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Service principles

Specialised burn care: Principles for service development and effective network working is the latest report from the Specialised Burns Project. This report was previously described as ‘the model of care’. The new title more accurately reflects the content and direction of the recommendations made.

The report makes a series of recommendations and proposes clinically led solutions to improve service delivery and ensure the provision of high quality specialised burn care services in the future.

The recommendations made are underpinned by several key principles:

• patient centred care
• maximisation of access to services wherever possible
• provision of care as close to home as clinically appropriate; service delivery through a network aligned to the patient pathway
• recognition of the importance of a workforce with the appropriate specialised expertise.

These requirements should be met for all patients irrespective of where they live, where they are injured or the severity of their injury.

Background

The National Burn Care Review (NBCR) report published in 2001 recommended a national service model where care would be provided for minor burn injuries close to home and care for severe burn injuries would be provided in centralised specialist centres that have greater resources and expertise.

It proposed a three tier service model:

• Burn facilities (BF) that care for people with minor burns and are linked with local plastic surgery services. These services would treat the majority of patients and access would be close to home.
• Specialised burn units (BU) that provide regional care to patients with a burn of moderate size and/or complexity. These services would treat patients across a wider area.
• Specialised burn centres (BC) that provide care for patients with the most complex injuries, of which there are very few. These services would be provided in a small number of centres in order to concentrate expertise, ensuring the best clinical outcomes.

It recommended that specialised burn services should be adult only, paediatric only or combined. Burn services at a given level will also provide a service to treat patients with minor burn injuries for their local population. For example, an adult burn centre will also provide an adult unit and facility level service. The majority of minor injuries can be dealt with in a primary care setting, with referrals made, where necessary, to a specialised burn service.

There is clinical consensus that the three tier model for specialised burn services, recommended by the 2001 NBCR, represents the best overarching structure for delivering high quality specialised burn services to patients in London and South East England.

Development of this report

Principles for service development and effective network working presents a set of proposals and recommendations which address the issues identified by the case for change. Recommendations made are mindful of the ongoing national work to update the burn care standards and the development of clinical outcome measures for specialised burn services.

Similarly to the process involved in the development of the case for change, this report has been clinically led by a multidisciplinary panel of expert clinicians. This panel included burns and plastic surgeons, nursing staff, therapists and anaesthetists from across the region.