and information for patient activity, including demographics information related to clinical pathways. As part of improving our Network data and information, in early 2018 all four ODNs Boards agreed to adopt the Network Contract Minimum Data Set (CMS) originally developed by London and South East Burns ODN. This will enable Burns Services to review their own data and identify areas for improvement, and will provide the ODN Board with network-level performance reports, with a focus on specific key areas. The ODN Board will then be able to make informed decisions on areas for service improvement and development activities within the ODN. Page 6 of 27

7 Mass Casualty Planning for Burns In response to a request from NHSE the ODNs and their stakeholders formed a National Task and Finish Group to develop the burns annex to the NHS England s Concept of Operations for Managing Mass Casualties. A mass casualty incident for burns is likely to involve significantly fewer casualties than other mass casualty incidents and it has been estimated that an incident involving more than 20 Level 3 burns will be a national (Level 4) event. This is likely to be significantly fewer in the case of paediatric burn patients. The purpose of the burns annex is to provide an overview of the expected response by the NHS, specifically burns services, to an incident involving large numbers of burns, and provide a description of the efficient and effective distribution of a significant number of people receiving burn injuries from one or more mass casualty incidents, to burn services suitably equipped and staffed to deal fully with the presenting injuries. Although the burns annex has not yet gone through the Gateway process for sign off, it was published in final draft form and circulated to all Trusts/Burns Services in November 2017 for embedding within their local emergency action plans. In the meantime, the Task and Finish Group will reconvene after the national burns EMERGO exercise has taken place so that any lessons learnt can be included in the document. This will include more details around the establishment of Burns Incident Response Teams (BIRTs). Thereafter, the final draft annex will go through Gateway. It will be a priority for the ODN to ensure Trusts/Burns Services fully embed the annex into their local emergency action plans and relevant staff are clear on their role when responding to a mass casualty incident involving burns casualties. Our thanks go to everyone on the group and, in particular, to Jacky Edwards, for chairing the group and taking the lead in drafting the annex. National Burns EMERGO Exercise Phoenix I represented the four ODNs on the planning group with NHSE and PHE to develop a national burns EMERGO exercise for the purpose of testing burns services response to a mass casualty incident involving burns, in accordance with the NHSE Concept of Operations for Managing Mass Casualties burns annex. Originally the exercise was planned for February 2018 however, due to the snow and severe weather conditions it has been postponed until 30 October National Burn Care Standards Many of us from across the Network have been part of the National Task and Finish Group set up to review the National Burns Care Standards. The revised Standards will be published later this year. Thereafter, the ODN will look at potential implications for the delivery of services and work with burns services to address them accordingly. Page 7 of 27

8 National and Network Clinical Audit Days In 2014 the four Burns ODNs agreed that, in addition to our respective mandatory network clinical audit days, we should hold an annual national clinical audit day. Although the national audit is not mandatory, it provides an additional tier of scrutiny and should be seen as good clinical governance and a great learning opportunity for burns professionals. I am delighted that the 2017 event was no different than that of previous years in that the Network was very well represented at both events by our clinicians from the burns services MDTs. Kayvan, as Network Clinical Lead, provides further detail of these events in his report later on. Network Objectives for 2018/19 Going forward into 2018/19 our main focus will be on the following objectives: To finalise the burns annex to the NHS England Concept of Operations for Managing Mass Casualties, and ensure it is fully embedded in burns services across the ODN. To review the National Burns Surge and Escalation Plan for NHS England to ensure it remains fit for purpose. To participate in the national EMERGO exercise Phoenix to test burns services response in accordance with the burns annex. Identify lessons learnt and training needs, and thereafter address accordingly. To continue our contribution on the National Task and Finish Group to finalise the National Review of Burn Standards. Thereafter, the ODN will work with services to assess compliance and address areas of noncompliance. To develop ODN Workforce Development and Training and Education Strategies. These will be informed by the workforce and training education surveys being undertaken. To review and develop where required Network Clinical Guidelines, Protocols and Polices to ensure they remain fit for purpose and make available on the ODN website. To roll out the Network CMS across the ODN. Put in place reporting mechanism to the ODN Board so as to inform our network s service improvement activities in ODN work programme. Complete our Network clinical audits: Microbiology and Infection Control, and Mental Health. Each Service Development Group delivers its Work Programme. Page 8 of 27

