How we developed our proposals
Assessed current provision
The programme team collected data on major trauma, on where and when it happens. The team took into account the population in each areas, to help anticipate how many people will suffer from major trauma, what/where care will be needed and how many beds are needed across the region. We took into account patient flows across the regional border and anticipated population growth. We also reviewed the strengths and weaknesses of the current services and asked our hospitals which level of service they wanted to provide. We mapped the catchment areas for services, base don a target 45-minute journey time and an agreed triage protocol, in order to develop the most effective system configuration. We took into consideration journey times on both urban and rural roads, teh effects of rush-hour traffic, proposed population expansion and the potential sites for major trauma centres just over the borders of our region.
Our information sources include the TARN (the Trauma Audit Research Netowrk); the East Midlands Ambulance Service; the East Midlands Public Health Observatory; the perforamnce intelligence unit of the strategic health authority and national reports.
Developed service models
Evidence tells us that we require:
Local data tells us:
That the number of people across the region who experience major trauma is relatively small at around 660 cases per year, which equates to less than 0.2% of Emergency Department activity.
A clinically appropriate transport time for our geography would be 45 minutes (from assessment at scene to accessing the correct level of service)
In developing our plans we have also taken into consideration:
The plans of the five regions that border the East Midlands
The aspirations of our hospitals
Views of the national trauma lead and the national and local clinical advisory group
Predicted population growth (particularly the Milton Keynes South Midlands (MKSM) growth agenda)
Set minimum standards for services in line with national guidance
We specified minimum standards of care for all levels of service. For example, the major trauma centre must offer 24-hour access to a consultant-led major trauma team. Trauma units must provide selected trauma management with a consultant on call within 30 minutes. All providers must offer appropriate facilities for relatives and clear patient information.
Undertaken gap analyses & development planning
In December 2008, hospital trusts were asked to say which level of centre they would like to provide. A gap analysis in April 2009 highlighted the services trusts already have in place and what needed to be done to bridge any identified gaps.
Nottingham University Hospitals (NUH) was invited to develop a service development plan in order to demonstrate its ability to meet the criteria required to be the region’s Major Trauma Centre. The NUH board is working with the SHA and NHS Nottinghamshire County as lead commissioner for NUH, on the development of its plans to become the regional major trauma centre. These plans still need to be formally approved before NUH can be officially designated as the East Midlands regional trauma centre. Hospitals that aspired to be trauma units were also asked to complete a development plan against their gap analysis.The final configuration of trauma units will be agreed by local PCT commissioning teams. As part of the above process all potential providers were asked to demonstrate how they could meet minimum standards.
It was identified that there is a need for a Major Trauma Network to support the East Midlands trauma and major trauma system. The configuration for the Network is being developed by members of the East Midlands Specialist Commissioning team in conjunction with Major Trauma programme team.
Assessed the impact on health inequalities
The programme carried out an Integrated Impact Assessments on the changes proposed. These included Health Impact and Equality Impact Assessments.