Written Statement - Provision of Critical Care Services in Wales

On June 11, 2013, Together for Health – Delivery Plan for the Critically Ill: A Delivery Plan up to 2016 for NHS Wales was published. It sets out actions to improve the experience and outcomes of people who are critically ill, reducing inequalities and variability in access to services to ensure patients who need critical care receive it in an appropriate environment, cared for by sufficient numbers of suitably qualified and experienced staff.

That plan represented the start of a programme of action with a focus on improving the efficiency of critical care, identified as a priority within health boards.

Critical care beds are not always used appropriately. For example, not all patients in critical care beds need that intense level of care and some patients in critical care beds may be waiting to be transferred to a normal hospital ward for ongoing care and support. Delays in transferring patients can result in cancelled operations or critically ill patients having to be transferred to another hospital because of a shortage of available critical care beds. Wales’ critical care beds are spread over a large number of hospitals but there is a growing consensus of opinion among clinicians that they may be better be concentrated on fewer sites.

I accepted it was unlikely that efficiencies alone would be enough to meet the increasing demand for critical care and investment to increase capacity may be necessary. A commitment was given that work would be undertaken to quantify the additional number of beds needed in Wales and to provide an update on progress.

Two reports – the first annual report for the critically ill and an assessment of the unmet need for critical care in Wales, which was produced by the all-Wales implementation group – are today being published.

The annual report on critical care services sets a clear baseline for the provision of services for the critically ill and will complement health board service and delivery plans.

It presents an overview of NHS performance and identifies what health boards need to do to improve care for patients. It highlights a number of important initiatives already in place and establishes a baseline against which future progress can be monitored.

Across Wales, the NHS provides good quality critical care services and has a committed workforce. All health boards have developed and are implementing robust delivery plans supported and developed by clinicians.

The care for people who are critically ill does not begin and end in the critical care unit. Health boards have developed ways in which critically ill patients can be proactively identified and treated across hospital wards. Hospitals which do not provide critical care also have a responsibility to ensuring their patients receive the best possible care when they are critically ill. This includes stabilisation, transport and retrieval and repatriation when their critical care stay is over.

The Welsh Government has developed a number of outcome and assurance indicators to measure how critical care services are improving in Wales. Progress against these, showing that critical care services are developing:

• Survival rates are improving - the number of patients being transferred back to the ward after being admitted to a critical care unit is increasing. In 2012, just over 80% of patients were discharged to another ward, up from 79% in 2011;
• The NHS is meeting the demand for critical care, which has been slowly increasing over time. In 2011 there were 8,991 admissions and in 2012 there were 9,887 admissions – an increase of 896 admissions, almost 10%;
• Readmissions to critical care within 48 hours are very low – less than 2% of all discharges, indicating ward-based care and the discharge process are effective;
• Since the introduction of the critical care networks, improvements have been made in the safe transfer of people who are critically ill between hospitals through training and continuous audit - 80% of all transfers are graded as good or excellent;
• The Intensive Care Society’s carers’ feedback questionnaire has been introduced to obtain the views of carers.  Hospitals which have taken part have reported excellent satisfaction rates on communication, facilities and medical and nursing staff.

We must continue to maintain and improve performance in these areas and ensure progress is made in those areas where performance has not been as good as anticipated.

The NHS is continuing to work to ensure health services in Wales are sustainable and meet the evolving needs of the Welsh population. As part of their service and reconfiguration plans health boards must consider the best location and function of their critical care units.

The annual report acknowledges it may be appropriate to concentrate critical care services in fewer hospitals than they are currently provided. This might mean bringing together intensive care services – level three care – but ensuring other hospitals maintain the facilities to resuscitate and stabilise critically ill patients before they can be transferred to an intensive care unit.

The assessment of unmet need for critical care report concludes that Wales may need another 73 critical care beds in the future. In the last year, an additional 10 critical care beds have been opened across Wales and health boards have plans for eight more.

However, both reports highlight the problems Wales currently experience with delayed transfers from critical care units, which can result in the loss of up to 14 beds a year. Until this problem is addressed and the rate of delayed transfers is reduced, as the report acknowledges creating scores of new critical care beds is unlikely to alleviate the problem.

Both reports are clear that the NHS must focus on reducing delayed transfers of care from critical care units in Wales and ensuring all admissions are appropriate and in patients’ best interests in order to make best use of existing beds before proceeding with a large, planned expansion of bed numbers.

We must make the best use of the resources we already have and action must be accelerated to tackle inefficient use of our critical care beds. All health boards in Wales should have a plan in place to do tackle delayed transfers of care and will be required to deliver a phased reduction. This will require co-operation and co-ordination across the hospital.

Work is being carried out by Aneurin Bevan University Health Board and the critical care networks to develop a new developmental measure based on hours lost as a result of delayed transfers of care in critical care. Health boards will be expected to reduce the number of hours lost to delayed transfers of care from critical care units by 10% every quarter until they reach a position where no more than 5% of bed availability is being lost to delayed transfers.

This action will ensure the NHS is making best use its critical care beds and they are available for patients when they are needed.

The measure will be piloted as part of the new NHS outcomes framework.

This statement is being issued during recess in order to keep Members informed. Should Members wish me to make a further statement or to answer questions on this when the Assembly returns, I would be happy to do so.