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The UK Forum for Multi-Professional Critical Care Outreach, 
   Medical Emergency, Acute and Rapid Response Teams

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NOrF Executive Board

Dr Isabel Gonzalez - Chair NOrF

Consultant Critical Care, South Tees Hospitals and Medical Lead for North of England Critical Care Network

Isabel is a consultant in Critical Care Medicine and Anaesthesia at The James Cook University Hospital in Middlesbrough, and the medical lead for the Critical Care Outreach Team and the Acutely Ill Patient at South Tees Hospitals. She is also the Medical Lead for the North of England Critical Care Network. 

She has broad clinical experience in Critical Care and Acute Care and she is fully engaged with the agenda of the Deteriorating Patient and safer care in her Trust. Her main interests are around the systems and philosophy of the early recognition and management of the acutely ill patients, including the educational needs and competency based programmes for the multidisciplinary team. Isabel leads trust-wide Acute Ill Patient (Recognising Deterioration) initiatives, which is involved in the introduction and updating of electronic track and trigger system, acute care competencies and developing trust systems and guidelines related to the adult deteriorating patient. 

She is one of the regional leads for Sepsis working collaboratively with colleagues towards achievement of a regional common system to address early recognition and management of patient with sepsis.

She has a great interest in multidisciplinary education and training involving acute care competencies, leading the Acute Illness Management™ and Survive Sepsis™ courses delivery, part of the North East Faculty of the Ill Medical Patient Acute Care and Treatment™ course, as well as setting up a Non Invasive Ventilation course, Sepsis Study Day, Trachesotomy Care and Practical Procedures for Foundation Programme course in South Tees. She is one of the co-founders of the Critical Care Outreach Course (competence-based training of nurses involved in Critical Care Outreach). 

Isabel was elected as Chair of the National Outreach Forum at the 2017 AGM.

e-mail: isabel.gonzalez@norf.org.uk

Dr Natalie Pattison - Vice Chair NOrF 
Senior Clinical Nursing Research Fellow, Royal Marsden Hospital

Dr Natalie Pattison is Senior Clinical Nursing Research Fellow at the Royal Marsden Hospital. She has worked as a nurse in critical care since 2000 at the Royal Marsden NHS Foundation Trust and has also worked in critical care outreach. 

Her clinical experience is in critical care and cancer care, and she still works in clinical practice, running critical care follow-up clinics. 

She has a doctorate in end-of-life care in critical care and her MSc explored the needs of ward nurses receiving patients back from critical care. She has undertaken and published research studies exploring the impact of outreach. She is currently exploring end-of-life transitions in acute illness and the role of critical care outreach in these. 

She has varied research experience, leading and collaborating in international and national funded studies in cancer and critical care. She is also the trust lead for patient public involvement in research. She is on the oversight and organising committees of the UK Critical Care Research Group and on the UK Critical Care Leadership Forum research sub-group, is a member of the regional Specialty Group for Critical Care, on the EfCCNa scientific advisory board, is an Associate Editor of a European journal and reviews for several others. Her studies and research interests include: end-of-life care in critically ill cancer patients; end-of-life care in critical care outreach, supportive care in cancer, user involvement in research, critical care outreach; cancer critical care, and critical care follow-up.

Natalie was elected as Vice-Chair of NOrF at the 2017 AGM.

e-mail: natalie.pattison@norf.org.uk

Sarah Quinton - Executive Board Member  and Treasurer for NOrF
Lead Nurse Critical Care Outreach, Heart of England Foundation Trust

Sarah qualified in 1988 gaining a variety of experience in surgery, urology and ophthalmology. In 1991 she moved to a general intensive care unit and has been working in critical care for the last 18 years.

Since 2000 Sarah has been involved the Critical Care Outreach Service at Heart of England NHS Foundation Trust and is currently the Lead Nurse. The team provides a 24-hour critical care outreach service across 3 hospital sites. Sarah has implemented an early warning scoring system which is now used Trust wide and has worked with colleagues on initiatives to improve the standards of observations within the Trust. This has involved developing education packages for staff, redesigning observation charts and conducting audit to evaluate standards of observations and recognition of the deteriorating patient.
Sarah completed an MSc in 2003, with a dissertation focusing on MEWS user satisfaction. She is actively involved in the development of future strategies for the care of the acutely and critically ill patients within the Trust, including ‘Hospital at Night', multidisciplinary education and development of new roles. She is currently Secretary on the Executive Board of the National Outreach Forum and is also an Associate Clinical Lecturer at Warwick University.