9 Report from Kayvan Shokrallahi Northern Burn Care Network Clinical Lead I joined the Network as Network Clinical Lead in January I am a Consultant Burns, Plastic & Laser Surgeon, and the Clinical Lead at Mersey Regional Burns Service, Whiston Hospital, Liverpool. In addition to these roles, I am also: Editor-in-Chief: Scars, Burns & Healing, Associate Editor: Annals of Plastic Surgery, Vice-Chairman: The Katie Piper Foundation and, Chairman: Communications subcommittee, British Burn Association. Network Audit Day It is the responsibility of all Burns ODNs to conduct regular mortality and morbidity audits. Our annual Network audit day took place on 14 June 2017, which I chaired. There was good representation from across the ODN. Appropriate cases were selected by consensus for presentation at the National Audit Day. A transition to prospective mortality audit was implemented whereby all deaths are documented by each service and reported quarterly including data that documents the date on which cases were discussed at in-house mortality meetings. This underpins important tiers of good governance at Trust level as well as ODN level. This year s Network Audit Day is planned for 20 June 2018 at Normanton Golf Club, Wakefield and will feed into the National audit a few weeks later in Birmingham. Network Clinical Audits Microbiology and Infection Control Audit Infection, cross-infection and antimicrobial resistance are international and national healthcare priorities. Outbreaks of multi-resistant organisms are increasingly common in burns patients, and a number of major burns services nationally have been forced to shut due to these issues, sometimes for prolonged lengths of time. The ODN Board agreed that there was an urgent need to look closely at issues relating to infection control and microbiology, and that there was important work to do in this area to inform the network as well as other ongoing work such as mass casualty planning and burn care standards, and also feed into education, training and research. A Task and Finish Group has been established comprising of individuals from a range of disciplines across all services in the network including participation from Public Health England. The first meeting of this group was by teleconference and was very well attended on 23 April It was clear from this first meeting that there is a great deal of variance in practice and that prior to any decisions being made on the remit of any potential data capture from services, a preliminary survey should be created and circulated to all services to capture current practice to inform an initial debate on what standard practice is or should be. Standardising practice is likely to be fruitful in itself, and subsequently the intention is to gather data on practice and patterns of antimicrobial resistance with a view to present this work at a regional conference hosted by the network in the latter half of What has already happened is that for the first time, infection control staff and microbiologists across the network have been connected, in what is the first step towards a peer-supported network of individuals that can discuss Page 9 of 27

10 issues outside of an individual service bubble, and which is likely to be increasingly important over the next decade. Mental Health Another national health priority and one highlighted as a concern across burns services by the ODN Board is mental health. Preliminary work has demonstrated the significant numbers of patients with severe mental health problems transitioning through burns services. This ranges from patients with massive self-inflicted burns, to those sustaining burns whilst in the care of mental health services, and those patients with mental health issues as comorbidities to their burn injuries. Preliminary contact information has been acquired in relation to key members of mental health staff supporting each burns service with a view to formally establishing a task and finish group to delineate the issues and work towards standardising practice, and ensuring appropriate and safe psychiatric service provision for burns patients. There appears to be variability across the network in psychiatric support and availability, and the group will look at some of the issues raised by the Psychology Special Interest Group a few years ago where they compiled a short report on the Psychologists views on the issues and priorities in this area. Page 10 of 27

11 Report from Vicky Edwards Northern Burn Care Network Lead Nurse and Chair of Nurses Service Development Group I was appointed as the Network Lead Nurse in April I am a senior specialist nurse, working in the Burns Outreach Service at the Burns Centre Wythenshawe Hospital, Manchester. My career includes working in the area of burns for over 15 years, prior to this I work in ICU. I initially started working in paediatric burns at Booth Hall Hospital, following completion of my degree in children s nursing, I was part of the team to set up the paediatric burns intensive care beds. As a promotional opportunity I took a senior sister post at Wythenshawe Burns Centre and was again a key member in setting up the adult intensive care beds, which I then worked in the area of burns intensive care for several years before moving to the Burns Outreach Service. This post has then developed over time in to the senior specialist post I now hold. I have completed the Certificate in Burns Care, and two modules from Advance Practice and Non-medical prescribing, at Masters Level. I have a wide range of experience in the area of burns from admission to rehabilitation, which gives me a good grounding to understand many of the complexities around many of the aspects of burn care, from admission to discharge. As Network Lead Nurse I represent nursing across the ODN and on national network groups. I also chair the ODN Burns Nurses Service Development Group which has a membership of senior nurses representing all the burns services that are within the Northern ODN. This group was formed in 2009 to bring together many years of experience and to encourage collaborative working across the Network, between the Burns Centres, Units and Facilities. The group delivers an annual work programme, agreed by the ODN Board, which is based on the ODN s overarching Work Programme. Some of our keys areas of achievement from 2016/2018 are: The development of the workforce survey to look at the staffing levels, skill mix and education, to help the services meet and demonstrate their compliance with the Burns Care standards. This survey will be used on an annual basis to continually assess the compliance, and identify the need for ongoing education and succession planning. The SDG has previously developed Network Referral Forms for Complex and non-complex Burns, and a Minor Injury Protocol. These, along with all other Network guidelines and protocols relevant to nursing are regularly reviewed and amended accordingly. Up to-date versions are available on the ODN s website in the Burns ODN section. As part of the ODN s teaching and advice role to both specialist and non-specialist burns staff, the group has worked with Conveto, a recording company, to create two training videos for use by staff in Burns Services, all community services and A&E s. The videos show how or apply dressings to an adult and paediatric hand with burns, and undertake blister debridement. The completion of the videos is in the final stages and these will soon be available on the ODNs website. Page 11 of 27

