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

The London Transformation and Learning Collaborative (LTLC) is a Health Education England and NHS England & Improvement initiative that was established in summer 2020 to support the cross-skilling of the London NHS workforce in response to the Coronavirus pandemic and to prepare for the second surge and beyond.

The LTLC adult critical care programme aims were to broaden the skills base of this workforce to manage existing, and potential future surges in, critical care demand. The programme supported London’s recovery plan by ensuring that:

  • training infrastructures could adapt to any future surge and increased critical care capacity
  • staff wellbeing for all colleagues was considered
  • opportunities for workforce and training innovations were maximised and continually adapted

The development of the LTLC adult critical care programme ended in September 2021, but this programme page and associated pages will remain live on elearning for healthcare (elfh) for the foreseeable future. Keep in touch with the team on Twitter and LinkedIn using the hashtag #NHSLTLC

Please contact the LTLC team for any further information or questions about the programme (

  • Our approach

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

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

    The programme has always been user-led, with both the systems and future learners actively involved in every stage, from development to delivery. We worked with the 5 integrated care systems (ICS) in London to ensure we were responsive to different needs across the capital during the July 2020 to September 2021 stages of the COVID-19 pandemic.

    The below chart illustrates the different stages of the programme.

  • Desired outcomes

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

    We also developed new materials to fill in gaps highlighted by mapping content to the skills matrix. The new materials we developed are showcased on the Rapid Access Resources page.

    For learners, we aimed 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 aimed 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)
  • Other LTLC programmes

    Since the Coronavirus pandemic, the LTLC has been responsible for the rapid and responsive co-development of a number of national cross-skilling programmes that aim to increase the capacity and capability of the workforce in response to urgent needs and demands of the healthcare system through the curation and development of free, open-access, interprofessional educational resources.

  • Meet the team
    • Julie Combes, Programme Lead
    • Lydia Lofton, Governance and Implementation Lead
    • Kathy Brennan, Governance and Implementation Lead
    • Libby Thomas, Education Lead
    • Ella Nuttall, Project Management Office (PMO) Lead
    Education Content Curation & Design
    • Becky Kay, Healthcare Science
    • Cecily Borgstein, Occupational Therapy
    • Clare Leon-Villapalos, Nursing
    • Dereck Gondongwe, Pharmacy
    • Emma Priestley, Nursing
    • Lliam Edger, Medicine
    • Lucy Brock, Physiotherapy
    • Nicola Dover, Nursing
    • Ruth McCabe, Medicine
    • Claire Wroe, Adult Digital Skills Passport Clinical Lead
    Project Management Office
    • Emma Harper, Communications Manager
    • Irene Maposa, Project Manager
    • Fatema Limbada, Project Manager
    • Simon Munns, Project Manager
    • Christine Strickett, Support Officer
    • Rani Mehmi, Support Officer
    Integrated Care System (ICS) Teams
    • Alison Dear, NEL ICS Lead
    • Emma Clarey, SWL ICS Lead
    • Diane Whyte, NCL ICS Co-Lead
    • Walter Burog, NCS ICS Co-Lead
    • Jenny Ekstrom, NWL ICS Lead
    • Colette Laws-Chapman, SEL ICS Lead
    • Vicki Newport – NWL ICS Lead and London Critical Care Digital Skills Implementation Lead
    elearning for healthcare (elfh) Team
    • Frankie O’Brien, elfh Project Manager
    • Bob Smith, elfh Platform Delivery Lead
    • Louise Garrahan, elfh Communications Officer
    • Cathryn Fowkes, elfh digital content support

COVID-19 Surge 2021 – Rapid Access Resources and Staff Recovery Resources

COVID-19 Surge 2021 – Rapid Access Resources
The LTLC has collated a range of key resources to help individuals, educators and systems prepare and to support NHS staff being deployed for the Coronavirus response. We recognise staff are very busy, so these resources are purposely designed to be short and read/watched on the move or on the ward and include: a searchable equipment support tool, a 360 ICU Orientation for new staff and the RSC and NRSS Passports for surge staff.

