The London Trauma System – Progress to date Simon Robbins Senior Responsible Officer Major Trauma Project 10 th September 2009

Context

Case for Change NCEPOD % of severely injured patients received sub-optimal care. Organisational Needs regional planning Data collection Clinical Lack of appreciation of injury severity Incorrect clinical decision making Lack of seniority of staff especially at night and weekends Victoria Australia – established Trauma System – 8 years of data The proportion of road trauma victims admitted to MTCs increased from 34% to 62% Unadjusted in-hospital death rate fell from 15% to 11% Adjusted odds ratio for death in major trauma patients fell 38% across all patient groups, 44% for road trauma and 38% for serious head injury

Project Objective To design and implement an inclusive trauma system that assures the care of all injured patients and ensures that optimal care is provided at all stages of the patient journey

Benefits of a London Trauma System Improved patient outcomes A system-wide prevention strategy to reduce the number of people suffering severe injury Improved education and training of those delivering trauma care Increased ability to deliver a pan-London Major Incident Plan More people surviving injury and returning to optimum social and economic functioning

Project Phases Phase 1 – Exploration – Until August 2008 Design a trauma system and trauma pathway for London Run a preliminary phase to determine provider interest Develop designation criteria and process Determine incidence, travel times Phase 2 – Preparation – August 2008 – Summer 2009 Run designation process x 2 Public consultation on options Implementation planning Phase 3 – Implementation – Summer 2009 onwards Decision by Joint Committee of PCTs (31 in London) Commissioning elements of the London Trauma System

Principles of the London Trauma System Comprised of networks Led by London Trauma Director Triage to Major Trauma Centre (MTC) or Trauma Centre (TC) Triage supported by clinical co-ordination desk Under-triaged patients do not require “permission” for transfer from TC to MTC Agreement around rapid repatriation to TC Rehabilitation – at network and system level Pan-London and local protocols

The Trauma System comprised of networks

Exploration Phase - Incidence Around 1,600 major trauma cases per year +/- 400 About one case a week for most A&Es (< 0.1% of total workload) Most Major Trauma occurs in central London

Travel times All MTCs within 45 mins by blue light Public expectation - videos London compared to rural areas Helicopters

Public Consultation

3 networks with April 2010 delivery date 2 networks for delivery by April 2012 How to arrive at a preferred option? JCPCT decision announced Monday 20 th July

Four networks – JCPCT preferred option

Next Steps Implementation London Trauma Director in post Establish London Trauma Office –System-wide TARN –Performance monitoring and quality imporvement Commissioning and Finance –LSCG will commission Major Trauma Centres and Trauma Networks –Trauma Centres will be commissioned by SACUs Service specification is agreed TARN sign up and data submission in all TCs