Peer review visit date: 26th February 2015
Compliance against national measures: 53%
Sussex benefit from a proactive Network Clinical Director who is well supported by a Network Manager and both are assets to the network. The network during the last twelve months has made significant improvements in terms of developing and implementing a more robust governance system, from the initial embryonic structure and this is to be commended. There is good engagement from constituent organisations, complemented by good active involvement from medical and allied medical professionals across the network, including units on the periphery.
At the time of review there is no network rehabilitation director in place or any funding to support this role and this needs to be addressed.
There is a network board and clinical advisory group in place, together with a data group and education and training group, the latter two being sub-groups of the network board.
There is executive representation at network board meetings and these meetings take place on a quarterly basis.
A clinical governance half day audit meeting was undertaken during January 2015 and some feedback was given to organisations, however this needs to be undertaken on a more formal basis and include the Kent, Surrey and Sussex Sub-Regional team and respective Clinical Commissioning Groups.
The continued delay in the transfer of neurosurgical services from Hurstwood Park Neurological Centre (HPNC) to the MTC site at Brighton remains a concern, and although assurance was given during the review meeting regarding timescales, it is essential that the network management team together with commissioners continue to closely monitor the transfer of these services. Any further delay could impact on the viability and sustainability of the MTC.
During the review discussion, commitment was given by trusts on the periphery of the patch to review patient pathways once neurosurgery has transferred to the Brighton site from HPNC.
The network evidence was well presented and ensured that the review progressed smoothly. At the time of review network protocols and guidelines remain in development. There is a picture archiving and communication system (PACS) in place across the network, which enables good access to images and the network has facilitated a data sharing agreement between organisations to support the sharing of these images.
There is a network CT protocol for adults, which is based on enabling TUs to use their own systems and together with a paediatric version for children. It is important that the network closely monitors arrangements in organisations to ensure that practice remains broadly the same and ensures a more detailed policy in terms of investigation is developed.
Guidelines for head injuries of AIS3+ require further development, as the time to CT is outside of NICE recommendations. The network team acknowledged that further work is required in relation to the production of rehabilitation guidelines and pathways. It would also be beneficial to liaise with the South East London and Kent and Medway trauma network regarding provision of rehabilitation for those patients in the north of Sussex.
Although the MTC has undertaken a useful patient experience exercise, there is a need to consider how this can be rolled out and achieved network wide.
A network transfer protocol has been developed but there is a need to audit this to ensure that it has been fully implemented at a TU level.
There are plans in place for a web based system for repatriation which will facilitate a smooth pathway of repatriation from TU’s, as well as supporting the completion of rehabilitation prescriptions – the review team considered this to be an innovative approach.
There is one patient representative on the network board which is positive; however, there is a need to increase this valuable representation.
A more robust programme for network audit needs to be developed, together with a more consistent approach to education and training. The review team welcomes the establishment of working groups and anticipates significant progress during the next 12 months.
Funding streams for rehabilitation and education and training need to be identified. It would be beneficial to consider regional funding streams (such as ‘learning beyond registration’).
A network wide major incident plan needs to developed, as although individual ones exist these differ on each hospital site.
During the review discussions at TUs, concerns were expressed regarding the potential de-skilling of certain groups of staff as a result of the major trauma pathways and this needs to be considered more widely at a network level.
A network rehabilitation directory has been established which is positive.
Good practice / significant achievements
- Committed Clinical Lead and Network Manager.
- Web based approach to repatriation.
- Patient engagement.
- Engagement from TU teams.
- Development of governance processes.
- Half day audit meeting.
- Lack of network rehabilitation director.
- Neuro-surgery not centralised at the time of review.
- Lack of audit activity.
- Not all guidelines consistent (e.g. emergency planning).
- Funding streams for rehabilitation and training.
- Rehabilitation provision for patients in North Sussex.