Furness General Hospital critical care service

No formal decision has been made. There are several reasons why this decision is being considered and the first and most important one is that the numbers of people needing Level 3 ICU care are low and falling. Even with projected increases in the population the need for a Level 3 ICU would not be there. With so few people needing extended Level 3 care, it is not possible for our clinical teams to maintain their clinical competencies to a level that would provide safe care. The level of expertise needed requires regular care of patients in multiple organ failure. Evidence nationally (Scotland and Cornwall) and globally (Canada and Australia) tells us that complex Level 3 care needs to happen in larger centres with higher throughput and outcomes are significantly better when this happens. We want the people of Barrow to have the safest and best care available. This is what they deserve. This is why we have chosen a ‘stabilise and transfer’ model. Patients requiring Level 3 care are still expertly stabilised and are then safely transferred to a unit used to dealing with multiple organ failure. This is evidenced both through our own data over the last six months and national/international data where transfers are significantly longer than the 47 miles between Barrow and Lancaster. It’s also important to note that outcomes for all patients that have been transferred have been good.

The secondary issue is that national guidance says that to provide this service we need a minimum of eight substantive consultants. We have three, and despite multiple recruitment drives, this hasn’t changed for years. But even if we had a full rota, those consultants would not be able to maintain their clinical competencies to a satisfactory level for us to provide safe levels of care because we aren’t seeing enough people who actually need Level 3 intensive care.

Due to the reasons above, UHMBT made the difficult decision to suspend the Level 3 intensive care service in September last year and then Lancashire and South Cumbria Integrated Care Board commissioned an independent review to look at the safety and sustainability of the service going forward.

This review was done by the North West Clinical Senate and they provide independent, expert clinical leadership and advice on how services should be designed to provide the best overall care and outcomes for patients and the public. 

The panel agreed that the suspension of the Level 3 critical care service at FGH needed to be made permanent and that the service should continue to provide Level 1 and 2 care accompanied by a stabilisation and transfer service for patients with Level 3 care needs at FGH to the ICU unit at RLI. 

The panel stated that this was clinically correct and entirely focused on patient safety and service sustainability. 

ICU care is classified in terms of 'levels':

• Level 1 - Patients who are at risk of deteriorating, who need close observation.
• Level 2 - Patients who are more seriously ill, and may need support for one organ - this includes high flow oxygen, medicine to support blood pressure (for example, in severe sepsis) or kidney support (dialysis).
• Level 3 - Patients who need life support for more than one organ, and usually need a ventilator to breathe.

Definitely not – the hospital has a very bright future and will serve a bigger population as the town of Barrow and the Furness peninsula welcomes new residents, due to the rapid expansion of the BAE Systems workforce and the major investment in the area. The Trust and its partners remain committed to FGH and its future as a district general hospital in Barrow. A brand new £5.8m Community Diagnostic Centre is about to be opened at the hospital and the Trust is hoping to receive national funding to expand emergency and family services on site as part of the health contribution to Barrow Rising. The independent expert clinical senate who provided advice on Level 3 safety and sustainability included the expected population growth, the geographical location of FGH and the location of ICUs with Level 3 capability in their thinking.

The Senate and Network have taken this into account and made their recommendation based upon the clinical evidence. Since the service was suspended, only 20 patients requiring Level 3 critical care have been transferred to RLI once stabilised (10 further patients were transferred but would have been anyway). Patients requiring Level 1 and 2 critical care have continued to be treated and cared for at FGH.  

The senate took account of the nature and scale of the industry at BAE in making its safety recommendations. Sellafield is best served by West Cumberland Hospital in Whitehaven, which is 20 minutes away from the site, some patients may be treated at Carlisle; the journey time from Sellafield to FGH is 80 minutes. The Lake District National Park covers 912 square miles, FGH serves south Lakes, north Lakes is served by Cumberland Infirmary in Carlisle, and west Lakes by West Cumberland Hospital in Whitehaven.

