BuildingBetterIntensiveCare: Prioritiesforthenextgovernment
|Invest|Prioritise|Enable|Support|Deliver|
TheIntensiveCareCommunitywantstoseethenextGovernmentto prioritise thefollowingfiveareastobuildastrongandsustainableintensivecareservice, properlyresourcedtocareforcriticallyillpatients...
Investinintensivecarestaff
Weneedmajorinvestmentin retaining,recruiting,and developingintensivecarestaff whocareforthesickest patientsbothinintensivecare andontheirrecoveryjourney.
Prioritiserehabilitationfor intensivecaresurvivors
Weneedrapidexpansionofthe provisionofpatientrehabilitation servicestoensureallpatients havethebestchanceof returningtolifebeforecritical illness.
Enablelife-savingresearch
Weneedring-fencedfundingto enableintensivecare professionalstoinvolvemore patientsinstructuredresearch studiesandimproveoutcomes.
Supportadiverseworkforce
Weneedstructuralchangewithin thehealthservicetofostera diverse,inclusiveand psychologicallysafeworking environmentforallstaff.
DeliveraCarbonZero intensivecare
Wemustacceleratethemoveto aCarbonZeroNHS.
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Invest inintensivecarestaff
Weneedmajorinvestmentinretaining,recruiting,anddevelopingintensive carestaffwhocareforthesickestpatientsbothinintensivecareandon theirrecoveryjourney.
TheNHSworkforceisincrisis.Unsustainablestaffingshortfallsand escalatingdemandsforcarehavecreatedaninsurmountable challengeforthosewhocareforthecriticallyill.Thecarewe provideisthemostimportantserviceinanyacutehospital.Our teamsdon’tonlyoperatewithintheconfinesofanintensivecare unit,wearealsorequiredtosupportpatientsandcolleagues throughoutreachandinotherareasofthehospitalsuchas emergencymedicine.Wearethelastlineofdefenceforour patients,yetourserviceremainsunderresourcedand understaffed,resultinginnoteveryhospitalbeingabletoprovide thesamelevelofcare.Thismakesimplementationofinitiatives suchasMartha’sRulenation-wideincrediblydifficult.
TheGuidelinesfortheProvisionofIntensiveCareServices(GPICS), setbytheIntensiveCareSocietyandtheFacultyofIntensiveCare Medicine,stipulatethataconsultanttopatientratioof1:8-1:12 shouldneverbeexceeded.ThemostrecentauditofUKintensive careunitsshowedthat43%ofsurveyedhospitalscannotmeetthis standard.Thisdilutionofstaffingisseenacrossallprofessions whichmakeuptheintensivecareteamandhasanimpactonthe qualityofpatientcareandoutcomes.
OneinninenurseslefttheNHSinJune2022,withafurtherfourin10 doctorsplanningtoleave.Existingshortagesandacontinued inabilitytomeetthestaffingstandardsoutlinedinGPICS,carrythe riskofacceleratinganunprecedentedstaffexodus,exacerbated bytheeffectofoveradecadeofunrelentingpressures.
ThenextUKGovernmentshould:
Immediatelyresolvetheimpasseandreacha dealregardingfairandequitablepayand recognitiontobringindustrialactiontoan end
Committoafocussedincreaseinnational intensivecaretrainingnumberstoboostthe volumeofspecialtytrainees
Investintheretentionoftheexisting intensivecareworkforce.Thecostof replacingonefullytrainednursecanbeas highas£12,000,aclearfinancialincentivefor retentionefforts
Maketherecruitmentofintensivecare professionalsanimmediatepriority
Ensureeverymemberoftheintensivecare workforcehasaccesstoring-fencedannual fundingtofacilitatecontinuedprofessional development,todemonstratetheirvalueand ensuretheyareequippedwiththerightskills toprovidecontinuedhighlyspecialisedcare
Establishareliablepipelineofintensivecare professionalsbyincreasingtrainingplaces byaminimumof10%andcreatingclear pathwaysintointensivecareby2026
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PrioritiserehabilitationforICUsurvivors
Weneedrapidexpansionoftheprovisionofpatientrehabilitationservicesto guaranteepatientshavethebestchanceofreturningtolifebeforecriticalillness.