12 Unfortunately the attendance for this group had fallen previously, but from 2016/2018 there has been excellent attendance from most services in the Network, and a positive forum. Key areas in work programme for delivering in 2018 are: Finalise the videos on adults hand dressing and debridement, and have them available on the ODN website, as well as completing the paediatric hand dressing. Complete the workforce surveys and formulate a report for the ODN network, and identify areas that need to be addressed to meet the Burns Care Standards. To run a Network MDT study day annually, including areas that have been highlighted as areas of interest across the Network. This will include relevant topics for Nurses, Therapists, Psychologists, as well as Dieticians and Speech and language therapists. The Burns nurses from across the ODN will participate in the Regional and National audit days, they will help to identify relevant cases and share cases within the SDG as appropriate. Page 12 of 27

13 Report from Ann Sanderson Chair of the Lead Therapies Service Development Group I have worked as a Senior Physiotherapist on burns since I work across both the adult and children s services at Pinderfields Hospital, Wakefield, including the care of our two designated burns critical care beds. I am responsible for the leadership and management of both our Physiotherapy and Occupational Therapy colleagues in Burns. I have taken on the role of Chair for the Northern Burn Care ODN Therapists Service Development Group since February, Prior to this Debbie Smith, a Senior Physiotherapist at Sheffield Children s Hospital fulfilled this role. Debbie has been a Senior Physiotherapist on burns since 2007 working solely with children. She acted as group chair from January 2015 until April The Northern Burn Care ODN Therapists Service Development Group (SDG), established in 2009, is made up of Physiotherapists and Occupational Therapists from all Burn Services in the Northern Burn Care ODN. I am the fourth from the left! Moving forward to the year 2018/19 we plan to meet 3 times per year as originally we met four times. In May 2017 our abstract titled Alternative Exercise Technology: an Innovative Media Option to Encourage Patient Participation was successful in being accepted for oral presentation at the British Burn Association Annual (BBA) Meeting in London at the Royal College of Surgeons. This was presented by Clare McGrory, Clinical Specialist Burns Physiotherapist from Wythenshawe Hospital on behalf of the ODN therapists and received excellent feedback as a project, and therapists from other ODNs would like to share this work for use with their burn patients. Now that the leaflets and videos are in use across the Northern Network, our plan for the upcoming year is to evaluate the use of the exercise leaflets and videos via feedback from patients. A scoping exercise is also planned to evaluate with parents and paediatric patients whether paediatric leaflets and videos would be of benefit, and if so the group would seek support from the ODN Board to proceed with such a project. Along with therapists from the other ODNs, we revised the National Standards of Physiotherapy and Occupational Therapy Practice in the Management of Burn Injured Adults and Children document. This was led by the Lead Therapist for the London and South East Burns ODN. Services across the Northern ODN are currently auditing themselves against the Burn Therapy Standards. Once the audit is completed, the next step would be to review the results from across the Network, share good practice and identify ways to improve. Louise Johnson (Senior Physiotherapist at RVI Newcastle) has represented the Northern ODN therapists as part of the national group reviewing the National Burn Care Standards led by the BBA. The Therapists SDG are looking forward to continuing to work towards their updated work plan in the year 2018/19 with Service Improvement Manager (SIM) Lorraine Rogers. The group would like to thank Lorraine Rogers and previous SIM Baljit Kaur for their support and hard work for the group. Page 13 of 27

