London Transformation and Learning Collaborative - Critical Care (LTLC) - elearning for healthcare
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About the London Transformation and Learning Collaborative Critical Care programme

The London Transformation and Learning Collaborative (LTLC) Critical Care programme supports the cross-skilling of the London NHS workforce in response to the Coronavirus pandemic. It aims to broaden the skills base of this workforce to manage existing, and potential future surges in, critical care demand. The programme supports London’s recovery plan by ensuring that:

  • training infrastructures can adapt to any future surge and increased critical care capacity
  • staff-wellbeing for all colleagues is considered
  • opportunities for workforce and training innovations are maximised and continually adapted

Follow updates on Twitter using the hashtag #NHSLTLC or HEE London @NHSHEE_LDN

  • Our approach

    The LTLC aims to increase the supply and resilience of London’s critical care workforce through:

    • the development of a modular education programme that can be tailored to distinct learner needs
    • multi-channel delivery of education to accommodate different skill training requirements and enable wide-spread accessibility
    • sharing of practice from critical care units across London (e.g. proformas, job descriptions and reports of positive interventions), that other units may want to consider adopting or adapting
    • mapping of optimal critical care workforce models in 8 key surge sites, that will inform their learner needs
    • incorporation of a feedback mechanism, to refine and evolve the programme’s educational content over time

    The programme is user-led, with both the systems and future learners actively involved in every stage, from development to delivery. We are working with 5 integrated care systems (ICS) in London to ensure we are responsive to different needs across the capital.

    The below chart illustrates the different stages of the programme.

  • Desired outcomes

    We have collated educational material for learners and educators that can be tailored to learners’ existing skill level and current, or future, critical care role. These include materials for elearning, face to face teaching, simulation and work-based placements as well as personal development.

    For learners, we aim to deliver:

    • easy identification of required and desired skills aligned to your current role or expected critical care role
    • materials for self-directed learning, resources, and work-based placements to improve confidence and competence working in critical care (including for COVID-19 specifically)

    For trainers, we aim to deliver:

    • easy identification of required and desired skills aligned to your learners’ current role or expected critical care role
    • efficient collation, design and delivery of educational content and train-the-trainer materials to cross-skill the critical care workforce (including for COVID-19 specifically)

    For systems, we aim:

    • to build the capability of the London NHS workforce capability to enable it to operate at a new, increased critical care capacity (our primary goal)
    • to demonstrate a new agile model for developing and delivering education rapidly in response to changing national healthcare requirements, in collaboration with existing regional systems (our secondary goal)
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COVID-19 Surge 2021 – Rapid Access Resources

To support NHS staff being deployed for the Coronavirus response, the LTLC have collated some key resources to help individuals, educators and systems prepare. We recognise staff are very busy; so these resources are purposely designed to be short and read/watched on the move or the ward.

COVID-19 Surge 2021 – Rapid Access Resources

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How to use this programme and microsite

Step 1: Download the critical care skills matrix, Step 2: Explore the multimedia resources, Step 3: Share any resources or feedback

Learners interested in resources to educate themselves should download How to use this programme for Learners (PDF, 153KB) for detailed instructions on how to use this programme. Further information is available below.

Trainers interested in resources to train others should download How to use this programme for Trainers (PDF, 121KB) for detailed instructions on how to use this programme. Further information is available below. Those interested in content to inform critical care units or system operations should download How to use this programme for Critical Care Unit or System (PDF, 119KB) for detailed instructions on how to use this programme. Further information is available below.

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Step One: Interprofessional skills matrix

We have developed a skills matrix that maps the most useful educational content to the skills they address, by professional group or role within critical care, and for learners and trainers. The content is matched against NMC, GMC, HCPC, NCFRN CC3N and CoBaTrICE professional competencies to aid presentation for revalidation and appraisal.

Download the London Transformation and Learning Collaborative (Microsoft Excel, 194KB)

The skills matrix is under active revision, so please regularly check this document for the latest version. Latest additions include:

  • Pharmacy resources (critical care specific)

Current updates in progress include:

  • Redeployed staff resources

The searchable equipment training matrix is available under ‘Generic Skills (includes Safety, Communication, Wellbeing, Human factors)’ either below, or via the elfh Hub.

  • About the skills matrix

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Step Two (for learners): Educational resources

The current educational resources available for learners can be found below. These have been mapped to the skills matrix by professional grouping. We are still in the resource collation and co-creation phase and would appreciate you sharing any relevant resources (please see the below ‘How to give your feedback’ section).