Survivingcriticalillnessisonlythebeginningforthosewhoaretreated inintensivecare.Thetreatmentsadministered,suchasmechanical ventilation(‘lifesupportmachines’),sedationandotherinvasiveorgan supportcantakeasignificanttollonboththemindandbody.For thosesurvivors,manywillneedtore-learntoeat,walk,talk,oreven swallow.Theselong-termeffectsmeanthataroundonethirdofICU patientsdonotreturntoworkwithinfiveyears.
Whilerehabilitationstartsontheunit,patientscanfaceaminimumof 18monthsofrecovery,buteveryrehabjourneyisuniqueasmanywill alsoneedtoadjusttoaradicallydifferentwayoflife.Atpresent, accesstothenecessaryexpertiseandsupportisvariedanddepends heavilyonwherepatientsarelocatedwithintheUK.Thislackofaccess topostintensivecarerehabilitationresultsinmanysufferingthe impactsoftheirillnessandhospitalisationfarlongerthanisnecessary.
Thisisfurthercompoundedbyourpatientsbeingunabletoreturnto workandneedingtoaccessfinancialhelpthroughthePersonal IndependencePayment(PIP)schemeastheyrecover.However, accessingthisschemecanbechallengingforourpatientswhohave tolearntowalk,talkorevenbeginusetheircognitiveabilityagain.
Itisfundamentalthatservicesthataredesignedtosupportthepublic suchasPIP,accountfortherepercussionsofthecareweprovideand howthisisreflectedinthesupporttheyreceivenotonlyafterleaving ICUbutondischargefromthehospitalandastheyre-enterthe community.
ThenextUKGovernmentshould: Investinrehabilitationwithappropriate staffinglevelstoreducetherateof hospitalreadmissionofthosewhohave experiencedcriticalillnessandhelpthem returntotheworkforcesooner
EnsurerehabilitationservicesacrosstheUK areusingafullyresourcedandconsistent modelthatenablesequalaccessforour patientsnomattertheirpostcode
EmbedaUKwidetoolthatcapturesour patientsrehabneedsandsupportstheir recoveryneedsbothontheunitandafter theyleaveintensivecare.Forexample,the PostICUPresentationScreendevelopedby theIntensiveCareSociety
Improvedinfrastructurefordatacollection andreportingtobetterassessandmeet rehabilitationneeds
ModifythePIPapplicationforICUpatients bytakingintoconsiderationtheirlongterm rehabilitationcareneedsandsimplifyhow theyaccessfinancialsupport
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Enablelife-savingresearch
Weneedring-fencedfundingtoenableintensivecareprofessionalsto involvemorepatientsinstructuredresearchstudiesandimproveoutcomes.
Intensivecareresearchsaveslives.TheGenOMICCstudy investigatesthegeneticfactorsthatdetermineoutcomesin criticalillness.EstablishedwithfundingsupportfromtheIntensive CareSociety,itisthelargeststudyofitskindgloballyandwas integraltofindingsuccessfultreatmentsforCOVID-19.Without similarresearchsupportintensivecarewillnotbeabletomeetthe needsofpatientsinthefuture.
Whileallintensivecareprofessionalsarerequiredtoundertake researchtoprogressintheircareers,thereiscurrentlyadistinct lackofprotectedtimeandfundingavailabletosupportthis. Researchinintensivecareiscrucialnotonlyfortheprofessional developmentofstaffbutalsoforthecareandexperienceof criticallyillpatients. Wecanonlyutiliseresourceseffectivelywithevidenceand researchiskeytoidentifyingwhatworks.
ThenextUKGovernmentshould:
Allocateadedicatedfundforintensive careresearchtoenablenew investigations
Provideprotectedtimeforallintensive careprofessionalsundertakingquality improvementprojectsand/orinvolvedin widerresearch
Investinlargescalecriticalcareresearch toimprovepatientoutcomesandlongtermrecovery
Implementimprovedinfrastructurefor intensivecaredatareportingtoinform futureresearchneedsandopportunities by2027
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Supportadiverseworkforce
Weneedstructuralchangewithinthehealthservicetofosteradiverse, inclusiveandpsychologicallysafeworkingenvironmentforallstaff.