14 Report from Sarah Heary Chair of the Lead Psychologists Service Development Group In the last financial year our group only met on one occasion. However, despite this a lot of work has still being happening! A summary of some of the key things we have completed are highlighted below. Burns Standards Review Group We have had good representation from the Northern Network Psychologists SDG in the Burns National Standards Review Group. We have had two members of the group representing psychology along with other psychologists from across the country. They have done a brilliant job of feeding back to us on developments and we thank them very much for their hard work in revising the standards. Family Therapy Weekends We have held two successful family weekends, one in April and one in November. These weekends are funded by the Children s Burns Trust and the Fire Fighters Charity. These weekends are attended by a wide range of staff across the Northern Burn Care Network including, nurses, OT s, physios and psychologists. These weekends are always evaluated extremely well by the families that attend. They seem to get a huge amount out of meeting other families who have had a burn injury. In addition to the benefits for families, it is a great way for staff to network with other staff within the Northern Burn Care Network. Moving forward as a SDG group the paediatric psychologists would like to think about additional ways they can evaluate these family weekends. In particular thinking about how we capture the longer term benefits of those who have attended. Joint Working with other SGD groups A number of us attended the joint meeting in November 2017 and enjoyed finding out about the work which other Service Development Groups within the ODN had completed. The psychologist group briefly presented their work on the Transition website. We were pleased to see that people were aware of the Transition website and importantly using it within their service. As a group we will work to try and ensure that this is website is kept up to date. This meeting highlighted the importance joint working and sharing skills. We are looking forward to being a part of the MDT study day and using this as an opportunity to share our knowledge. As a group we are particularly keen to ensure that our colleagues from other disciplines are trained on psychological aspects of burn care. Each member of our group will be working hard within their own hospitals to ensure training is delivered in line with Burn Care Standards. Moving forward We are looking forward to meeting on a more regular basis and working through our work plan. We have a new agenda item at each our meetings to spend some time looking at a clinical case or issue. We think that this will be a helpful and effective use of some of our meeting time and provide an excellent opportunity for some CPD with psychology colleagues working in burn care. Page 14 of 27

15 SERVICE REPORTS Alder Hey Children s Burn Centre We provide a Regional Burn Service offering centre-level care as part of the Northern Network for Burn Care. Our multidisciplinary service deals with all burn-related care from minor scalds up to major burns and rehabilitation including scar management and reconstruction after burn injury. Our service plays an active role in supporting the Northern Network s aims of collaborative working and education and training for local, non-specialist providers, such as A and E departments and walk-in centres. Our catchment area includes Liverpool, Warrington, Leighton, the Isle of Man and North Wales as far south as Aberystwyth. The service receives over 500 referrals per year with around 300 requiring in-patient admission. We hold monthly Burn Review clinics, weekly scar and pressure garments clinics and complex scar multidisciplinary clinics. We offer a range of scar treatments, including non surgical options, pressure garments, laser, prosthetics and reconstructive surgery. In 2017 / 18 we were delighted to welcome two new substantive consultant s to our Burns and Plastics Department, Ms Elly Breuning and Mr Pundrique Sharma. Ms Breuning supports the acute burn service and provides laser treatment for burn scarring. Three of our nurses have attended training in cosmetic camouflage and now run clinics for scar patients which have high patient satisfaction. Our ward of 5 high dependency cubicles is fully staffed. This year, we became the first and only ward in the Trust to be awarded Gold Accreditation for our quality of care. We have had no deaths or never events; no MRSA; our hand hygiene rates are the best in the hospital; our PDRs are 100% and our mandatory training rates are 95%. We have had no formal complaints and score well on patient feedback. We are grateful to AMEX for donating funds to the Unit to improve décor. We installed a 4D immersive system into our bathroom / treatment room last year which has considerably improved patient experience in dressing changes. We participate in all activities of the Burns ODN. We are engaged in collaborative research projects and published three papers over the last year, with others in progress. In addition, we presented several papers at the BBA and ECPB in Burn team members provide external teaching by invited lectures and supporting peripheral units and we organise an annual EMSB course every November. We continue to support education and training in resource poor countries and provided consultancy to a new burn unit in Hebron, West Bank in July 2017, in collaboration with Interburns and Medical Aid for Palestinians. We were awarded a 3000 BMA Humanitarian Grant to visit Nepal in March/April 2018 as part of our on-going partnership with Kanti Children s Hospital in Kathmandu. An Alder Hey team of two burn surgeons, a nurse and a therapist spent a week there and carried out an evaluation which showed substantial improvement in care over the 10 years of our working together. Sian Falder, Clinical Lead of the Burn Service, Jun 2018 Page 15 of 27

