Written Statement: An update on the care for the critically ill

Winter can bring increased pressure for our health and social care services and therefore I want to update members on the progress we have made to improve care for the critically ill. Resilient critical care services are an essential component in the smooth functioning of the NHS, particularly during the winter months. We are determined to address some of the issues faced by this part of the service. This nationally directed work has important links to other developing areas such as major trauma and a number of specialist services, such as treatment following an out of hospital cardiac arrest and vascular surgery. It is therefore important that it is seen in that wider context. 

In July, I announced that critical care services in Wales will benefit from an additional £15 million a year from next financial year. To inform the allocation of this funding, a Task and Finish Group, chaired by the Deputy Chief Medical Officer, Professor Chris Jones, was established. The Group is looking to develop a national model and make strategic recommendations for the future. I want to be clear this does not mean that we are looking to downgrade any services, but rather to support services to be consistently effective and sustainable.

The Task and Finish Group has met three times since August. The membership of the Group and its work streams are representative of the various relevant specialties and professions across Wales. This collaborative approach is enabling recommendations to be made from an all Wales, evidence led perspective.

Reporting back to the Task and Finish Group are seven work streams designed to look at:

• The mapping of service models, demand and capacity;
• Future workforce requirements;
• Outreach;
• Post anaesthesia care units;
• Long term ventilation;
• Patient transfers and
• Performance measures.

The work streams will undertake their work and research as they deem appropriate, allowing this important national programme of work to be steered by staff leading and working in their services. They are considering the impact of any recommendations, taking into account our need to deliver consistent standards for care, thresholds, managing bed flow, demand and making the best use of capacity.

Early progress has included critical care becoming a strand within the Train, Work, Live campaign, highlighting the existing opportunities to work in critical care in Wales. In addition, critical care will be included in the unscheduled care dashboard with new performance measures to be reported on from January 2019.

To support critical care this winter, Members will be aware that I have also allocated nearly £5 million to health boards. This funding will help health boards to surge their capacity in times of high demand and in Cardiff and Vale University Health Board permanently increase their of number critical care beds.

This one off funding will not set a precedent for the recurring annual £15 million funding from the next financial year, because that will be subject to recommendations from the Task and Finish Group. However, it underlines the Welsh Government’s commitment to support the NHS this winter and plan for new, more sustainable ways of working in the future. Health boards are required to evaluate the impact of this additional funding following the winter and to report back to the Task and Finish Group and Critical Care Implementation Group. Work is also ongoing to explore if patient repatriation and transfer processes between health boards can be improved. This would allow patients to be closer to their homes and for the varying levels of critical care units to be better utilised.

Our national programme of work is clinician led, innovative and will result in significant and sustainable improvement in critical care. The need to increase critical care bed numbers will undoubtedly be a conclusion of this work, but it will not be the only change needed if services are to be transformed. We acknowledge there are big challenges ahead particularly in relation to dealing with workforce issues. This programme of work is likely to take several years to fully implement but our approach has already been commended by the Faculty of Intensive Care Medicine. The programme has also attracted professional and governmental interest from outside Wales. The Welsh Government will continue to work with our NHS, as equal partners, to improve services and outcomes for our critically ill patients.

Finally, I wish to express my gratitude to the healthcare professionals and managers who are working together to bring real and meaningful transformation to our critical care services. I look forward to this work concluding next spring when we will update Members on the recommendations.