>>Gale Pearson: My name is Gale Pearson, I am an intensive care consultant at Birmingham
Children’s Hospital. I am also chair of the clinical reference group for intensive
care in England, at NHS England, and in that role I have been very heavily involved in
running the review of paediatric critical care and specialised surgery.
The review is of paediatric critical care and specialised surgery in children and it
looks at the whole pathway of care for those children, where they present, how they are
transported to the lead centres or other centres for their care, the type of care that they
get. We are also looking at extracorporeal support which is a support system very similar
to cardiopulmonary bypass that goes on in the lead centres, and how the patients are
repatriated back after their intensive care.
We started in October 2016 and the first part of the process was a series of engagement
meetings with stakeholders – webinars and that sort of thing. We’ve also, in the critical
care side of things, had access to a database of activity from an organisation called PICANet
and we’ve been looking at that database and doing an analysis to look at exactly what
the profile of the work is in the critical care units. We’re now in a phase where we’ve
got several different work-streams looking at things like the extracorporeal support,
transport, the workforce and the general sorts of models of care – how the work is done,
where it’s done. And that’s all timed to produce at least some fairly high level
conclusions by the end of the year.
We’re releasing the analysis pack, which is what we’ve done with the data that we’ve
been able to get about intensive care activity in the UK. It’s a very informative pack
and it shows that there’s quite a lot of variation which we need to explain and account
for. And it shows why, for example, the winter is a time of acute pressure for paediatric
acute critical care units. What happens in the winter is that the services are overrun
by respiratory illness in children under a year of age, and those children are receiving
the fairly basic level of intensive care - not the more advanced things that are associated
with, for example, care for children after cardiac surgery or the extracorporeal support.
Well we want the whole review to be as evidence based as possible and we’ve had access to
this data from PICANet and what it shows is that there’s a lot of variation in different
parts of the country which is largely unexplained, and it shows that the service is in acute
demand and struggles during the winter months. The analysis also shows that there are some
long stay patients in intensive care that take up a huge amount of intensive care time.
The statistic is that 10% of the patients take up more than 50% of the activity and
after patients have been in intensive care for a long period of time it’s quite possible
that they could be looked after somewhere else, the reason that there is that they are
dependent on technology – usually some form of long term ventilation. And it’s not a
very nice place for a child who is dependent on a ventilator to be looked after because
they’re alongside a lot of other acute medical emergencies and things occurring - it’s
not the right place to live or grow up in.
You might expect that if you’ve got a problem with intensive care beds being full you should
just create more intensive care beds. Experience has shown that that is not the solution – if
you make more beds you fill them, and you still have a problem. It’s also the most
expensive approach.
The next steps are a series of work-streams looking at the way the units are staffed,
looking at how the patients are moved between units, looking at this extracorporeal support
which only goes on in a few of the centres - not all, and looking at the general model
of care, and as I say, the whole pathway, right from presentation to discharge home.
Hospitals work well together to look after critically ill children, and patients are
moved between hospitals when they need that care and what we’ll be looking at is that
network, and what the roles are of the different hospitals within it.
It’s very important that people get involved in this review. Everybody’s opinion is relevant
and will be taken into account.