Generic Skills (includes safety, communication, wellbeing, human factors) and COVID-19 Generic Skills are the basic skills required by all healthcare professionals working in the critical care and/or COVID-19 environments. Additional skills and resources are described in the individual professional grouping sections.​

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Step Two (for trainers): Educational resources

The current educational resources and train-the-trainer materials can be found below. These have been mapped to the skills matrix by professional grouping. We are still in the resource collation and co-creation phase and would appreciate you sharing any relevant resources (please see the below ‘How to give your feedback’ section).

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Step Two (for Critical Care Units or Systems): Great operational practices

The LTLC programme includes networking across the whole of London and learning from the great practices in each of the Critical Care Units.

Please see below the current resources available which have been shared through this pan-London network as examples of great practices. Though they may be site specific, we hope that by sharing them here, other units can learn and adapt these to their own needs, and share their own great practices in return.

We are still in the resource collation and co-creation phase, therefore we would appreciate you sharing any relevant resources (please see below the ‘How to give your feedback’ section). We also are a continuously learning ourselves so all feedback, ideas and comments gratefully received – both constructive and positive!

  • A Toolkit for rapid cross-skilling, supporting safe redeployment

  • Just-in-time training for Deployed Staff

  • RSC / NRSS Task Allocation for ‘Pod’ Structure and Passports

  • Staff Wellbeing Bundle

  • SBAR ABCDE Critical Care Handover Tool

  • Paediatric critical care nurses cross-skilling documents

  • Bay Template

  • Nurse Shift Handover Document

  • COVID-19 Critical Care Plan - A Resilient Approach

  • Daily shift planners for NRSS staff on Critical Care

  • COVID-19 Critical Care Made Easy Guide

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Step Two: Field Hospital Resources

  • NHS Nightingale London Educators Resources

    The core aim of the NHS Nightingale London Education and Training curriculum was to develop staff who were confident and able to practice safely in their allocated roles within the NHS Nightingale Field Hospital at The ExCel Centre. Between March and May 2020 over 2,700 learners were trained face-to-face and a further 1,000 participated in on-line training.

    Learning was all delivered interprofessionally and was were organised into four broad programmes as outlined below and has well-being threaded through. All of these programmes also had corporate and local clinical induction sessions. It is important not to forget the importance of Local Clinical Induction for staff new to a Critical Care Unit.

    (further information available in the ‘Overview Documents‘ section)

    Green education and training for those working in an ICU role already.

    Amber education and training for registered healthcare professionals who will be working in a critical care role that is different to their current role and require some additional critical care training to enable them to do the job. Ideal for RSC training.

    Red education and training for those who will be working in a critical care unit in a role that is significantly different to their current practice: They may not have any health or care experience. These roles do not have direct patient responsibility but will be part of care teams such as Washing, Turning etc. Ideal for NRSS training.

    Purple education and training for those who will be undertaking a specialist role in the critical care unit that is the same as their current NHS role.

    Curriculum Components Red training Amber training Green training Purple training
    Safety Critical Training
    Corporate and Local Clinical Induction
    PPE
    Communication
    Wellbeing (PsychPPE)
    Compassionate Care
    Documentation
    Pharmacy skills
    Safety Critical Clinical Skills
    COVID Cardiac Arrest (and prone pt)
    Airway
    Breathing
    Circulation
    Fluids In
    Fluids Out
    Patient positioning, moving and handling
    Consolidation of Learning
    Full Immersion Clinical Simulation

     

    Day Zero

    The underlying principles of Day Zero are to alleviate anxiety and to deliver learning needs not met within induction. The aims when used at NHS Nightingale London were:

    • To orientate staff to the hospital site, ward space, equipment and hospital layout
    • To focus on patient safety and prepare people to step onto a critical care unit on a “day one”
    • To identify outstanding learning objectives for new starters at NHS Nightingale London and meet them or signpost to where they can be met
    • To alleviate anxieties prior ahead of clinical work the Nightingale London
    • To reinforce messages around culture and well-being

    Posters

    These posters were developed to support the training of staff for NHS Nightingale London and to be used in the clinical areas to remind staff of key information about communication tools including SBAR, CUSS, Closed-loop communication and Hand signals for non-verbal communication.

    Simulation Scenarios

    These scenarios were written to support the face-to-face training within the London Nightingale Education team.

    They are designed for a range of participants from those with no healthcare experience (red) through to pre-existing ICU staff (green) tackling more complex issues.

  • NHS Nightingale Yorkshire & Humber Educators resources

    The core aim of the NHS Nightingale Yorkshire & Humber Education and Training curriculum was to develop staff who were confident and able to practice safely in their allocated roles within the NHS Nightingale Field Hospital at The Harrogate Convention Centre.

    Learning was all delivered interprofessionally and organised into three broad programmes as outlined below. All of these programmes had corporate and local clinical induction sessions. It is important not to forget the importance of Local Clinical Induction for staff new to a Critical Care Unit.