Staff Recovery Resources
These resources have been created to support healthcare staff recovering from the COVID-19 pandemic. Not all people approach wellbeing by the same means; these resources acknowledge those differences and cover a variety of approaches, including Developing Wellbeing Conversations, Spaces for Listening, and Creative Story Telling.

How to use this programme

Step 1: Download and use the Interprofessional skills matrix to:

  • understand the key skills for working in critical care for your professional role mapped against national frameworks, for example, The Nursing and Midwifery Council (NMC), General Medical Council (GMC)
  • identify any skill gaps or skills you would like to learn more about
  • find educational resources for these specific skills

Step 2: Explore the multimedia resources for learners and/or trainers:

  • Learner: resources for self-directed learning, mapped to skills in the interprofessional skills matrix, split by professional groups and sub-categories. Track which resources you have completed, partially completed or are yet to complete
  • Trainer: resources, mapped to skills in the interprofessional skills matrix, split by skills categories and sub-categories. Consider pointing your learners in the direction of the Adult critical care digital skills passports, to prepare in advance for future surges
  • How to access

    In order to access the LTLC programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.

    Register >

    To view the 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.

    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 LTLC programme, please contact elfh directly.

    More information

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

Interprofessional skills matrix (Step 1)

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, The Health and Care Professionals Council (HCPC), The Critical Care National Network Nurse Leads Forum (CC3N) and Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) professional competencies to aid presentation for revalidation and appraisal.

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

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

  • How to use the skills matrix

Educational resources for learners (Step 2)

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.​

Adult Critical Care Digital Skills Passports

The LTLC adult critical care digital skills passports are endorsed by the Intensive Care Society, British Association of Critical Care Nurses (BACCN) and Critical Care Network National Nurse Leads Forum (CC3N) and have been developed:

  • to support staff to understand, document and acquire new skills to support the safe delivery of critical care (levels 1, 2 and 3) to adults in a surge model of care
  • for managerial staff overseeing these surge model roles to have visibility of their team members’ skillsets and capability

The adult critical care digital skills passports can be accessed via mobile, tablet and desktop and have been created for:

  • non-registered support staff (NRSS) (for example a health care support worker or a non-registered member of staff specifically recruited to ICU in this role or healthcare students who may wish to work on critical care units during the surge as bank staff
  • registered support clinician (RSC) (for example a junior ICU nurse who has not yet achieved their step 1 competencies in the national competency framework, a registered nurse, who works outside of ICU or a registered (non-nursing) healthcare professional)

Resources from the LTLC adult critical care programme have been mapped to the passports’ skill domains to support self-directed learning.

Knowledge Checker for RSC Skills Passport

This Knowledge Checker is designed to help registered healthcare professionals preparing for deployment to critical care assess their core knowledge on elements of patient care as covered in the RSC Skills Passport. This knowledge and these skills should allow them to slot into the bedside patient care role in critical care with increased confidence. Each element of the passport is covered in the Knowledge Checker and links are provided to free education resources for each question to support further understanding where needed. (under 30 mins to complete, no pass / fail)

CapitalAHP C3Framework

The CapitalAHP Critical Care Competency framework (C3Framework) has been created to support the professional development of AHPs new to critical care and aid workforce planning of critical care services. More information about its rationale and methodology can be found in this short paper (PDF, 209KB).

Visit the CapitalAHP C3Framework website to access and download the framework and its supporting materials, including supervised learning events logs and templates. There is ongoing work to implement and improve the framework. Contact details can also be found on the website.

Educational resources for trainers (Step 2)

The current educational resources and train-the-trainer materials can be found below. These have been mapped to the skills matrix by professional grouping. These have been re-organised for ease of access. Your feedback on these resources would be welcomed. Please email:

Managing the COVID-19 surge: 10 quick wins for ICUs

Frontline clinicians working with the National Clinically-Led workforcE and Activity Redesign (CLEAR) Programme for ICU, as part of the LTLC, are sharing 10 recommendations that can be adopted in ICU in 48 hours. While working collaboratively across 4 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

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).

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.

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

elfh is a NHS England programme in partnership with the NHS and professional bodies