Innovation in London: Major Trauma Centres get ready to develop integrated psychological treatment pathways for Major Trauma patients

London has implemented a world class pan-regional system of trauma care since 2010, resulting in improvements in patient outcomes, largely due to the restructure of the Major Trauma System that has optimised clinical care delivery (Cole et al, 2015)^[i].

It is well documented that long-term consequences of physical trauma (defined as a life threatening experience) involve psychological impacts post injury. Over a third of survivors report post-event psychological distress that is serious (life-limiting) and can have substantial negative effects on their long-term health and well-being, as well as impacting their families and carers^[ii].

When psychological support is provided for Post-Traumatic Stress Disorder this intervention makes a significant difference to long-term outcomes, particularly to reliable improvements in quality of life.

With this in mind the NHS London’s Violence Reduction Programme (LVRP) wanted to understand the support available to people experiencing psychological trauma related to their injury whether that be as a result of a road traffic accident, knife injury or terrorist incident, for example.

The LVRP review of psychological support highlighted the disparity between the delivery of high quality trauma physical health care, and the psychological support provided in response to major incidents, compared to psychological support provided in response to trauma injuries.

As a result of these findings a Pan London Clinical Psychology working group was established and an evidence based integrated psychological model of care was developed. This work has been supported by senior Clinical Directors and Executive leads across London’s Trauma system and Mental Health Trusts as well as regional Emergency Preparedness Resilience Response representation.

In terms of innovation, London had its stroke and psycho-oncology pathways to draw on as exemplars: having psychological practitioners fully integrated into physical health care is not merely a luxury, it can save lives! Additionally, the NHS learnt so much during the pandemic about the long-term impact on staff while supporting others to recover from trauma: this learning will also be deployed in and beyond the MTCs. The development of this model of care is also in line with the Association of Clinical Psychologists UK ‘Standards for Psychological Rehabilitation in Major Trauma’^[iii]

We are delighted to share the news that the beginning of the journey to evaluate the integration of physical and psychological care for trauma survivors in London is now fully underway, with the appointment of Consultant Clinical Psychologist Dr Idit Albert as the Clinical Lead for the psychological pathways, and a remit to build the psychology workforce into the teams in all four MTCs.

In the wider context, Psychological Professions now account for over 12% of the workforce in NHS Mental Health Trusts and it is great to see the numbers are increasing throughout physical health and social care sectors. This is a good start, but there is still much work to be done to improve this number.

We are excited about the innovative practice in the Capital, and we are very happy to be able to spotlight innovative practice all year round via the London Psychological Professions Network Innovation events.

We will be celebrating our learnings during the Psychological Professions conference week (13-17 November 2023). Join us in London to learn more about the mobilisation of evidence-based psychological support in physical health and the difference this makes to outcomes! Information to follow via Twitter, LinkedIn and the PPN website.

^[i] Cole et al (2015). The Impact of a Pan-regional Inclusive Trauma System on Quality of Care. Annals of Surgery.

^[ii] Spreadborough S, Radford K, das Nair R, Brooks A, Duffy M. (2018). A study of outcomes of patients treated at a UK major trauma centre for moderate or severe injuries one to three years after injury. Clin Rehabil. Mar;32(3):410-418. doi: 10.1177/0269215517730862. Epub 2017 Sep 20. PMID: 28929802.

^[iii] Standards for Psychological Rehabilitation in Major Trauma - ACP UK