Critical care cash 'saving lives'

Increasing the number of beds has reduced patient transfer rates

Changes and extra investment since 2000 in critical care in England are saving 4,000 lives a year, researchers say.

London School of Hygiene and Tropical Medicine researchers told the British Medical Journal they had been a "highly cost effective use of NHS resources".

An extra £300m investment has helped to fund a 35% rise in bed numbers and the introduction of outreach services.

Doctors' leaders said the improvements were the result of staff efforts and of raising funding to acceptable levels.

Dr Keith Brent, deputy chairman of the British Medical Association's Consultants Committee, added: "What is crucial now is that we do not allow any backsliding.

The argument that the NHS was no more productive now despite all the money poured into it has not been borne out Professor Nick Black

"Politicians are falling over themselves to talk about efficiency savings, and there are attacks on the supporting professional time which consultants use to create and maintain improvements to care.

"We must not allow frontline services to be targeted."

The researchers compared data covering nearly 350,000 admissions to 96 critical care units across England from just before the plan started in 2000 until six years later.

Late adopters

They found that annual expenditure on critical care increased in real terms from £700m (1999-2000) to £1bn (2005-6).

They say there was a 13.4% decline in hospital mortality, 11% fewer patients needed to be transferred between intensive care units and a significant reduction in the number of patients having to be discharged from units at night to make way for other patients.

Improvements were associated with later, rather than earlier, adoption of organisational changes.

The researchers think that later adopters might have benefited from the experiences of early adopters and might have spent longer preparing for change ensuring greater commitment from staff.

Increasing the number of beds was not directly associated with improvements in outcomes but it was associated with declines in the rate of transfers and early discharges.

Professor Nick Black, who led the research, said the improvements was saving 4,000 lives per year by 2006.

He said: "The argument that the NHS was no more productive now despite all the money poured into it has not been borne out.

"What this shows is that it's absolutely essential, if you are measuring the productivity of the health service, that you take into account the outcomes for the patients not just the numbers treated.

"In critical care, the quality of care has definitely improved, which means that the productivity and health produced by the NHS has gone up dramatically."

Health minister Mike O'Brien said: "This study clearly demonstrates that critical care services continue to improve as a result of increased investment and the adoption of new ways of working.

"We remain committed to support the NHS in maintaining and enhancing these fantastic achievements."