16 Royal Manchester Children s Hospital, Manchester Burns Centre The Royal Manchester Children s Hospital is part of the Manchester Foundation trust NHS Hospitals and provides centre-level care for burn injured-children. The service has 8 individual thermoregulated rooms and a 4-bedded thermoregulated bay providing HDU level care with the adjacent PICU providing care of the ventilated burn patient. The service has an integrated theatre suite and a sensory room as well as an after-care unit located adjacent to the entrance. RMCH is one of two Paediatric burn services in the North West and provides care for all children with major or minor burns and diseases resulting in extensive skin loss. The Burns service continues to provide training, in the management of burn wounds in children, for community staff in order to provide equitable care closer to home in our shared care programme. The training includes interactive workshops and provides the opportunity for community staff to visit our after-care service and shadow our staff for practical training. The team have continued to benefit from a multi-disciplinary team approach to care. There has been a notable drive on shared care plans, with each allied health professional working in a holistic way towards the patient s rehabilitation goal. Of note, our Clinical Psychologists have developed close links with the Therapeutic Play Specialists working on the burns unit to support young people with dressing change procedures and to manage procedural anxiety issues. Training for all staff regarding psychosocial care remains a priority. With the support of the Children s Burns Foundation, we are now able to provide our older children with online counselling by trained psychologists. This avoids children missing school and parents not having to take time off work. The School Reintegration Programme continues to be a successful intervention offered to children on the burns unit who have had a prolonged inpatient admission. The programme aims to facilitate a smooth and timely return to school following a burn injury. It can help other children to think about difference and to consider the questions they may ask a burn injured child. It can also alleviate some of the fears of parents and their teachers relating to the transition back into education. In addition, the programme provides burn prevention and first aid education. In collaboration with other members of the MDT, the programme has been reviewed and amended, incorporating feedback from young people and teachers. As a result the programme now has three age-specific variations, that it is hoped can meet the needs of children aged from 4 years old up until 16 years of age. Manchester Burns Camp continues to provide a range of activities for children outside hospital settings. In addition, the service has maintained its close relationship with the Children s Burns Trust and the Firefighter s Charity to offer biannual family weekend events in Penrith. Please see the annual report for further details. Finally, the Northern Burn Care Network Psychologists SDG has continued to meet. These are quarterly meetings with other Psychologists working into Burns services in the North of England. The Psychology Team also continue to be active members of the national BBA Psychosocial Special Interest Group. Our Consultant Clinical Psychologist has been a member of the Burns Standards Review Group. Page 16 of 27

17 Our clinical audit and research programme is progressing from strength to strength and our research nurse s poster presentation won the award at the ECPB in Birmingham. Our work continues to be presented at national and international meetings. Prof. Mamta Shah Clinical Lead Paediatric Burns Service RMCH (2017/18) Page 17 of 27

18 Mid Yorkshire Hospitals NHS Foundation Trust - Pinderfields Adults & Paediatrics Burns Unit Background The Mid Yorkshire Burns Service is located at the Pinderfields General Hospital, Wakefield. The regional burns service serves a catchment area that includes Yorkshire, Humberside and North Lincolnshire serving a population of 5 million (centre level care) including unit level care to 3 million. The Adult Regional Burns Centre has two level 1 beds and five level 3 beds. Burn injuries and skin loss conditions of all levels of complexity are cared for. The Children s Regional Burns Unit is a 5 bedded unit and outpatient department with 1 High Dependency bed. Activity levels No significant change in the number of inpatients compared to previous years. We treated over 1700 acute burn injured patients and 886 assessments in burn scar clinics. Changes to the Service in the last year There was expansion in the therapy services (with the appointment of a third band 6 Occupation therapist) and the second paediatric burns psychologist was appointed in August Challenges in the past year Staffing levels continue to present a challenge especially with the outreach service. This is compounded by increasing numbers of outpatient assessments and steps are being considered to address these issues. Achievements Mid Yorkshire Burns Club was awarded the Duke of York s community initiative The Pinderfields Burns Charity was selected as the Mayor of Wakefield chosen charity. The Pinderfields paediatric play specialist was awarded a British Empire Medal for her services to children with severe burns in Yorkshire. The Pinderfields burns service was highlighted in the filming for the 70 th anniversary of the NHS. The service has always received positive comments from the patients and their families about the experience they had on the unit Mr U Anwar, consultant burns surgeon was involved in a burns and plastic surgery camp in Nepal providing surgery to burn injured patients and education programme to surgical trainees. Pinderfields continued to organise their successful annual burns course for primary care providers Everything you wanted to know about burns but were afraid to ask. Increasing number of staff are now attending the EMSB course as part of an action plan following the 2015 peer review. Research and Audit The burns MDT carried out several audit and research projects on topics such as enzymatic debridement, paediatric sedation and analgesia, teaching tools, waiting times etc. At the 2017 BBA meeting, there were several podium and poster presentations. The service won the best poster award for their work on distraction therapy titled Not all dressing changes need to be traumatic. Several members of team also attended the European Page 18 of 27

