Purpose

The primary concern of the ODN board is to facilitate, through ODN activity, high quality individualised care for patients requiring these services. It will identify and monitor strategic aims, align service development to national and local priorities and ensure identification of future needs to maintain and improve patient access and equity of service delivery to the required standards.

The ODN board will formally review NHS business cases for expansion (or contraction) of these specialty areas of care to ensure effective and efficient use of resources and to minimise loss of specialty capacity. The ODN board will not be responsible for funding of these services but may recommend transfer of funds from one provider to another to ensure continued capacity across Cheshire & Mersey.

The ODN board will receive formal reports from each ODN regarding progress of work plans and identification of network risks. It will receive benchmark reports relevant to each specialty and make recommendations for remedial action to alleviate quality or capacity risks as required. Exception reports may be included as needed.

Cheshire & Mersey (& the Isle of Man) Major Trauma & Adult Critical Care Networks

Who are we?

A small team of senior NHS staff who provide specialist clinical expertise, advice and guidance to providers and commissioners regarding the major trauma and adult critical care pathways.

• C & M Critical Care Network (CMCCN) covers all aspects of adult critical care including intensive care (level 3) high dependency care (level 2) and specialist critical care (e.g. neurosurgery, cardiac surgery). We also link with associated acute care pathways (e.g. renal, spinal), rehabilitation and paediatric critical care.
• C & M Major Trauma (CMMTN) covers the major trauma pathway (children and adults) from pre-hospital care to rehabilitation. This includes clinical aspects of a major incident response across the healthcare system.

What do we do?

We are a co-ordinator and facilitator for all stakeholders to achieve a collaborative approach to safe, equitable and effective service delivery. We work across organisational and professional boundaries to improve the patient pathway reduce variation and define best practice.  We consider implications to patients and staff of changes to care delivery and redesign and are a positive influence to those driven by current research and best practice. We provide quality assurance through:

• Identification and spread of best practice
• Benchmarking  services against  national, regional and local standards and regulations
• Service accreditation and recommendations for improvement based on a robust framework for each network
• Development of consensus guidance (policies, protocols, guidelines etc.)
• Clinical Governance encompassing incident reviews, identification and management of risk (networks are non-statutory organisations) and adverse outcome review
• Provide forums for clinical, operational and strategic discussion, sharing of best practice/lessons learnt and peer support.

Nationally both networks have a high profile and are seen as exemplars of this network model. A number of team members have held or currently hold a variety of national roles and continue to influence national developments, standards and processes.

What have we achieved?

CMCCN Key Achievements - examples

• Established Service Improvement Lead posts  (0.20 WTE seconded in each critical care unit); collectively delivered over 750 network wide and local projects
• Established adult critical care service specification providing assurance for service compliance. Table 1 (below) shows steady progress to standards achievement. Although additional fields are added each year there has been an overall increase in compliance with 100 sub-sections (fields) where all units fully comply with the specification (or that field is not applicable). Reassuringly there are no fields where compliance has reduced. 
• Ensured access to complex rehabilitation for critical care patients through the rehabilitation network implementation board
• Established standards for critical care transfers (inter- & intra-hospital) and audit compliance; commissioned the SCITT (Safe Critically Ill Transfer Training) eLearning programme and implemented across the NW
• Established principles for critical care capacity management, developed and supported local and NW escalation plans and processes, audit delayed discharges
• Produced numerous guidelines, consensus best practice and publications some of which have been adopted at national level

Table 1: Network Specification compliance year on year   

CMMTN Key Achievements - examples

• When major trauma services were reconfigured across England in 2012-2013 Cheshire & Mersey had some of the poorest outcomes. Since the instigation of major trauma networks this has improved to being second in the country (see Fig 1. & 2. below).
• A single framework of SOPs for major trauma care implemented across the network
• Implementation of a single receiving site (adults) Major Trauma Centre Collaborative (MTCC) (Aintree & The Walton Centre)
• Implementation of Enhanced Pre-Hospital Care across the NW provided by a partnership between the North West Ambulance Service and the North West Air Ambulance Charity
• Rehabilitation network that leads the country in provision of rehabilitation for patients with complex needs following trauma &/or critical care
• Developed into a mature network through CMMTN leadership with excellent clinical engagement with both the MTCC and trauma units, collaboration and implementation of best practice (e.g. chest injury pathway, trauma ward, sharing of trauma team leader rotas between Major Trauma Centre and Major Trauma Units consultants, )
• Introduction of a robust governance process to review relevant clinical incidents, reduce variation in practice and improve patient safety

 What are our current objectives?

1: Improving patient centred pathways

2: Enhancing patient safety

3: Promoting equitable access

4: Developing a sustainable workforce

5: Supporting the response to network-wide events

6. Advice to acute sustainability programme

7. Setting and maintaining standards for MT & CC specialist pathways

Contact us

If you would like further information, have any queries about our work or would like to get involved please visit our websites (www.cmccn.nhs.uk and www.cmmtn.nhs.uk), contact the network office (tel: 0151 5563260) or contact one of the team:

Network team members:

CMCCN Interim Director Julie Peacock  julie.peacock8@nhs.net

CMMTN Networks Administrator Nicola Ludlam  Nicola.ludlam@nhs.net

CMCCN Medical Lead  Dr Jonathan Walker jonathanwalker@nhs.net

Quality Improvement Lead Nurse  Karen Wilson   Karen.Wilson93@nhs.net

Clinical Information Lead Joanne Fynn    j.fynn@nhs.net

CMMTN Medical Lead  Dr John Matthews  john.matthews@sthk.nhs.uk