Furness General Hospital critical care service

Intensive/critical care (provided on an Intensive Care Unit - ICU) 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.

In September 2024, the difficult decision was taken to admit Level 1 and Level 2 critical care patients only to FGH.

Any Level 3 patients are stabilised at FGH and then transferred to the ICU at the Royal Lancaster Infirmary (RLI).

No. The local population will not lose this service, but it is currently operating differently. Patients who require Level 1 and Level 2 intensive care are continuing to be treated at FGH. Patients requiring Level 3 intensive care are still seen at FGH, but they are treated and then stabilised. Once they are stabilised, they are transferred to RLI or another appropriate provider. Once the patient no longer needs Level 3 care, they are returned to FGH for their ongoing care.

Currently, other services at FGH continue to be provided as they always have been, and there is absolutely no change to this. There are no plans that involve the ICU closing. Critical care is vital to safely run other services like A&E and maternity, so these will continue at FGH.

The main reasons are for clinical safety and demand/patient safety.

• Medical staffing in FGH ICU has been a concern for many years and has been identified as unsafe with just three consultants covering an eight-consultant rota.
• 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.

In September 2024, unsafe staffing levels and the low numbers of bed usage (as described above) led to UHMBT making the difficult decision to suspend Level 3 critical care at FGH.

In May 2025, a review was carried out by the Lancashire and South Cumbria Critical Care Network.

In July 2025, a review was carried out by the North West Clinical Senate.

The Critical Care Network is a group of clinical leaders and care professionals across Lancashire and South Cumbria. The findings of their review were:

• Reinstating Level 3 admissions is not desirable or feasible in next 12–24 months.
• Current model of stabilisation and transfer is pragmatic and safe.
• Recommend Level 2-only unit with safe arrangements for stabilisation and transfer.
• Future Level 3 care requires further sustained improvement in medical staffing and increased activity.

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

The North West Clinical Senate report is here: 20250423_-_FGH_ICU_-_full_report_-_v8_-_RATIFIED.pdf The findings of their review were:

• Unanimously agreed that the decision to cease the Level 3 ICU service was clinically correct and entirely focused on patient safety and service sustainability.
• Level 3 ICU cannot be maintained in its current form at FGH.
• Described the needs of the population accurately.
• A Level 3 critical care service response to stabilise prior to transfer will always be required at FGH.
• The optimum solution is to maintain a Level 1 and 2 critical care service at FGH accompanied by a stabilisation and transfer service for patients with Level 3 needs.

The Clinical Senate panel also fully recognised the multiple different attempts by the Trust 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 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.

The ICB and UHMBT have worked closely with BAE Systems, via Team Barrow 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. The number of people Team Barrow are estimating is around 35,000 people, including partners, children, and babies born in Barrow. That isn’t an NHS number; that’s what we have been told. Team Barrow includes BAE, the council, local businesses, planning departments and the construction industry. They consider the amount of people coming to Barrow to get ready for the additional workforce expected to come to Barrow in the future.

The 7-9,000 additional workforce BAE has advised us is over a 15-year period, so they won’t all arrive at once. This will bring with it new shops and businesses which will dovetail over the next 10 to 15 years. In addition to this workforce there will be construction workers who will often already live in Barrow or will be brought in from elsewhere and then leave.

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.

 The North West Clinical Senate panel were in consensus agreement with the commissioners’ conclusion that any such need would most likely arise from a major trauma incident, in which case patients would be taken to Preston or beyond; or from a nuclear incident, in which case critical care services at FGH would be unlikely to provide a viable operational response.

This will be kept under review as part of the annual planning cycle and if there was increased demand and need then appropriate steps would be taken to reconsider the commissioning and delivery models.

There aren’t enough suitable doctors in the country so recruiting to these roles is difficult for many trusts.

It is especially hard in this part of the world because despite all the positives, the distance from major cities, relatively low patient numbers and inability to train new doctors has proven to be stumbling blocks to recruiting.

The Trust has faced a real challenge in attracting and recruiting appropriately qualified medical staff to support and sustain level 3 ICU care. A significant recruitment effort has been undertaken by the Trust over the years with little success. This has included:

• Advertising on 19 separate occasions - including FGH only posts and cross-Trust posts.
• Working with recruitment specialists to reach potential candidates that we might not be able to.
• Looked at new ways of working and investing in new staffing models.
• Explored offering substantial financial incentives to any potential new starter but discounted this option as it has not worked well in other areas.

The Trust has continued to try to recruit in the last 13 months but even though 17 candidates have been put forward, most weren’t suitable to work independently at consultant or specialist level.