email: sarah.quinton@norf.org.uk

Alison Dinning - Immediate Past Chair NOrF and interim Secretary
Critical Care Skills Educator, Nottingham University Hospitals

Alison has worked as an Outreach Nurse since the service commenced at Nottingham in 2000. The Nottingham University Hospitals (NUH) Critical Care Outreach Service has developed and expanded according to the needs of the Trust, and now covers two large campuses. Her primary interests are improving the quality and safety of patient care; improving the patient experience; teaching, supporting and developing the multi-professional ward team, and continuing to adapt and update the track and trigger tool which was introduced in 2001.

She currently works as a Critical Skills educator and leads the trust Preceptorship Team. She has worked with specialist educators to develop a focussed 7 day acute care skills education programme for newly qualified nurses, and supporting them clinically in order to  improving their experience when caring for sick patients in non-critical care areas. She is also working with other senior education leads to devise a strategic approach to inter-professional education at NUH.

She continues to work clinically as an Outreach nurse each month and liaises closely with the team.

Alison was part of the original team who instigated the National Outreach Forum, and was involved in writing the "The National Outreach Report - Progress in Developing Services in 2003". She is passionate about networking, sharing ideas and best practice both locally and nationally. She is currently chair of the National Outreach Forum Executive Board and is delighted to link closely with ICUsteps as part of the ongoing Patient and Public involvement Initiative.

Alison is the immediate past Chair of the National Outreach Forum and the interim NOrF Secretary.

e-mail: alison.dinning@norf.org.uk

Catherine Thomas - Executive Board Member
Consultant Respiratory Physiotherapist, Tameside Foundation Trust

Cath qualified as a physiotherapist in 1996 in South Wales. She quickly directed her career towards working within respiratory speciality as a senior physiotherapist in 1997. She moved to England in 2000 to pursue career in more acute respiratory areas as senior physiotherapist and worked at Hope Hospital and Warrington Hospital in medical and surgical specialities.

She held a position as Physiotherapy Inpatient Superintendent and Respiratory Clinical Specialist from 2002 at Tameside Foundation Trust working in critical care and linking with respiratory outreach services and she was successfully appointed as Consultant Respiratory Physiotherapist in April 2005 for Tameside Foundation Trust.

Her general areas of interest and activity include clinical supervision for PHD student, re-establishing own PhD, honorary Senior Lecturer for Manchester Metropolitan University, assessor for pre registration Medical Practitioners, contributing a chapter for the second edition ‘Caring for the seriously ill patients', Trust wide education and assessment for Doctors, Nurses and Physiotherapists and attendance to Research and Development Group and Respiratory Advisory Group for Tameside and Glossop.

Her clinical areas of interest and current projects are to establish, lead and manage the Trusts Non Invasive Ventilation service, Oxygen Champion for the Trust, leading on the Trusts rehabilitation post critical care NICE 83 guidance (currently working on seamless care pathway through Acute / Intermediate/ PCT services) and to provide a Consultancy service Trust wide for non-medical management of acutely unwell respiratory patients on wards, critical care areas- direct link with outreach team.

e-mail: catharine.thomas@norf.org.uk

Lesley Durham - Executive Board Member NOrF
North of England Critical Care Network (NoECCN) Director

Lesley trained at the Royal Masonic and Queen Mary's hospital in Roehampton London, qualifying in 1983. After consolidating her training as a staff nurse on a general surgical ward, Lesley spent 2 years working in Johannesburg Southern Africa on a neuro-surgical / high dependency unit. Caring for patients requiring a higher level of care prompted Lesley to undertake her                                                                   Care (ENB 100) training at Kings College London.

Lesley has now spent over 20 years in critical care, and has recently been appointed as Director for the North of England Critical Care Network. Her previous role was Nurse Consultant in Critical Care & Clinical Lead for Outreach Services at City Hospitals Sunderland NHS Foundation Trust.

Lesley believes emphatically that since their introduction, ‘Outreach' services have made an immense and invaluable contribution to the quality of care for critically and acutely ill patients in hospital. To this end, she and NOrF believe that Outreach Teams are ideally equipped and positioned to significantly contribute to the successful implementation of the NICE CG 50 and the acute / critical care interface.

