Thames Valley Trauma Network
A suggested structure and function
This document discusses what the Thames Valley Trauma Network might have as its major
goals and roles, how it might be structured in terms of committees and working groups, and
who should be on the Network Board. It will also raise some issues concerning governance, but
it cannot answer them. This document is written because it is apparent that at present (end
February 2012) there is no functioning network and no agreed set of goals and roles, no agreed
membership, no agreed way of functioning and no agreed governance arrangement. The
document proposes some ideas that will need extensive consultation and discussion, and they
are at present purely personal and reflect my own ignorance, and my own interests. It is
centred on a proposed Thames Valley Trauma Network (TVTN) board, a committee that will be
responsible for the whole network (both acute trauma and rehabilitation). This committee will
contain no more than 12 members who need to represent and/or consider the interests of all
interested parties. It suggests that three major sub-committees would be needed to cover acute
trauma, rehabilitation, and community services and long-term support services.
1.0
INTRODUCTION
On April first 2012 the Major Trauma networks are expected to start work. But at
present in the Southern England Strategic Health Authority area there are no fully
functioning trauma networks in place covering both the acute trauma part and the
rehabilitation part of the network. Moreover at present there does not appear to be any
preferred or proposed set of roles, functions or structures.
1.1
However a network needs to have a clear framework setting out both what it is
supposed to achieve, and how it is going to function in pursuit of its goals. The
functions will determine the structure needed, and the goals will to an extent determine
its governance arrangements.
1.2
This document draws upon an earlier document that considers in general the purposes
and functions of a network, and this document is available (Thames Valley (Trauma)
Rehabilitation Network. A discussion document.) It was written on January 29th 2012.
2.0
ONE NETWORK, OR TWO?
There are two clinical directors appointed to lead the Thames Valley Trauma Network,
one for Trauma (Dr Simon Hughes) and one for Rehabilitation (Dr Derick Wade).
There has been no specific guidance as to whether there should be one network, or two
separate networks with one focused on acute trauma management and one focused on
rehabilitation.
2.1
The advantage of two separate complementary networks is that it ensures that each
component is recognised as a legitimate are of interest with assumed equal importance.
In any single network there is a risk that one or other component might dominate
discussion and might dominate resources available.
2.2
There is a very substantial disadvantage to having two networks: it perpetuates the
false belief that rehabilitation is somehow a separate process that occurs unrelated to
trauma management, and it perpetuates the false belief that somehow rehabilitation
Thames Valley Trauma Network; a discussion on organisation. March 4th 2012
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only occurs after trauma care is complete. To be effective and efficient, rehabilitation
must be a process that occurs in parallel with other healthcare processes from the outset
(i.e. from time zero). It must not be considered separate in any way.
2.3
There are other less important disadvantages. Separate networks would need and use
more resources. They will increase the risk of policies not being aligned towards the
same goal. Resources might all be given to one network.
2.4
I strongly recommend a single clinical network to encompass both the acute medical
and surgical management of the trauma itself and the rehabilitation process. Only in
this way will the changes deliver a high quality service that maximises the use of all
available resources and maximises patient outcome.
3.0
NETWORK GOALS AND ROLES
The primary goal of the Trauma Network is to ensure that each and every patient who
suffers trauma achieves the best possible long-term clinical outcome given the initial
trauma, and does so in the most efficient way possible. In other words, the goal is to
deliver a service to the population that is both effective and efficient.
3.1
It must be noted that this goal applies across all patients; it is a goal applied to the
whole population of people with trauma. Consequently the network is concerned not
simply with patients who are in the system, but it is also concerned to ensure that all
patients who should benefit from the network’s services actually do so.
3.2
It must also be noted that the goal concerns the long-term clinical outcome, which can
be defined as ‘quality of life’. In practical terms this means for each patient:
minimising pain and other troublesome symptoms, and/or
maximising the range of functional and social activities that an individual can undertake,
and/or
minimising emotional distress, and/or
optimising satisfaction with social role functioning.
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3.2
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The subsidiary goals of the network needed to achieve this overall aim are to:
ensure that every patient with trauma is identified and transferred to an appropriate
trauma service as soon as possible
ensure that new trauma patients can always be admitted by facilitating transfer of
patients out of acute trauma wards as quickly as possible.
arrange that each transfer is to a service with the necessary clinical and care skills and
resources, able to meet all the patient’s needs
make sure that transfers of care are smooth and clinically appropriate
engaging other non-health organisations in the process, both statutory and voluntary
organisations
auditing the processes to identify any opportunities to increase effectiveness and to
reduce inappropriate or ineffective use of resources
auditing patient satisfaction and patient outcome
developing new services and re-organising existing services in response to audit and
patient feedback
Thames Valley Trauma Network; a discussion on organisation. March 4th 2012
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3.3
The primary role of the Trauma Network is to monitor and improve the quality of the
network’s performance on a continuous basis, this being achieved through collecting
and analysing data on the structures, processes and outcomes of the network .
3.4
It must be noted that this applies to the whole network; obviously the network’s
performance depends upon performance of individual components but where a part of
the network fails to deliver an adequate service, the network as a whole has the choice
either of trying to improve the quality of care from that part or of removing that part
from the network. In other words, the network’s main concern is with the overall
performance, and it is possible for services to be added to or removed from the
network.
