Our view on the NHS 10 Year Workforce Plan: What’s missing for intensive care?
The Intensive Care Society (ICS) has submitted a formal response to the NHS Workforce Plan consultation. We support the ambition to shift the NHS towards prevention, digital care, and community services. However, the plan has notable, stark deficits in planning for acute emergency and intensive care.
About 200,000 people per year in the UK are admitted to critical care, receiving treatment that, requires access to acute secondary and tertiary care. Intensive Care provides support to tens of thousands of patients receiving planned life-saving and life-preserving surgeries each year. We also provide emergency treatments to patients presenting with acute medical, surgical, trauma and obstetric related conditions. The specialist skills required to ensure an adequate service exists for the whole spectrum of patients we cater for will always require the maintenance of centralised, specialist centres. The adequacy of our service relies on a commitment to continued investment in the care we provide, where we provide it, and on a willingness to learn lessons necessary to ensure that our services will be kept adequately prepared to face the threat of future pandemic(s).
Our response focused on three core asks.
1. Improving workforce capacity and supporting a culture for staff to thrive
We call for the acceptance that the standards laid out the Guidelines for the Provision of Intensive Care Services (GPICS) should be supported and implemented to achieve sustainable and safe service delivery. Adequate staffing, training, and resources will enable ICU staff to deliver a high-standard care as set out by the Guideines.
We advocate for policies that mandate sustainable rotas, ensure 24/7 access to rest facilities and hot food, and promote psychological safety. This includes implementing formal support structures, such as peer support systems and debriefing tools like the 'Team Immediate Meet' (TIM), as championed by the ICS’s 'Thrive at Work' programme, alongside embedding practitioner psychologists within critical care teams.
2. Using technology to make care safer
The NHS must invest in the specialist staff and infrastructure needed to properly use Clinical Information Systems in and between every ICU in the UK.
Clinical information systems help ICU teams manage large amounts of complex patient information, and in an environment where a patient may require over 200 clinician-led decisions a day, have the potential to increase efficiency and decrease error. The current digital NHS landscapes is also failing to support the sharing of information between primary, secondary and tertiary care services that is required to provide critical care.
3. Building the bridge between ICU and community
At present, the NHS critical care pathway focuses intensely on survival within the ICU but fails at the next crucial step: recovery. This recovery pathway is blocked by inadequate resourcing and a lack of universal access to specialist post-ICU follow-up clinics and rehabilitation services
The provision of post-ICU rehabilitation must recognise the need to invest in full multi-disciplinary teams. We also recommend the introduction of a new, named Rehabilitation Care Co-ordinator role. This post would ensure continuity of care from the ICU to the ward and into the community and facilitate access to primary care and specialist rehabilitation services.
The ICS cares deeply about health inequalities, many of these were brought to the fore by the stresses society faced during the pandemic. The need to respond and mitigate for health inequality as it applies to critical care and the patients we serve, did not go away when the Covid-19 pandemic ended. We strongly believe that a workforce plan that overlooks its most acute services will ultimately fail the vulnerable patients, when they need it most. We stand ready to work with the government and NHS England to help address these gaps.