No, absolutely not. The local population are not losing this service; it will just operate differently. Patients requiring Level 2 and Level 1 intensive care will continue to be treated at FGH. Patients requiring Level 3 intensive care will still be seen at FGH, but they will be treated and then stabilised. Once they are stabilised, they will be transferred to RLI or another appropriate provider. Once the patient no longer needs Level 3 care, they will be returned to FGH for their ongoing care.

All Level 3 intensive care patients will be stabilised before being transferred.

We know from data in Australia, Canada and Scotland, that once patients who require Level 3 care are stabilised by a consultant anaesthetist, they are able to travel long distances safely. When being transferred between hospitals, many patients will travel further than the 47 miles between Barrow and Lancaster, even in bad traffic and adverse weather conditions. We understand that this can certainly feel quite frightening for families and even staff who are involved in the transfers, but the evidence is clear that this method is significantly safer than trying to care for the patient on a unit with less experience or capacity. 

Transferring patients along the A590 to other hospital sites has been going on for many years as patients sometimes need specialist care at other hospitals. 

North West Ambulance Service (NWAS) covers the whole of the region including some very remote areas of Cheshire, Lancashire and Cumbria. Ambulance crews are extremely skilled clinicians with specialist blue light driver training and can navigate road networks under various conditions e.g. adverse weather, congestion etc, while monitoring and treating patients. The transfer of patients to specialist centres occurs throughout the North West region, and sometimes beyond, under the care of NWAS and, due to the rural locations they serve, the transporting of patients from incident scenes to a hospital could also cover a substantial distance.

Over a six-month period, there have been 30 patients who have been transferred from FGH and there have been no adverse outcomes. Ten of these patients would have been transferred even if there had been a Level 3 unit at FGH due to their clinical needs.

The ICB and UHMBT have worked closely with BAE Systems, Barrow Rising and the Barrow Delivery Board to understand, model and predict the scale of the population relocating to Barrow and the likely needs this will generate.

Modelling suggests that the demand for Level 3 critical care services will not significantly increase due to the likely make-up of the population that will move to the area – who are more likely to require other services the hospital provides. Whilst the demand for Level 3 services remains under the viable threshold, the safety risks of attempting to provide a Level 3 ICU service at FGH remain. Of course, the decision will remain under review.

Yes, each year the Trusts carry out an annual planning cycle and should the demand be required it would be shown in this work. Then, if demand required it and recruitment was successful, of course the service could be reinstated.

It isn’t a change from the situation that has been in place for the past six months and therefore we hope the impact will be minimal.

The panel fully recognised that the previous level 3 service model was fragile and could not now be expected to meet national standards due to workforce and recruitment challenges leading to intensive care unit (ICU) service cessation in September 2024. The panel also fully recognised the multiple different attempts by University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) to attract and retain sufficient intensive care medicine accredited consultant numbers over many years without success.

It also considered moving consultant cover from the Royal Lancaster Infirmary (RLI) or other hospitals to Furness General Hospital (FGH), but this would potentially de-stabilise the other services without fully addressing the gap in service at FGH.

The panel and Lancashire and South Cumbria ICB also considered a suggestion that the recruitment of further colleagues could sufficiently provide the Level 3 service, but this did not meet the standards required.

Critical Care services at FGH will still be provided, only the highest level of need – Level 3 will need to be stabilised and transferred out to RLI. As soon as patients can step down from Level 3 they will be returned safely to FGH for their ongoing care. We recognise that this is tricky for families, but safety risks and the much better patient outcomes (that are possible in a Level 3 unit which has enough demand to sustain it) is so much better for their loved one’s recovery and health.

Children from South Cumbria who require intensive care and newborn babies who require intensive care are stabilised at FGH and transferred out already, this has been the case for many years. As soon as our children and babies are able to step down the intensity of their care needs, they return to FGH.

The NW Clinical Senate provides free, independent, expert, strategic clinical leadership and advice regarding how services should be designed to provide the best overall care and outcomes for patients and the public.

Visit the NW Clincial Senate website to find out more.