After 4 successful and fulfilling years as Chair of NOrF, Lesley step down from this role at the 2010 AGM.

e-mail: lesley.durham@norf.org.uk

Tracey Moore - Executive Board Member NOrF
Senior Lecturer and Head of Undergraduate Studies, University of Sheffield

Tracey is a Registered Nurse with a background in acute and critical care medicine, working mainly within Intensive Care and High Dependency Care at the Royal Hallamshire Hospital, Sheffield, and as an Intensive Care Medicine teacher with North Trent College, School Of Nursing and Midwifery. She is now employed in the University of Sheffield, Faculty of Medicine, School of Nursing and Midwifery as a Senior Lecturer and Head of Undergraduate Studies.

Over the past few years, Tracey's teaching and research interest have focused on the identification and assessment of the deteriorating patient and this interest has proven invaluable in her work with NOrF as a Vice Chair. In 2006 she was part of the ICNARC and University of Sheffield research team that undertook a systematic review of the literature on track and trigger / early warning systems used by critical care outreach teams, as part of the NHS SDO R&D Programme Evaluation of outreach services in critical care.

Tracey is currently Principal Investigator for a national survey "An investigation into failure to rescue deteriorating patients" funded by Yorkshire and the Humber Strategic Health Authority. This study also provides the focus for her Doctorate in Medical Science due to complete in November 2010.

e-mail: tracey,moore@norf.org.uk

Carmel Gordon-Dark - Executive Board Member NOrF 
Critical Care Outreach Sister, London Clinic
Carmel is a Critical Care Outreach Sister at the London Clinic. She is a Registered Nurse that worked at Northwick Park Hospital, achieved ENB 100 at Central Middlesex Hospital and worked as a staff nurse in the Critical Care Unit for two years. She then went to work in the King Fahad National Guard Hospital Riyadh for four years in the Critical Care Unit. She returned to London and became a Critical Care Sister at the London Clinic.

She undertook ENB 998 A1 Award (NVQ Assessor) 7407 Further Education for adults following her return. She has also undertaken a DMS at Westminster University. Carmel set up the Outreach Service and Patient Group Directives for the London Clinic. She directed the compiling and setting up of the Radar Course (Recognition and detection of the Patient at Risk), which has been accredited by the RCN.

She has been nominated for the Laing and Buisson Health Care Award under the category of Innovation. She has also spoken at International Conferences in Jordan for the Royal Medical Services on the benefits of Critical Care Outreach and most recently in Madrid at the  3rd Wold Congress of Clinical Safety.

Carmel has been a member of the executive board of National Outreach Forum since 2008.

e-mail: carmel.gordon@norf.org.uk

Peter Gibb - Executive Board Member NOrF and  Patient and Public Representative
Secretary & Chief Executive ICUsteps

Since being a patient in the ITU at Milton Keynes General Hospital in 2003, Peter has been active in advocating support for patients and relatives following critical illness.  He has served as a patient representative on two NICE guidelines and is currently Secretary of ICUsteps, the patient support charity he helped found. 
Peter co-authored an article on ‘The development and setting-up of a patients and relatives intensive care support group’, published in January 2009’s edition of ‘Nursing in Critical Care’ and led the project to produce a patient and relative intensive care guide now used by over 40% of ICUs around theUK.
Outside of his interest in critical care, Peter works as a website and webuser interface developer.

e-mail: peter.gibb@norf.org.uk

Christopher Hancock - Executive Board Member NOrF and Wales Representative
Programme Manager, Rapid Response to Acute Illness Learning Set (RRAILS), 1000 Lives +

Chris Hancock MSc, BSc (hons), RGN is manager of the Improving Critical Care and Rapid Response to Acute Illness (RRAILS) collaborative programmes which form part of the  NHS Wales 1000 Lives Plus quality and safety programme.

Between 2006 and 2008 he managed the Welsh Critical Care Improvement Programme (WCCIP) which enabled critical care clinicians throughout Wales to improve the quality of patient care and demonstrate reductions in adverse events including CVC Related Blood Stream Infection (CRBSI) rates, improvements which have been sustained to the present day.