TheIntensiveCareSociety’srecentEquality,Diversityand Inclusionreportfoundsignificantdifferencesinthe experiencesofintensivecarestaffaccordingtotheir socioeconomicstatus,gender,ethnicity,sexuality,ability, andothercharacteristics.Italsoexposedfailingswithinthe NHStoprotectstafffromdiscrimination,bullying, harassmentordisadvantageoccurringasaresultoftheir backgroundsorotherfactors.
RecentdatafromtheInequalitiesinHealthAllianceshows that75%ofpeoplewereconcernedthatthehealthgap betweenwealthyanddeprivedareasisgrowing.Thisgap mustbeclosedimmediately.
Intensivecareprofessionals’andpatients’experiencesof healthcareintheUKshouldbeuniversal,andanindividual’s personalcharacteristicsand/orcircumstancesshouldhave nobearingontheiraccesstocareorrighttoapositive workingenvironment.
TheNHSwouldnotbeabletofunctionwithoutits internationalworkforce,whoaccountfornearlyoneinevery fivepeoplewhoworkinthehealthservice.Recent immigrationpolicychanges[2024]nowrestrictdependents frombeingaddedundertheHealthandCareWorkervisa. Thosewishingtojointheirlovedoneswillneedtosource alternativepathwaysintotheUK.
ThenextUKGovernmentshould:
Committoacross-governmentstrategythatconsiders theroleofeverygovernmentdepartmentandevery availablepolicyleverintacklingthefactorsthatmake peopleunwellinthefirstplaceasperthe
recommendationsoftheInequalitiesinHealthAlliance UndertakeafullreviewandamendoftheHealthand CareWorkervisapolicytoensuretheprocessof internationalrecruitmentnotonlyremovesunnecessary barriersforourcolleaguesandtheirdependentsto entertheUK,butalsoallowstheNHStoattractmembers oftheglobalintensivecarecommunity
Investinenhancedequality,diversityandinclusion trainingforallintensivecarestafftoensuretheyare quippedtoprovideaconsistentlyhighstandardofcare forallpatientsandtheirlovedones,regardlessoftheir protectedcharacteristics
Increaseinvestmentinequalaccesstoeducationand trainingopportunities,includingforthosewith protectedcharacteristics,toexpandaccessto pathwaysintoworkinginintensivecare
Embedbettersupportandresourcesforstafftrained internationallytoensuretheyareembeddedas smoothlyandquicklyaspossibleintoroleswithinthe NHS
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DeliveraCarbonZerointensivecare
WemustacceleratethemovetoaCarbonZeroNHS.
Theclimatecrisisisaglobalhealthcrisis,andtheNHSisboth acontributortothisandavictimofitseffects.Asairquality deterioratesandweregularlyseetheimpactsofbothextreme heatandextremecold,thehealthservicecaresforasteadily increasingstreamofpatients.Between2017and2025the effectsofairpollutantswillcosttheNHSabout£1.6billion.
Healthcaregloballyaccountsforabout5%ofCO2emissions, andcriticalcareisaleadingcontributortothis.Asoneofthe mostresourceintensivepartsofahospitalourworkcaringfor thecriticallyillcomeswithaseriousimpactontheplanet.
ThenextUKGovernmentshould:
Facilitatethemoveawayfromfossilfuels andtogreenenergyacrossallNHS properties
Workwithsuppliersandprocurementteams toensureallproductscommissionedand purchasedmeetsustainabilitystandards duringbothproductionanduse
Acceleratethemilestonesoutlinedinthe NHSclinicalwastestrategytoensureall wastegeneratedisdisposedofinthemost appropriateandenvironmentally sustainableway
Workwithprofessionalbodiesandtheir industrypartnerstoidentifyandimplement low-carbonalternativesandlean pathways
MandateareviewacrosstheNHStoreduce theamountofwastecreatedby unnecessaryuseofPPEandothersources
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