London Transformation and Learning Collaborative (LTLC) - e-Learning for Healthcare
Menu Access our e-learning programmes on the e-LfH Hub Hub Register / Log in >

About the London Transformation and Learning Collaborative

The London Transformation and Learning Collaborative (LTLC) is aimed at supporting the cross-skilling of the London NHS workforce to manage:

  • existing critical care demand;
  • potential future spikes in critical care demand as a result of Covid-19; and
  • longer-term permanent expansion of critical care capacity.

This programme supports London’s recovery plan by ensuring that:

  • system-level training infrastructure sustains readiness for future surge and increased critical care capacity;
  • well-being is integrated for all staff; and
  • opportunities to enable workforce and training innovations are maximised and continually adapted.
  • 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 eight key surge sites, that will inform their learner needs; and
    • 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 five 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 will be collating educational materials and training activities for learners and educators that can be tailored to learners’ existing skill level and current or future critical care role. These will include materials for e-learning, face to face teaching, simulation, and work-based placements as well as personal development. We aim to deliver:

    For learners:

    • 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 improved confidence and competence working in critical care (including for COVID-19 specifically).

    For trainers:

    • 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 critical care workforce (including for COVID-19 specifically), particularly in the on-line era.

    For systems:


    • To build the London NHS workforce capability to operate at a new increased critical care capacity.


    • Demonstration of a new agile model for developing and delivering education rapidly in response to changing national healthcare requirements, in collaboration with existing regional systems.

Programme content: Interprofessional skills matrix

To support you identify the most useful educational content for yourself or your learners, we have developed a skills matrix that map the content to the skills they address, by professional group or role within critical care.

Click here for the ‘Skills Matrix

The skills matrix is still in draft phase. Please use the 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 very much in advance.

It is under active revision, so please check back regularly for the latest version. New additions this week include:

  1. Mapping of ICU Generic Skills and COVID-19 Generic Skills to NMC & GMC professional competencies
  2. Red / amber / green ratings for RSCs & NRSSs to suggest high / medium /low priorities for training
  3. Pharmacy (Pharmacist) learning domains & objectives

Current updates in progress include:

  1. Train the Trainer resources
  2. Field Hospital resources
  • About the skills matrix

Programme content: Educational resources (for Self-directed learning)

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).

​ICU Generic Skills 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.​

Programme content: Educational resources (for Trainers)

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).

  • Programme outlines / timetables (NEW)
    • Red training plan from NHS Nightingale London Education team – suitable for NRSS (2-day)
    • Amber training plan from NHS Nightingale London Education team – suitable for RSC (2-day)

    Content required: please see section below on How to give your feedback and share resources.

  • A-E Assessment

    Assessment, Monitoring and Interpretation

    • A to E assessment (in development)
    • Arterial blood gas interpretation (in development)
    • Critical Care Patients – full assessment (in development)
    • Electrolyte abnormalities (in development)
    • Hypoglycaemia and management (in development)
    • IV infusions – preparation / administration / management of infusion device or prescription (in development)
    • Observation Chart (ICU)
    • Observation Chart (Step down)
    • Outcome measures (in development)
    • Renal Physiology (in development)
    • Renal replacement therapy (in development)
    • Respiratory Assessment (in development)
    • Systematic nursing patient assessment (in development)
    • Systematic patient assessment (in development)
    • Taking and recording of vital signs (in development)
    • Waveform recognition and escalation (in development)


    • Air way essential (in development)
    • Endotracheal tube care
    • In-line suctioning (in development)
    • Intubation and/or reintubation (in development)
    • Mouth care (for intubated and non-intubated patients) (in development)
    • Mouth care (for intubated patients) (in development)
    • Tracheostomy care (in development)
    • Tracheostomy weaning (in development)


    • Non-invasive ventilation (in development)
    • Assessment (in development)
    • Respiratory Physiology (in development)
    • Ventilator management (in development)
    • Chest drain management (in development)
    • Weaning from ventilation (in development)
    • Additional Therapy (in development)
    • Oxygen therapy – Step down specific (in development)
    • Chest drain insertion (seldinger and tube thoracostomy) (in development)
    • Weaning from ventilation (in development)
    • CXR interpretation (in development)
    • Non-invasive ventilation (in development)


    • 12 lead ECG (in development)
    • Arterial line insertion (in development)
    • Arterial line management (in development)
    • Central venous catheter management (inc. care bundle) (in development)
    • Fluid administration (in development)
    • Fluid Balance (in development)
    • Fluid prescription (in development)
    • Insertion of central lines (in development)
    • Intravenous vasoactive drugs (in development)
    • Venepuncture and Insertion of peripheral lines (in development)

    Gastrointestinal (GI)