    (further information available in the ‘Overview Documents‘ section)

    ​Blue education and training for those working in an ICU role already.

    ​​Yellow education and training for registered healthcare professionals who will be working in a critical care role that is different to their current role and require some additional critical care training to enable them to do the job.

    Pink education and training for those who will be working in a critical care unit in a role that is significantly different to their current practice. These roles are healthcare support roles, may have direct patient responsibility but will be part of care teams overseen by a registered healthcare practitioner.

    These scenarios were written to support the face-to-face training within the Yorkshire & Humber Nightingale Education team.

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Step Three: Sharing your resources and feedback

The skills matrix and educational resources are still being developed and we would appreciate any feedback and contribution you may have to support their finalisation. You can contact us on LTLC@hee.nhs.uk. See the drop-down sections below for more information.

  • Skills matrix

    There are 2 ways to give feedback on the skills matrix:

    A. Use this survey link below to provide us with some feedback on the skills matrix. This resource is under constant review so your input is highly valued. The survey is designed for both learners and educators and should take no longer than a few minutes to complete. Thank you in advance for completing it.

    B. For more detailed and specific feedback you can download a copy of the ‘Skills matrix Excel’, and make direct edits to email to us. We would appreciate input on the following areas:

    1. A change to language – please add “notes” on the excel with the appropriate language and rationale, and indicate in your email body the areas you have made recommendations on
    2. Addition or deletion of a skill – please add new rows to the excel and put additions in GREEN, or highlight suggested deletion skills in RED
    3. Essential vs desirable – please indicate this by writing in column D (in a contrasting colour or highlighting a cell where a change has been made)
    4. Educational resource recommendations – please see the below section on ‘Educational resources’
    5. An indication of how you intend to use the skills matrix – we would be interested for feedback on the usability of the skills matrix. If making suggestions, please provide enough of an explanation that your input can be actioned
    6. Links to other competency frameworks – please provide links to (or copies of) competency frameworks which should inform this skills matrix
  • Educational resources

    The LTLC are collating existing high-quality education resources developed across London to make them openly accessible. We are asking anyone with such a resource to send it to LTLC@hee.nhs.uk. If you are able to complete the attached coversheet (Microsoft Excel, 15KB) we would be grateful but this is not imperative as we really need any resources submitted ASAP.

    Please ensure that you have permission from those involved in its development before you share it with us. When sharing the resource, we will always attribute authorship to the original authors. We may make minor edits before it is shared to ensure that the content is accurate, up-to-date and in a standardised format. Please note that LTLC are not responsible for the resource after it has been shared.

    The resources we are looking for include any critical care related educational resource from all professions, such as:

    • Lesson plans
    • ICU competency frameworks​ (especially occupational therapists, physiotherapists, SALT, dieticians, pharmacists)
    • Video content
    • Simulation scenarios
    • PowerPoint lectures

    Examples of topics we are interested in are:

    • ICU skills such as ventilation, ICU drugs, tracheostomy management etc
    • Profession specific topics (for example, content developed by dieticians to teach ICU feeding)
    • ICU rehabilitation and delirium
    • Moving and handling intubated patients
    • Equipment training, such as ventilators and infusion pumps
    • ICU leadership
    • Wellbeing
    • Up-to-date COVID management
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Managing the COVID Surge: 10 Quick Wins for ICUs

Frontline clinicians working with the National CLEAR Programme for ICU, as part of the LTLC, are sharing ten recommendations that can be adopted in ICU in 48 hours. While working collaboratively across four London trusts, clinicians identified these “quick wins” in response to the experience and reflections of staff in the first wave of the pandemic.

  • Managing the COVID surge: 10 Quick Wins for ICUs

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Research outputs informing our programme

  • Learning from the Education Experiences of ICU Staff (Survey)

    The LTLC have surveyed almost 1000 ICU staff from across London in order to understand their experiences of education during the COVID pandemic. This includes critical care educators, critical care staff who received education and staff redeployed to ICU. The feedback that has been received from across London is informing the work of the LTLC, including the co-development of the skills matrix and the collation of resources.