19 burn association meeting in Barcelona in September 2017 and presented papers on a variety of topics. Mr Anwar was invited to chair a session at the Burns Congress 2017 in Islamabad. The service has developed close links with Huddersfield University with the initiation of collaborative research projects. Future Nurse led assessments of non-complex burns will shortly be introduced in Paediatric burns in the near future. We are looking at using social media to improve patient experience through education videos and preliminary work had started. We look forward to hosting the BBA annual meeting in 2019 in Leeds. We plan to continue to improve and work together as an MDT to provide the best quality of care for our patients. Preetha Muthayya Consultant Plastic Surgeon, Mid Yorkshire Hospitals NHSFT Pinderfields Hospital Burns Unit Page 19 of 27

20 The Royal Preston Hospital, Lancashire Burns Facility The regional Major Trauma Centre at Lancashire Teaching Hospitals is based at The Royal Preston Hospital site and serves a patient population of 1.6 million throughout Lancashire and South Cumbria. The burns service at The Royal Preston Hospital provides facility-level burn care for adults and children. The adult service is based on a 32-bedded adult ward which includes 22 plastic surgery & burns beds, 3 neurosurgical and 7 medical outlier beds. The ward has 6 side rooms accommodating 7 patients. Paediatric burn patients are cared for on the paediatric ward on which the paediatric HDU and outpatient dressings clinic are located. A dedicated burns and plastics theatre is located close to the ward and is available for all burn surgery as and when needed. The Burns service at Royal Preston Hospital continues to develop: The start of 2018 saw the appointment of new nurse managers for paediatrics: One of our new mangers will be Leanne Ratcliffe who has a wealth of experience of paediatrics burn care from her time at The Royal Manchester Children s Hospital. She will join as part of our paediatric MDT, going forward. In mid-2018 following PIA approval, the Tele-referral system developed by MDSAS (Medical Data Solutions and Services) will be introduced to the service. Introduction of the system will enable us to improve patient care irrespective of their location in our geographically large catchment area. Teaching and education continue to be important aspects of our work within the burns service with Tissue Viability Link Nurse Days. In May 2017, the service hosted a Burns Management Study day for nursing staff, district nurses and ED nurses within our region with over 40 delegates attending. Delegates also received presentations from our therapy team lead by Lisa Moon and Bernie MacFarlane on rehabilitation and scar management. Public education is an important part of our role in prevention and we were pleased to be part of the Health MELA in September 2017 in Leyland, in raising burns awareness with a focus on safety and first aid in relation to burns. Last year with the rise in acid attacks, we created displays to advice the public on actions to take in such an event with the distribution of advice cards. As part of our commitment to ensure safe and effective care for all our burns patients, outpatient care has been restructured to include a new Consultant led multidisciplinary clinic in Preston, to commence in June The move will mean that the excellent care offered by the wider members of the multidisciplinary team, becoming centralised. Mr Chidi Ekwobi BSc(Hons) MBBS MSc FRCS(Plast)Glasg Clinical Lead for Burns, Lancashire Teaching Hospitals NHS Foundation Trust Page 20 of 27

21 Sheffield Teaching Hospitals NHS Foundation Trusts Northern General Hospital Burns Unit Sheffield Teaching NHS Foundation Trust is a designated Trauma Centre for the region. The hospital now has a helipad directly linked to the Emergency Department. The Adult Burns Unit is collocated within the Major Trauma Centre Site at the Northern General Hospital There have been no significant physical changes to the unit in the last 12 months as the Unit has only been on its current site since It is a modern, well designed Unit with excellent facilities and spacious layout. The Burns Service The Burns Service is provided in a standalone unit for both in patients 6 beds as well as the dressing and outpatient clinics.. It is in close proximity within the hospital to other key services, including Operating Theatres, Critical Care and the Renal Unit The clinical service is managed by 3 Consultants and there has been a full complement of junior doctors over the 12 month period. The clinicians are supported by a team of nursing staff which comprises of 15 Qualified Staff and 5 Support Workers as well as the other key members of the multidisciplinary team, Clinical Psychologist, Physiotherapists and Occupational Therapists. The unit had 2140 patient episodes throughout the year either as an inpatient or outpatient ward attender. Elderly patients continue to form a large proportion of the patients treated, despite that there have been no deaths on the Unit this year. There have also been no critical incidents in the last 12 months Patient Experience (Friends & Family Data April 17-March 18) During this financial year, patient feedback was gained from the Friends and Family Test. The response rate was 60%(amongst the highest in the Trust) and comments received were uniformly positive. You should be incredibly proud of your staff Amazing and Incredible care I couldn t have asked for more Every nurse went over and above to deliver my care David Ralston, MD, FRCS(Plast) Clinical Director Plastic and Breast Surgery, Consultant Burns, Plastic and Reconstructive Surgeon Page 21 of 27

