CM/AP/lp/s:secure/CE/Burns
4 August 2005
To:
The Chairmen of Health Overview and Scrutiny Committees
The Chairmen of Patient and Public Involvement Forums
Cc:
SHA identified leads for burn services
Specialist Commissioners
Preston Hall
Aylesford
Kent
ME20 7NJ
Tel: 01622 710 161
Fax: 01622 719 802
Dear Chairman
Improving services for people with burn injuries
I am writing to invite you to take part in a consultation on proposals to improve the health outcomes for
people with the most complex burn injuries (about 1,000 a year in Britain).
You may be aware that existing burn services have developed in an ad hoc way in a range of settings
from district general hospitals to specialist services. Over the past two years, the National Burn Care
Group (NBCG) has been taking forward recommendations from the National Burn Care Review
Report, published by the British Burn Association in March 2001. The main recommendation was that
burn care services should, in order to improve patient care and optimise recovery outcomes, be
organised according to the complexity of burn injuries.
A lot of work and thought has gone into identifying exactly how such outcomes are reached and the
recommendation would mean that services dealing with the most straightforward burn injuries, would
be located in most district general hospital Plastic Surgery departments and become known as Burn
Facilities. A number of hospitals across the country already provide some specialist burn services
and, as Burn Units, they would continue to deal with patients requiring resuscitation and/or high
dependency care, as well as acting as a Facility for their local population. A few of these would also
be regional Burn Centres (probably seven for adults and four for children) for patients requiring the
most complex or intensive care. Burn Centres would act as Units and Facilities for their local
populations. In common with other clinical specialities, the numbers of units and centres are based on
the critical mass of cases that supports good practice and optimum recovery outcomes.
The Facilities, Units and Centres would work together in four managed networks (North East, North
West, Central and South) to provide appropriate services as close to the patient’s own home as
possible. None of the current burn injury services would close – but a number of them would use a
protocol they have already agreed to decide which cases were complex enough for them routinely to
refer to either a Burn Unit or a Burn Centre.
This approach supports the following principles:

Burn injury patients will only be admitted to hospital under the care of specially trained staff after
being initially stabilised in the nearest Accident & Emergency Department.

Children and adults will be considered separately while being able to share the best aspects of a
scarce service.

Patients will receive the best care possible, which may not always be from the nearest burn
service

The network approach will enable patients to be cared for in specialist services for the most
acute phase of treatment and use services closer to home for continuing care and rehabilitation.

Staff will best maintain specialist knowledge and skills by caring for a critical mass of the most
complex cases.

The service will be equitable for all patients.

Services will be close to their centres of population and enable a nationwide approach to
capacity planning.
Chairman: Kate Lampard
Chief Executive: Candy Morris

Care audit and research could be better undertaken.
In 2004, the process for identifying which hospitals should be Burn Facilities, Units or Centres was
circulated to Burn Injury Services, patient support groups and the NHS. Five road shows were held
across the country so that stakeholders could discuss them. In addition, 86 people from all clinical
disciplines, patients, at least one Overview and Scrutiny Committee and the Department of Health
took part in a Stakeholder Day where they agreed the weighting of the various benefits that this
stratification of services would bring for burn injury patients.
By around the end of September 2005, a sub-group of the NBCG will be in a position to propose
where the Facilities, Units and Centres should be. The full NBCG will then agree a set of proposals
and associated consultation arrangements and hopes to be in a position for a three month public
consultation to begin in December.
This is the first time a consultation of this kind has been held since the creation of Overview and
Scrutiny Committees and Patient and Public Involvement Forums. It involves a number of regional
debates that are co-ordinated to describe nationwide arrangements for a specialist NHS service – and
it is important that it can be properly scrutinised. But at the same time we must recognise that
stakeholders in many areas of the country will not have strong views about which regional centre of
population they would want to host their nearest specialist service for the most complex burn injuries.
Discussions with the Department of Health, the Centre for Public Scrutiny (CPS) and members of the
CPS Practitioners Forum, have suggested that those Patient and Public Involvement (PPI) Forums
and local authority Overview and Scrutiny Committees (OSCs) wishing to take an active part in the
consultation process will receive a full consultation document and will be responsible for forming
themselves into joint PPI Forums and joint OSCs for the purpose of making a formal response to the
issues. In some parts of the country OSCs and PPIFs are already involved in this process.
Members of the NBCG will, of course, be happy to attend meetings convened to discuss the proposals
and will hold regional meetings for stakeholders so that information is provided and discussion
promoted. A National Burn Care Group website containing all the background work and information
will be published in good time to support the consultation process.
It would be helpful if you could notify the Project Manager, Lyn Wray, if you wish to participate in this
consultation. Contact details are below.
If, however, you are satisfied that the process is being carried out in a manner that will ensure a
pattern of service that is in the best interest of patients across the country, then you may feel that your
active participation is unnecessary. In that case, it would be helpful if you would signify your position
by email or letter to Lyn Wray. A response by 30 September 2005 would be appreciated.
Thank you for considering this way of working.
Yours sincerely
Candy Morris
Chief Executive, Kent & Medway SHA, Chairman, National Burn Care Group
Contact details:
Mrs Lyn Wray, Project Manager
Specialist Commissioning Group
Victoria House, Capital Park
Fulbourn, Cambridge CB1 5XB
Or
lyn.wray@erscg.nhs.uk
Attached:
 Membership and Terms of Reference of the NBCG and its Options Sub-Group
 Indicative timetable
Chairman: Kate Lampard
Chief Executive: Candy Morris