Intensive Care: Services (Hansard, 13 December 1995)

§ Baroness Cumberlege
My Lords, it is for health authorities and NHS trusts to determine the level of intensive and high dependency care according to the needs of their local populations.

§ Lord Ashley of Stoke
My Lords, I thank the Minister for that Answer, although it does not say very much. Does she agree that the recent report on post-operative deaths stated that surgery and anaesthetisation were both safe but that patients' lives were at risk because of the shortage of high dependency beds in hospitals throughout the country? Is the Minister aware that the report recommended that that shortage should be dealt with urgently? Are the Government dealing with it urgently? Indeed, why have they not dealt with it so far?

§ Baroness Cumberlege
My Lords, we welcomed the report of the national confidential inquiry into peri-operative deaths; but we did not entirely agree with its view on critical care because there is a lack of scientific evidence which could either support or refute the view that was expressed. That is why the 1275 Government commissioned a study into the provision of intensive care in England. That report was published in February of this year.

§ Lord Rea
My Lords, does the noble Baroness agree that the distribution of intensive care beds is uneven throughout the country, with under-provision in some areas and possible wasteful over-provision in others? Will the research that she mentioned lead to strategic planning of intensive care across health authority boundaries, involving trusts, and operating across purchasing authority boundaries? Will the noble Baroness answer my noble friend's question about high dependency beds, which are less costly than intensive care beds and can be used effectively in conjunction with them?

§ Baroness Cumberlege
My Lords, yes, the noble Lord is right in saying that provision is uneven across the country. Indeed, different admission criteria apply in different parts of the country. The study to which I referred was undertaken by Professor McPherson, and reported that one in six intensive care admissions was inappropriate. That meant that people with life-threatening emergencies were possibly denied treatment. The professions are producing guidelines on admission and discharge policies which we think will make a great difference. In April we set up an intensive care bed bureau in the south-east of England, since when there has been no occasion on which an intensive care bed was not found when needed. That practice has been adopted in other parts of the country.

§ Lord Hayhoe
My Lords, I pay tribute to the staff, to the nurses and others involved in intensive care, for their great dedication and high professional skills, but does my noble friend accept that there is sometimes a shortage of staff which leads to difficulties in finding intensive care beds for particular patients? Is my noble friend satisfied that proper arrangements are in hand to improve and extend the training of intensive care staff?

§ Baroness Cumberlege
My Lords, yes, my noble friend is correct about trying to staff intensive care units. In fact, more training places are now in the pipeline. Since 1990, 1,000 extra intensive care nurses have joined the service, so we are seeing an improvement on that front.

§ Baroness Robson of Kiddington
My Lords, is the Minister equally satisfied about the existence of proper rehabilitation services in most of our hospitals? After all, rehabilitation is tremendously important if one has been in a high dependency or intensive care unit. I fear that some of those services are no longer available.

§ Baroness Cumberlege
My Lords, I am not certain what the noble Baroness means by rehabilitation because it can be a long-term thing—two or three years. With regard to rehabilitation for those coming out of intensive care, what the noble Lord, Lord Rea, said about high dependency units can apply here also. 1276 People on general wards are conscious of the need to rehabilitate those coming from intensive care, and they do it well. It would be very hard for any Minister to give a guaranteed assurance that it is done perfectly.

§ Baroness Masham of Ilton
My Lords, is there not a problem with an increase in emergency admissions which sometimes take up the intensive care beds so that people waiting for serious operations have to have them cancelled at the last minute? Is she also aware that there is a shortage of intensive care cots for babies throughout the country?

§ Baroness Cumberlege
My Lords, the noble Baroness is right when she says that we have seen a rise in emergency admissions. We are not sure why that is. There is a study going on at the moment which is just about to report to the Government. We shall follow that up. With regard to neo-natal admissions, the problem in those units often is that there is no criteria for admission. I know that some trusts are addressing that issue.

§ Lord Ashley of Stoke
My Lords, will the Minister tell us how she reconciles her statement that there is a lack of scientific evidence about the situation, when this report was written by the best medical brains in Britain who were invited by the Government to do so? I refer to top class surgeons and anaesthetists. Secondly, will she kindly confirm that only one hospital in five in Britain has high dependency units?

§ Baroness Cumberlege
My Lords, when these committees do their work, they are often closely targeted on certain areas. In this case I believe that it went beyond the area one would normally consider. As I said, we welcome the report, but I have to say that there is no scientific evidence to support or refute its view.