22 Sheffield Children s Burns Unit Introduction Sheffield Children s NHS Foundation Trust is a designated Major Trauma Centre for the region and services a paediatric population of around 414,000 (0-16 years). The Unit has been active since 2006 and sees around 360 patients a year either as inpatients or outpatient ward attenders. The Burns Service The Burns Service during was based on a stand alone Burns Unit which was a 3 bedded ward with a fourth bed being shared with Neurosciences. The Burns Unit is now located in the new build area of the hospital still on the same site as many other key services, including PCCU and Theatres. Developments With the new build move the burns units staffing has been merged with the nursing staff from the Trauma and Orthopaedic Ward. A two year training plan has been developed to training Orthopaedic nurses in burns care Concerted effort has been made to improve the figures for patients receiving Psychotherapy screening prior to discharge so that we compare more favourably to national outcomes. Patient Experience During this financial year, patient experience was gained from a Traffic Light System The vast majority of comments were positive (12) and praised the hard work done by the Burns MDT Staff are excellent. Really helpful and very supportive which helped to ease a very stressful situation Can t thank all the staff enough for helping my little boy and supporting us as a family. Thank you so much Couldn t live without the Burns Unit. Friendly, helpful staff Page 22 of 27

23 Friends and Family Data for the Burns Unit (April 2017-March 2018) Theo s Burns Club Membership of the Club stands at 280 children from 0 to 18 years old Multiple well attended events run over the year (usually one a month) with additional family play sessions every other month Event highlights include: National day at Alton Towers (21 children attended from SCH) National Camp (6 attended) Christmas parties for over 8 years (21 attended) and under 8 years (70 attended) Annual Fundraiser Party in the Park in August 2017 raised 2,719. National Burns Awareness Day As part of the National Burns Awareness Day the Unit set up information points around the hospital (on the Unit, the Emergency Department, and Outpatients). South Yorkshire Fire and Rescue (SYFR) were involved and also set up a stall in Outpatients. The company Sun Sense gave out free samples of sun cream and advice about sun safety. The SYFR arrived with a fire engine for patients and family to explore. Governance The service ran three new audit/evaluation projects during the year Outpatients Workload in the Paediatric Burns Unit: A Service Evaluation Assessment of Current Use of Oramorph in Paediatric Burns Unit Review of Patients Developing Toxic Shock Syndrome and Parent Advice The Burns Service has taken in part in the following Research Projects during : Retrospective Review of Burns Unit Patients (IRAD: ) Use of Virtual Reality During Burns Dressing Changes Page 23 of 27

24 The Burns Service continues to improve it s compliance with the National Burns Standards (2013) and has been developing its internal teaching programme to ensure equitable educational access for staff members. It is expected that the move into the New Build will further improve the care offered in line with the Standards. Summary The Unit looks towards moving into the New Build which will provide better facilities for the care of Burn injured patients. The care given to patients is rated highly amongst the patient group. Theo s Burns Club continues to grow and offers an outstanding level of care for both patients and families. The staff on the Unit continue to seek to look for opportunities to improve the care they can offer their patients through audit/evaluation and research. The Burns Awareness Day is still used successfully as an opportunity for the Unit to inform the public and to address patient knowledge regarding injury avoidance David Ralston, MD, FRCS(Plast) Clinical Director Plastic and Breast Surgery, Consultant Burns, Plastic and Reconstructive Surgeon Page 24 of 27

25 South Tees Hospitals NHS Foundation Trust - James Cook University Hospital, Middlesbrough Burn Facility James Cook University Hospital in Middlesbrough is home to a busy, Major Trauma Centre. As part of this, the Plastic Surgery team provide Burns Facility level care for adults and children including in-patient care, surgery when required, specialist therapy and out-patient care to approximately 500 patients per year. Our immediate local population is approximately but due to the geographic spread of patients and hospitals in the North East of England our draining population is much larger at 1.1 million. We have a huge petrochemical and pharmaceutical industry in Teesside and other constituents of potential disaster include rail and motorway networks, airport and Nuclear power. We are the local hospital for the largest UK military base at Catterick. The majority of our patients injuries are small. We see approximately 10 new burns patients per week in the department, although our Emergency Department see and supervise the discharge of other patients to primary care. We admit on average one patient per week and we work closely with our regional burns centre In Newcastle to provide EMSB care and transfer of approximately 8 patients per year with larger and complex burns. Since we hosted an ODN peer review in October 2016 we have formalised the delivery of our service to hold a burns MDT every two weeks, alternated with a specific and consultant delivered burns clinic. This is in addition to daily plastic surgery dressing clinic access on our plastic surgery ward. We have held our first two AGMs attended by all of the plastic surgery staff and with presentations from all members of the team on activity and progress made. In the last six months we have instituted new patient and carer information leaflets within ED and the plastic surgery out-patient and ward areas with better and up to date contact information. Within the next six months we hope to be able to appoint a Clinical Nurse Specialist for the burns service to help increase burns clinic access and improve the quality of patients care; to help with nurse training within the hospital and further development of the service with the clinical lead. We have tried to raise our profile locally and nationally with presentations at the last three annual British Burns Association Meetings and with publications and presentations on the use of Diphoterine and Hexafluorine in chemical burns and our experience of DNA patients in our burns service. Burns Service Clinical Lead: Keith Allison, MBChB, MD, DIMC RCSEd, FRCS(Eng), FIMC, FRCS(Plast) Consultant Plastic, Reconstructive and Aesthetic Surgeon Page 25 of 27

