Case for change

The case for change looks at whether specialised burn services in London and South East England can be improved to ensure they are of high quality and sustainable for the future. The project scope includes adults, children and young people who require treatment from a specialised service. It does not include people with a burn injury that can be appropriately treated in primary care or at a local emergency department (ED).

Over the last ten years several reviews have made recommendations to improve specialised burn care services in line with National Burn Care Standards. However, national standards have not been fully implemented within London and South East England.

The case for change found that improvements to specialised burn services in London and South East England are needed to ensure sustainability for the future and equal access for patients with a burn injury requiring specialised expertise.

The Burns Clinical Expert Panel agree that the key issues facing specialised burn services in London and South East England are:

  • The positioning of services: Current services are not positioned in line with factors such as population density, deprivation levels and concentration of need
  • Care for minor injuries: There is a lack of facility level services  which provide treatment for minor burn injuries which has contributed to a gap in service provision in the north eastern part of the network
  • Lack of effective network working and infrastructure: Historic referral patterns, lack of support for local emergency departments (EDs) and joined up working arrangements with community health services mean that care for patients with burn injuries requiring specialised care is sometimes fragmented
  • Paediatric intensive care provision: The network’s paediatric burn centre is not co-located with a paediatric intensive care unit. Co-location of paediatric burn centres with a paediatric intensive care unit is a national standard
  • Co-location with key support services: One service is not co-located with the supporting services of a general hospital, for example an emergency department and general intensive care
  • Severe space constraints and capacity: Severe space constraints and lack of capacity at one provider in outpatients and critical care mean it cannot effectively serve the regional population
  • Major incident resilience: The infrastructure of current services and resilience within the network may not be adequate to cope with major incidents involving a high number of burn injuries or outbreaks of infection.