Prior to this he had worked as both clinician and educator in many branches of critical care since registering as a nurse in 1990. His special interests are in patient safety, quality improvement, human factors, detection of the acutely ill patient and sepsis treatment.
Chris has spoken widely on these subjects both nationally and internationally, has been influential in the development of pre and post graduate training and education packages and has a particular interest in embedding quality improvement methodologies in the education of healthcare professionals.
He has sat on the Expert Advisory Groups for the English Matching Michigan Study and the European IMPLEMENT Programme and sits on the inaugural committee of the United Kingdom Sepsis Group (UKSG).

e-mail: chris.hancock@norf.org.uk

John Welch - Executive Board Member NOrF 
President of the International Society for Rapid Response Service and Nurse Consultant in Critical Care at UCLH

John has degrees in psychology, and in nursing science. He worked as a Staff Nurse, Charge Nurse, Senior Nurse and Lecturer in critical care through the 1990s, was then appointed to one of the first Consultant Nurse posts in the UK, and set-up one of the first Critical Care Outreach Services.

John is now Consultant Nurse in Critical Care and Outreach at University College London Hospitals, and co-lead of the UCL Partners Academic Health Science Network Deteriorating Patient Collaborative using quality improvement methodology to reduce cardiac arrests across 15 acute trusts. John was the first Chair of the National Outreach Forum, co-wrote the Department of Health Quality Critical Care: Beyond 'Comprehensive Critical Care ' report and sat on the Royal College of Physicians National Early Warning Score Design & Implementation Group. 

More recently, he has become pro tem Honorary Secretary of the nascent international Society of Rapid Response Systems, and a member of the All Party Parliamentary Group on sepsis. In 2013, John co-wrote, developed and delivered a novel Nurse Intensive Care Skills Training programme in Sri Lanka which is now being rolled out across that country. 

He is now focusing on research, with a multi-centre study of nurses using cognitive behaviour therapy techniques to treat psychological problems in critical illness; a study of how key patient risk factors might be graphically displayed and managed by ward staff working with patients and relatives; and an analysis of cardiac arrests in 100+ hospitals.

e-mail: john.welch@norf.org.uk

Tara Hughes - Executive Board Member NOrF

I am currently the Lead Nurse for the Clinical and Critical care Outreach Team (CCCOT) at Heart of England Foundation Trust, based in the midlands. I inherited ‘the role from Sarah Quinton but have worked in the outreach team since 2000 which seems like only a few months ago. My team manage CCO 24/7 across 3 sites and deal with the challenges of all areas of the trust and all ages of patients, and never cease to amaze me with their enthusiasm for their specialised role.

Alongside the critical care outreach role we have a dedicated clinical practitioner service for the wards which aids patients experience and medical workload in the 24/7 NHS of today.

I started my MSc at nearby Warwick with a clinical focus but transitioned across towards human factors and patient safety and now have a particular interest in multidisciplinary education around the prevention of the deteriorating patient. Aside from facilitating several courses for the trust to empower staff, our team are constantly looking at new ways to promote and share good practice sometimes in a less than traditional format.

Joining NOrF as an executive member in 2016 has allowed me to share and discuss ideas with like-minded people from around the country and hopefully continue to promote the fabulous work that critical care outreach teams do every day on a national basis.

Jenny Bull - Executive Board Member NOrF and Paediatric Representative

Paediatric ANP for Paediatric Outreach Service University Hospital Southampton

Jenny is the Nurse lead for Paediatric Critical Care Outreach Service at University Hospital Southampton (UHS) at Advanced Practitioner level.

Her background includes both adult and paediatric ICU moving to paediatric ICU in 1996. Whilst in this role she was actively involved in the regional paediatric retrieval service along with day to day management of a busy 14 bed PICU at senior sister level. With an avid interest in nurse education & development she was instrumental in developing education programmes for all levels of nurse including the development of the PICU Foundation programme paving the way for newly qualified nurses and there ongoing development within this setting. She was heavily involved in education groups across Child health within UHS. She was chairman of the Paediatric Intensive Care Society Nurse Educator group (PICSE) for two years and was involved in the ongoing development of education standards for nurses within the PICS standards document.  

In 2013 she embarked on her current role setting up a Paediatric Outreach Service at UHS recruiting a team to deliver a service to provide education and decision support to the inter professional team regarding the deteriorating child in 2014. This is a clinically focussed service delivered in any environment where children are managed and includes PICU, ED, theatre/recovery and wards. Predominant initiatives include ongoing development of the Paediatric Early Warning Score (PEWS) through clinical audit and feedback mechanisms to staff and facilitation of the daily ‘Huddle’ concept as a means to improve both communication and patient safety. Jenny also introduced High Flow oxygen delivery devices in Child Health and was part of the working party in the development of the regional guideline.

She works as a credible clinical resource within the Critical Care Outreach team on a daily basis along with the ongoing strategic nurturing of this developing service.

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