SICS SCCDGC

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The Scottish Critical Care Delivery Groups' Chairs SCCDGC

In 2000 a group convened under the auspices of the Scottish Executive Health Department (SEHD) and, chaired by Prof. Sir David Carter, produced a report entitled “Better Critical Care”. One of the suggestions of this excellent report, was the creation of Critical Care Delivery Groups (CCDG) in all acute Trusts. The composition of the groups was to be multidisciplinary, bringing together medical, nursing, AHP, medical physics, pharmacy and management staff reflecting local requirements. The remit of the groups was to be:

1. Definition of level 2 (HDU) and level 3 (ICU) capacity in individual Trusts
   
   Undertake a needs assessment of level 2 & 3 capacity
   
   Establish escalation policy
   
   Co-ordinate winter planning
   
   Establish admission and discharge guidelines for level 2 &3 facilities
   
   Develop Patient at Risk guidelines and aim to establish outreach processes
   
   Establish priority action plans
   
   Establish programme of clinical audits
   
   Monitor developments
   
   Establish Critical Care Services strategy
   
   Co-ordinate training and education
   
   Liaise with Trust Management Teams or Health Boards

A number of CCDGs were established but there was no common Scottish-wide forum. The Council of the Scottish Intensive Care Society (SICS) proposed that I contact fellow Chairpersons of the various CCDGs so as to obtain a nationwide picture. This was done and we had our inaugural meeting on November 8th 2002. Chairs or their representatives attended from across Scotland. Since then we have had two other meetings where we have been joined by Ms Sandra Campbell, Senior Medical Officer at the SEHD and Fiona MacKirdy, Director of the Scottish Intensive Care Society Audit Group (SICSAG). We nominated Ms Rosemary Lyness, General Manager at Monklands Hospital and Lanarkshire CCDG Co-Chair, as our Secretary and myself as Chairman.

The above meetings have established that there are CCDGs in the vast majority of acute Trusts, including most of the island health boards. Most CCDGs are chaired by anaesthetists. We have collated their compositions and local remits, which reflect the “Better Critical Care” recommendations with local flavours. We have collated level 2 & 3 capacities and we are currently undertaking a medical level 2 needs assessment. We have discussed the development of domiciliary ventilation and outreach teams. We have also discussed winter funding of critical care provision, transport of the critically ill and funding of the SICSAG HDU audit on a national basis akin to the ICU audit. At the next meeting on September 1st 2003 we plan to discuss a common CCDG critical care services strategy, medical level 2 needs assessment and 2003/4 winter planning amongst other things!

What have the various collations shown?

1. There is a inadequacy of level 3 capacity across Scotland reflecting, but not as severe as, the English picture.
   
   There is a greater inadequacy of surgical level 2 capacity and a ubiquitous and dangerous inadequacy of medical level 2 capacity.
   
   No analysis has been made of cardiothoracic, neonatal and paediatric services.
   
   Most of the above remits have been achieved or actioned.
   
   Outreach has not been seen as a priority in most Trusts but it is being considered.
   
   Clear problems exist: lack of central resource to back up the recommendations of “Better Critical Care".
   
   There is often a lack of management response to well considered proposals and transport of the critically ill is still not harmonised and contravenes Health and Safety regulations (this is currently being addressed by a separate group).

In summary

The CCDG Chairs Group has had excellent and consistent nation-wide representation. It meets regularly, providing a useful forum for the exchange of information and a communication route to the SEHD. Formal links have been established between it and the SICS council.

Dr Mike Fried

Current Chairman

John Colvin, Ninewells

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