3.5
Therefore the subsidiary roles of the network are, in close consultation with the
membership of the network, to:
identify the data needed about:
o structures available and used – resources, organisational arrangements etc
o processes being used – pathways
o outcomes, both patient-centred and also network-centred
develop and maintain systems for collecting data about:
o structures available and used – resources, organisational arrangements etc
o processes being used – pathways
o outcomes, both patient-centred and also network-centred
ensure that the data provided by services are:
o valid, representing actual structures, performance or outcomes
o timely, being delivered as soon as possible
o complete
analyse the data to:
o give timely feedback to all services about their performance
o identify areas of good (efficient and/or effective) practice
o identify areas of inefficient and/or ineffective practice
o identify areas where new services and/or resources are needed
o identify areas where services and/or resources can be reduced or moved to a
more appropriate place within the network
o identify opportunities to link in with and use other resources not currently within
the network but able to meet the clinical needs of trauma patients
develop and consult of ways in which the network’s performance can be improved, at a
strategic level
engage the services within the network in undertaking service change and development
on a collaborative basis
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4.0
SUGGESTED ORGANISATIONAL STRUCTURE
It is clear from the above discussion that success can only be achieved if there is general
agreement on the overall aims of the network by all parties, and if all parties work
together collaboratively. It is also clear that the network will involve a large number of
services and organisations across a large geographic area and also from outside the
NHS. It is also clear that there needs to be some way of organising and developing the
whole network. This section considers the difficulties and suggests a solution.
4.1
The following organisations have a legitimate interest in the Network:
Thames Valley Trauma Network; a discussion on organisation. March 4th 2012
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 Commissioners, both specialist commissioning and local commissioning. The Thames
Valley encompasses at least two and possibly more local commissioning bodies.
 Local NHS provider Trusts. This probably includes not only ‘acute’ Trusts, but also
Trusts that encompass community services and mental health services.
 Individual services within NHS Trusts (e.g. the Trauma services, spinal injury services,
burns units etc)
 Local General Practices
 Commercial and not-for-profit organisations that do or could provide services (e.g.
Thomas Edward Mitton House in Milton Keynes)
 Social Services, and services within Social Services
 Housing services, employment services, educational services, schools etc
 Voluntary organisations, especially any providing services on a paid basis (e.g.
Headway)
 Patients and families
4.2
It is obviously impossible to have a single committee or board that has representatives
of each and every service, or even each and every organisation that has an interest.
4.3
Therefore the following organisational structure is suggested.
4.4
Trauma Network Board
There should be a Trauma Network Board that takes responsibility for the whole
network and its performance.
4.5
This network board would have a membership of no more than twelve people. Its
members would be responsible for considering and representing the view of all
potentially interested parties, not simply their own individual views or the views of
their parent service or organisation.
4.6
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4.7
The membership should cover a wide range of expertise and interests, and membership
would be based upon the areas of interest and expertise on individuals more than their
host organisation. It should cover:
commissioning
management, including finances
acute trauma services
specialist rehabilitation services
general rehabilitation services
community-based services, including general practice
Social Services and other statutory services
voluntary services
patients
different clinical areas (musculo-skeletal, neurological/spinal injury, burns, paediatric)
different professions (doctors, psychologists, nurses, therapists etc)
the three subcommittees mentioned below
The Board would be chaired by one of the two Clinical Directors (acute trauma,
rehabilitation). All members would be expected to have a nominated deputy able to
cover as much of their roles as possible. The members are likely to be senior people
within their organisation, and to have some knowledge of trauma service. The patient
Thames Valley Trauma Network; a discussion on organisation. March 4th 2012
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representative could be a patient, a relative, or someone from an organisation of
patients.
4.8
Three subcommittees, and working parties
Below the Board there would be three major sub-committees focused on:
 acute trauma services
 rehabilitation services
 long-term and community support services
4.9
A member of each of these three sub-committees would be on the Board. As it is likely
that the two Directors would chair the two Health subcommittees this should not be
difficult to ensure.
4.10
Below this there could be as many working groups as needed. It would be preferable to
have working groups with specific goals and an expected life-span rather than subcommittees that might expect to continue indefinitely.
4.11
Support services
The Network would need some support services, and the most important of these
would be a department responsible for data handling.
4.12
Governance
It is not clear to me at present who the Network board is accountable to, or how it is
financed and supported.
4.13
As far as I know, the Network is currently the responsibility of the Major Trauma
Centre which, in the Thames Valley, would mean the Oxford University Hospitals NHS
Trust. However this does not necessarily seem the most appropriate long-term
arrangement, and it should probably be accountable to and funded by the South of
England Strategic Health Authority once formed, and the South Central Strategic
Health Authority at present.
5.0
RELATIONSHIPS WITH OTHER TRAUMA NETWORKS
It is likely that trauma networks will vary in their organisation and processes, which is
reasonable as (a) circumstances vary and (b) it allows experimentation with different
structures and comparison of advantages and disadvantages. However it is likely that
Wessex and Thames Valley will share much in common, and we might have a
particular relationship.
5.1
At present all one can say is that there should be some mechanism set up for networks
to share experiences and collaborate, and to allow non-competitive comparisons to be
made.
6.0
SUMMARY
This document proposes a structure for a trauma network, this being derived from a
particular set of goals and roles for the network.
Derick T Wade,
Consultant and Professor in Neurological Rehabilitation
March 4th 2012
Thames Valley Trauma Network; a discussion on organisation. March 4th 2012
Director of Trauma Rehabilitation, Thames Valley area (Bucks, Berks, Oxon)
Oxford Centre for Enablement, Windmill Road, Oxford OX3 7HE
Tel: 01865-737306; Fax: 01865-737309;
email: derick.wade@ouh.nhs.uk; derick.wade@ntlworld.com
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