    Summary of results

    Please find below summaries of the survey results broken down by group:

    1. ITU staff who primarily delivered education (PDF, 790KB)
    2. ITU staff who primarily received education (PDF, 391KB)
    3. Redeployed nursing staff (PDF, 1061KB)
    4. Redeployed occupational therapists (PDF, 794KB)
    5. Redeployed speech and language therapists (Microsoft PowerPoint, 428KB)
    6. Redeployed Dieticians (PDF, 1490KB)
    7. Redeployed Physiotherapists (PDF, 1174KB)
    8. Redeployed Doctors (Microsoft PowerPoint, 445KB)
    9. Healthcare Assistants (PDF, 1454KB)
    10. Redeployed healthcare scientists (Microsoft PowerPoint, 423KB)
    11. Redeployed Pharmacists (Microsoft PowerPoint, 406KB)
    12. Other redeployed staff groups (PDF, 1232KB) including operating department practitioners dentists/dental assistants and nurses, students, podiatrists, midwifes, nursing associates and advanced clinical practitioners
  • A Survey into the Workforce utilised to Support Critical Care Units during COVID-19

    Two short surveys were developed in collaboration between the Intensive Care Society (ICS) and the Operational Delivery Network (ODN) representatives, and disseminated via Survey Monkey over the month of May 2020. One was specifically for critical care managers/nurse leads to complete, the other for staff who were redeployed into critical care.

    The aims of the surveys were to obtain a snapshot of the additional workforce mobilised to manage critical care surge during the COVID-19 crisis. The aim was that that the data returned can help inform areas of good practice, and identify areas for improvement in future, should the need for staff redeployment to critical care be required again.

    Download the results of the survey (PDF, 885KB).

  • LTLC Emerging Findings: Changes to Models of Care on ICU (infographic)

    Results from a rapid qualitative appraisal based on telephone interviews with staff across ICUs in London to:

    • document changes made it ICU models of care
    • explore challenges and enablers in the implementation of these changes
    • identify the aspects of care delivery that worked well and areas for improvement

    Download the infographic (PDF, 6460KB).

  • NHS Staff Experiences of Working in Critical Care – The CLAP Study (infographic)

    Results of telephone interviews with 40 staff from critical care units in Scotland and England.

    Download the infographic (PDF, 1527KB).

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Additional materials

  • FICM and HEE Skills Passport

    FICM (Faculty of Insensive Care Medicine) and HEE (Health Education England) launch COVID Skills Passport

    “The entire intensive care community is keen to acknowledge the contributions made during the COVID-19 pandemic by many members of the multidisciplinary team (MDT). In particular, those who were deployed into Critical Care areas, joined rotas, used existing skills, and cross-skilled as abilities and supervision permitted.

    The Faculty understands that for medical trainees, nurses and Allied Health Professionals (AHPs) who do not generally work in Critical Care, getting recognition for any new or added ICM skills obtained during the pandemic can be problematic. In conjunction with Health Education England (HEE), we have developed a ‘COVID Passport’ to help those individuals get the recognition they deserve.

    The Passport is comprised of two sections:

    • Care Packs: Each ‘Care Pack’ contains examples of skills and work undertaken during deployment to Critical Care that individuals can denote that they have completed. This section is counter-signed by a supervisor in ICM (this may be a consultant, charge nurse, senior AHP or line manager, as appropriate) to certify that the health professional has worked in these general areas to the denoted level of supervision.
    • Skills Self-Certification: Specific skills developed can be delineated further, in the ‘COVID-19 Skills Passport Clarification’ section of the document. This will provide future employers and trainers with more detail on individual attainments. Please note that this section is entirely self-certified and is not signed-off by an ICM supervisor.”
  • Delivering oxygen therapies

    This resource (PDF, 6.6MB) was designed as a high-level document to highlight the risks of a catastrophic event relating to oxygen use, limited supplies and failure. The following topics are covered:

    • Catastrophic oxygen failure and mitigating the risks
    • Oxygen consumption and good housekeeping guidance
    • Risk of fire and mitigating actions

    This resource is designed for all clinical staff working in areas delivering oxygen therapies. This document does not present any original guidance; national and regional guidance has been collated where appropriate. All guidelines used are referenced and linked in the relevant sections. This document is correct at the time of construction (January 2021); however, please be aware that specific guidelines may change with time.

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Further information

NHS England/Improvement and Health Education England have worked in partnership to develop this approach which has already been extensively tested with stakeholders.

Please contact the LTLC team for any further information or questions about the programme (ltlc@hee.nhs.uk)

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How to access

The London Transformation and Learning Collaborative (LTLC) programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.

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To view the London Transformation and Learning Collaborative (LTLC) programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.

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Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the London Transformation and Learning Collaborative (LTLC) programme, please contact elfh directly.

More information

Please select the following link for more information on how to use the elfh Hub.

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Relevant organisations with useful content

Critical Care Network NW London   South London Adult Critical Care Network  NENCL Network  British Association of Critical Care Nurses

Critical Care Networks National Nurse Leads  National Association of Medical Device Educators and Trainers  UK Clinical Pharmacy Association  The Faculty of Intensive Care Medicine

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