26 St Helen s and Knowsley Hospitals NHS Foundation Trust - Mersey Adults Burns Service The Mersey Regional Burns Unit is the regional centre for all adult burn injuries covering Merseyside, parts of Cheshire, North Wales and The Isle of Man. Serving a total population of 6.5 million. The burn ward 4D has 12 burn beds with 8 individual cubicles, 4 of which are HDU level and is co-located next to the intensive care unit which has a normal working capacity of 5 staffed ITU beds in a segregated area for burn patients. The service had a busy year seeing 246 admissions to the burn ward and 645 attendances to the burn assessment unit (BAU) with 1424 outpatient episodes over this time. Mr Ian James, Consultant Burn Surgeon retired after more than two decades of dedication to Whiston hospital and our burns service. Sister Donnas Wilkinson transitioned from Burns Ward Manager and Burn Nurse Specialist to Outreach Nurse Specialist and Clinical Nurse Educator providing an outreach service to our region along with a teaching commitment to our burn nurses back at base. Sister Lindsey Bidston was welcomed into her new role of interim ward manager and is doing an excellent job. Highlights of 2017/18 One patient with over 80% burns and a Baux score of 155 was discharged with good function despite her poor prognosis and multi-resistant infection during her stay. It was another successful academic year with 14 presentations accepted for presentation at the 2018 BBA annual meeting in Swansea. The unit appears to have cleared the persistent multi-resistant pseudomonas from the service which was acquired from a patient from the Romanian Fire disaster. With input from Public Health England the experience generated a joint paper on learning points submitted for publication. Excellent friends and family test results. Ward 4D were the first ward in the Trust to receive a gold QCAT (quality care assessment tool) award with a score of 97% and the first ward to maintain it for a second year running with a score of 98%. Service Improvements 2018/19 Continue to maintain infection prevention. Further develop the outreach service and focus on the education and development of junior medical, nursing and therapy teams. Report from Kayvan Shokrallahi - Consultant Burns, Plastic & Laser Surgeon, the Clinical Lead at Mersey Regional Burns Service, Whiston Hospital, Liverpool. Editor-in-Chief: Scars, Burns & Healing, Associate Editor: Annals of Plastic Surgery, Vice-Chairman: The Katie Piper Foundation and, Chairman: Communications subcommittee, British Burn Association Page 26 of 27

27 Manchester University NHS Foundation Trust (MFT) - Wythenshaw Hospital Adult Burns Service Introduction The Manchester Burns Service (MBS) is located at Wythenshawe Hospital (WH) for adults and the Royal Manchester Children s Hospital (RMCH) for Children, and both part of the Manchester University NHS Foundation Trust (MFT). Both services operate at Burn Centre level. Wythenshawe is not a major trauma centre, however RMCH is a major trauma centre. The hospital at WH now has a helipad directly linked to the Emergency Department. The Burns Unit is collocated within the trauma quarter of the hospital (Acute Block) and has access to an internal burns theatre and has 2 ITU beds within the department. Main intensive care in adjacent. There have been no significant physical changes to the centre in the last 12 months. The facility and the staffing provide a flexible and hybrid system allowing for quick adaptability depending on capacity needs. The Burns Service The Burns Service physically occupies the Burns Centre that is a well-defined space secure access and has 12 beds which include 3 HDU level and 2 ITU level beds. In house as well we have a physiotherapy and occupational service and an Outreach service. We also have a dietician and a psychologist who is in the process of appointing a psychology team. We have a Complex Needs Discharge Facilitator. A microbiologist attends our MDT. We have 4 dedicated PA sessions for theatres and 3 PA for MDTs per week. We have a dedicated Hot week consultant on site every day of the week and run a separate Burns Rota for oncall. The unit is staffed by 9 consultants, 2 registars and 2 CT grade level doctors. Catchment Area Figures ADULTS (Age 16 and over) Number of adults 1a TBSA% Burn Injury <10% b TBSA% 10% to <40% 16 1c TBSA% 40% 5 1d Total all Adult Referrals 1054 Ward Attenders 161 Burns Outreach 663 Page 27 of 27