They have managed to recruit one specialist doctor and two locum consultants, but they’re on temporary 23-month contracts.

That still leaves FGH without enough senior doctors to safely run a full Level 3 ICU service 24/7.

No, this is not a financial decision. This is entirely based on maintaining quality and safety for patients. The full establishment of medical staff is included within the department’s budget so if UHMBT were able to fully staff the unit, it would not cost the Trust any additional money.

Since the temporary change has been in place, patients who require Level 3 critical care are transferred to Royal Lancaster Infirmary (RLI) from FGH, once they are stabilised – known as ‘treat and transfer’. Patients who require Level 1 or Level 2 critical care continue to be treated and cared for at FGH.

Patients needing critical care are admitted to the stabilisation bay at FGH. If they need ongoing Level 3 care, they’re safely transferred to RLI or another hospital once they’re stable. Every patient is carefully assessed before, during and after transfer, and specialist doctors and nurses are always with them.

All transfers of Level 3 patients - to RLI and the rest of the region/country - are carried out using a specially designed patient transfer trolley, which incorporates an ICU ventilator, monitor and infusion pumps, and keeps the patient secure and warm.

This trolley replaces the usual ambulance trolley and is plugged into the ambulance power and oxygen supply. The patient is accompanied by a senior skilled anaesthetist and senior ICU nurse who have undertaken critical care transfer training.

Any ambulance can be utilised for this purpose. There are no specialised ambulances.

The transfer trolley is kept in the ICU at FGH and the patient is stabilised on the trolley prior to transfer.

The patients are intensively monitored during transfer, with physiological observations documented on a standardised chart every 5 minutes. A copy of this chart stays with the patient's notes, and another copy is sent to the regional critical care network who monitor all inter-hospital transfers.

Critical care clinicians and leaders, the North West Clinical Senate, the Critical Care Network and NWAS have all indicated that the “treat and transfer model is safe and pragmatic”. Evidence from around the UK and internationally is clear that this model is safe and effective.

Since the service was suspended, 58 patients requiring ongoing Level 3 critical care have been transferred from FGH once stabilised (up to 31 October 2025). None of these patients experienced any harm or worsening of their condition because of the transfer. Four of these patients were transferred to tertiary centres as they would have been prior to the temporary suspension. Patients requiring Level 1 and 2 critical care have continued to be treated and cared for at FGH.

Our teams remain in touch with families of those transferred throughout and support them in any way they needed, including helping with travel expenses, open visiting hours and overnight stays on the unit.

All Level 3 intensive care patients are stabilised before being transferred.

We’ve had safe transfer systems in place across the Trust and the North West for many years - also used for neurology, stroke, care following heart attacks and very sick children.

We know from data in Australia, Canada and Scotland, that once patients who require Level 3 critical care are stabilised by a consultant anaesthetist, they are able to travel long distances safely.

The general principle of ‘treat and transfer’ is not uncommon. 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.

Transfers such as these happen if you have a heart attack, it happens in some specific types of stroke, and it happens in very ill children who will be stabilised at FGH and may go to anywhere in England including Newcastle, Manchester, Liverpool or indeed London.

If you're in Barrow today and you have a heart attack, you will go either straight from the ambulance in the street or you may stop briefly in the emergency department at FGH where you will be stabilised and you'll be transferred then by road Blackpool to have your acute heart attack treatment. That's been in place for several years.

For the last 13 months fewer than one patient a week has been transferred to RLI and there have been no issues related to delayed transfer on the A590 or clinical issues with transfers.

Many more patients have been transferred to Blackpool, Preston, Alder Hey, Newcastle, Manchester along the same road. We do hear of occasional incidents on the A590 but in the vast majority of those transfers, the road remains passable for the ambulance service.

There are a very small single figure number of times where that's not the case but if that happens, the patient is assessed and transported safely with an anaesthetist and qualified nurse in attendance. The patient is conveyed to the ambulance in a specialist ICU bed for the journey.

Assessment of the best way to transfer patients and how they will get there through any number of means, whether that's taking a risk assessment about the journey by road, or whether to use an air ambulance for transfer. In addition, the ambulance service can obtain police escorts if needed, and there are well known diversions which can be used in extreme situations, but this has never been needed.

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.

We are running a series of engagement events that are a mixture of face-to-face sessions at venues in the South Cumbria area and some over Microsoft Teams during an eight-week period, as well as local drop-in sessions. All of the details and how to book onto a session, can be found at the top of this webpage.

Members of the public can also contact the ICB and UHBMT with their queries.