    • Dysphagia and oral feeding (in development)
    • Administration and troubleshooting of NG feed
    • Dietetic Care Plan (in development)
    • Enteral and Parenteral feeding (in development)
    • Estimating Targets (in development)
    • GI Function (in development)
    • Insertion of NGT in sedated/unsedated/ventilated/non ventilated patient (in development)
    • Metabolic Response (in development)
    • NG (in development)
    • NG feed / medications (in development)
    • Nutritional diagnosis (in development)
    • Nutritional intervention (in development)
    • Nutritional screening (in development)
    • Refeeding (in development)


    • AVPU (in development)
    • Delirium recognition and management (in development)
    • Glasgow coma score (in development)
    • Monitoring, managing and weaning sedation (in development)
    • Pain assessment in awake patients (in development)
    • RASS & CPOT pain scores (in development)
  • Medication
    • Administration of drugs nasogastrically (in development)
    • Administration of IV Therapy (in development)
    • Administration of IV therapy (in development)
    • Antimicrobials (in development)
    • Drug chart & prescription protocols (in development)
    • GI prophylaxis (in development)
    • Glycaemic control (in development)
    • IV drugs – preparation / administration or prescription (in development)
    • IV infusions – preparation / administration / management of infusion device or prescription
    • Recognition of common medications (in development)
    • VTE Thromboprophylaxis (in development)
  • Around the bed space


    • IV infusions – preparation / administration / management of infusion device or prescription (in development)
    • Optimisation of Medical Device Effectiveness and Efficiency (in development)
    • Planned Maintenance and Repairs to Devices (in development)
    • Rehabilitation equipment (in development)
    • Risk management and governance (in development)
    • Ventilator management (in development)
    • Waveform recognition and escalation (in development)

    Bedside and patient hygiene

    • Bedside cleaning (in development)
    • Eye care (in development)
    • Personal care (in development)
    • Skin care (in development)
    • Stocking/Transport of samples and collection (in development)
    • Urinary catheter care (in development)
    • Urinary catheterisation (in development)
    • Washing & personal hygiene

    Moving and handling

    • Moving and handling patients
    • ADL support (in development)
    • Falls prevention (in development)
    • Proning (in development)
    • Rehabilitation (in development)
  • Rehabilitation and End of life care


    • Recovery (in development)

    End of life (EOL) care

    • Chaplaincy
    • Communication with family (in development)
    • Completing respect forms/DNAR (in development)
    • End of life care (in development)
    • End of life care plan (in development)
    • End of life prescription (in development)
    • Last offices
    • Symptom control (in development)
  • Admission: Documentation: Transfer


    • Admission (in development)


    • Local IT training (in development)
    • Transfer and Discharge (in development)


    • Intrahospital (in development)
    • Intrahospital / Interhospital (in development)
  • Safety and Governance: Communication: Professional Development

    Safety and Governance

    • Bed space preparation (in development)
    • Bedside safety checks (in development)
    • Bedside safety checks/equipment (in development)
    • Cardiac arrest
    • Cardiac arrest in the COVID patient
    • Debriefing (in development)
    • End of shift debriefing (leading) (in development)
    • Infection prevention & Control (in development)
    • Local Induction (in development)
    • Patient Safety (in development)
    • PPE donning & doffing
    • Risk Management (in development)


    Professional Development

    • Clinical Governance (in development)
    • Clinical Practice (in development)
    • Human Factors: Assertiveness (in development)
    • Human Factors: Decision Making (in development)
    • Human Factors: Escalation (in development)
    • Human Factors: Graded Assertiveness (in development)
    • Human Factors: Handover (in development)
    • Human Factors: Leadership (in development)
    • Human Factors: Risk management (in development)
    • Human Factors: Stress and Resilience (in development)
    • Human Factors: Teamwork (in development)
    • Professional Practice (in development)
    • Professionalism (in development)
    • Research, Development and Innovation (in development)
    • Teamwork Followership (in development)
    • Teamwork Leadership (in development)
    • Teamwork MDT (in development)
  • Wellbeing
  • Train the trainers (NEW)

    Content required: please see section below on How to give your feedback and share resources.

  • Simulation (NEW)

    Content required: please see section below on How to give your feedback and share resources.

Programme content: 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!

  • Bay Template

  • Nurse Shift Handover Document

Programme content: Research outputs

How to give your feedback and share resources

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 See the drop-down sections below for more information.

  • Skills matrix

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

    A. Use the 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 very much in advance.

    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 If you are able to complete the attached coversheet 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

Additional resources

  • FICM and HEE Skills Passport

    FICM (Faculty of Insensive Care Medicine) and HEE (Health Education England) 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.”

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 thread 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
    Wellbeing (PsychPPE)
    Compassionate Care
    Pharmacy skills
    Safety Critical Clinical Skills
    COVID Cardiac Arrest (and prone pt)
    Fluids In
    Fluids Out
    Patient positioning, moving and handling
    Consolidation of Learning
    Full Immersion Clinical Simulation

    Day Zero


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 (

How to access

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

Register >

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

View >

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 e-LfH directly.

More information

Please select the following link for more information on how to use the e-LfH Hub.

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

e-LfH is a Health Education England Programme in partnership with the NHS and Professional Bodies