Critical Futures: First Report

Background

In the late 1990s ICM hit crisis point. Patients were being transferred between hospitals for reasons unrelated to need, rather due to the lack of beds to meet demand. This was the trigger point for a step change in critical care services.

Following the Audit Commission’s report into critical care services 1999, Comprehensive Critical Care (CCC), published by the Department of Health in 2000, introduced the concept of ‘critical care without walls,’ a service responding to the needs of critically ill patients throughout the hospital. It recommended more critical care (CC) beds, opening more High Dependency Units (HDU), the development of CC outreach teams and hospital wide critical care delivery groups. Aided by the accompanying £140m, we have seen a dramatic positive change in care for the sickest patients in our hospitals.

The 12 Recommendations

1. Critical care healthcare professionals need to be consulted when acute hospital services are being reconfigured. Guidelines for the Provision of Intensive Care Services should be the blueprint for safe and effective services.
2. Standards and service design should be aware and responsive to the needs of all types of critical care services, including those that are specialist or remote and rural.
3. There needs to be an increase in the provision of Level 2 beds.
4. There needs to be an investigation into the development of Enhanced Care (Level 1+) services.  
5. There needs to be wider education and training in critical care for doctors who interact with its services.
6. There need to be more posts created for doctors in training and as a 24/7 high stakes specialty, there should be consideration as to make their careers sustainable.
7. Government and national healthcare stakeholder organisations must also consider all the other roles in critical care, across doctors, nurses and Allied Health Professionals, and how to make these roles attractive and sustainable to retirement.
8. The new workforce of Advanced Critical Care Practitioners needs to be supported and expanded.
9. There is an urgent need for a validated patient activity/acuity tool to determine nurse patient ratios.
10. There needs to be a full review of the issues surrounding treatment options and end of life care. 
11. The Faculty needs to consider if any outstanding elements of Comprehensive Critical Care (CCC) needs a review.  This has now been done and the Board unanimously agreed that, other than the issue of rehabilitation covered in Recommendation 12, Critical Futures recommendations now supersede CCC.  This Recommendation is therefore now closed.
12. The critical care community and national stakeholder bodies need to make consideration of the rehabilitation and follow-up of critical care patients a priority area for research and standard setting.

The first wave survey and report

Where are we going next, and what is the future for ICM? The Critical Futures initiative began with research undertaken via a survey designed by a multidisciplinary group. This was completed by both members of the Faculty and our sister stakeholder organisations in critical care. A number of strong messages came out and were brought together as 12 recommendations