Since the Clinical Senate report was sent to the Trust, it has continued to work hard with their doctors and nurses to ensure that all colleagues are treated with respect, care, consideration and that they understand their roles and objectives. There have been numerous meetings internally with the staff at FGH, and the Trust has held open divisional forums where staff can freely ask questions. Additionally, a working group has been established to design the ‘treat and transfer’ operating procedure.

The ICB and UHMBT met with the MP and have been in regular correspondence with her about this proposal.

The ICB and UHMBT attended the Westmorland and Furness Health and Adult Scrutiny Committee, an important part of local democratic scrutiny.

Both organisations have provided all information about this proposal including the Clinical Senate report and relevant data on our websites.

Clinical experts have expressed a preferred option, which is that Level 1 and Level 2 critical care continues at FGH, but Level 3 critical care is provided at RLI. However, we will look at all available options. We have already heard members of the public make suggestions along the lines of the options.

Some options are more viable than others and each brings with it its own risks.

Our work is now to appraise the different options to see which ones are viable. Building on what we have already heard, the following options are being considered:

• Continue with current operating model of a Level 1 and 2 service at FGH which also stabilises Level 3 patients and then transfers them to RLI.

This is the only clinically safe model. External experts supported permanent change to maintain the critical care service at FGH - rather than to continue attempting to sustain provision of a high risk, lower quality Level 3 service. We can keep the change temporary and continue to try to recruit with an aim to reinstate Level 3 at FGH when it is safe to do so. This will take time and has proved difficult over many years. Even if we can recruit, we must also consider the lack of demand.

• Rotate the workforce.

This would destabilise both services at FGH and RLI, which in turn does not provide better outcomes for patients. This option does not create a better environment for staff nor does it help with retention or recruitment in the future.

• Cease Level 3 services at RLI and retain Level 3 critical care at FGH.

This does not meet national guidance. It also does not create a good work experience for staff or promote retention. It does not make best use of resources and does not create better outcomes for patients as there is a greater demand for Level 3 critical care at RLI. RLI meets GPICS requirements in terms of senior and resident medical staffing and RLI is a training unit for the North West Deanery.

Choosing this option would require formal public consultation and there has been limited desire from medical and nursing colleagues to move sites.

Permanently moving Level 3 services to FGH would mean more patients have to travel.

It could destabilise recruitment and retention at both sites - causing unacceptable patient safety risks for people across Morecambe Bay. This is a view shared by the Critical Care Network.

Reinstate a Level 3 service at FGH immediately is missing from the above list of options as it is not clinically safe to do so nor is it a good use of resource in terms of staff since there is not enough demand.

We expect the public engagement currently being run will be an important part of the rigorous and regulated legal process we will need to follow prior to confirming and launching a formal consultation. We are committed to following the appropriate steps in the process which are needed prior to making a decision to launch a public consultation. 

Whilst we have appraised the options, we now need to develop a robust Case for Change and Pre-Consultation Business Case (PCBC), which will need approval from the ICB Board and NHS England as part of the national service change process. This will include a further appraisal of clinically viable options that meet the public consultation criteria and could then be consulted upon.

We are prioritising this work, and we have looked at a realistic timeline for completing these steps, and we believe we may have a PCBC developed by the end of December 2025. This will then require approval and to be taken through our governance processes. Whilst we consider the steps we need to take, we expect that the earliest we will be in a position to be able to confirm our intention to launch a public consultation will be in spring 2026. However, this would be subject to the steps described above and approval from the ICB Board and NHS England and is, therefore, subject to change.

FGH has an A&E department and the hospital also provides emergency surgery. These are important services which will continue. In addition, the hospital also provides other important services such as women's services, maternity services and this year funded a new £5.1 million community diagnostic centre. There are no plans to change other services at FGH.

We are developing our plans for future healthcare in Lancashire and South Cumbria. As part of our these plans, we have created ‘Team Barrow’. This demonstrates how important Barrow is and how necessary it is to support the developments there including primary care (GP services) growth. Team Barrow aims to support all of the work that's going on with education through the government and through the investment in Barrow. We are absolutely committed to doing this. As commissioners of healthcare, the ICB’s intention is to grow and develop services in line with the proposed developments for Barrow.

We recognise that in other hospitals different networking staffing models are in place e.g. Whitehaven hospital has three ICU beds with a rotation of eight consultants across North Cumbria for Level 3 critical care. We will continue to investigate what they and other hospitals are doing and what we can learn from them. Our real challenge at FGH is recruiting consultants; we have seen that some areas are more attractive than others for many different reasons and we will continue to investigate how we can overcome this recruitment challenge.