Written Statement: Critical care capacity and ventilation

Everyone will recognise the unique pressure the COVID-19 pandemic is placing on frontline resources and in particular those who work within a critical care environment.

Critical care colleagues across Wales have undertaken a huge amount of work in recent weeks drawing up plans of how we can maximise critical care capacity for those most acutely ill with COVID-19. Across Wales, training has been provided to upskill hundreds of staff who do not normally work in critical care. The time and space to undertake this training was a key consideration in my decision to pause large amounts of NHS activity on 13 March.

Extra areas have been identified in hospitals to provide more invasive ventilation to patients over and above the space normally available in critical care units. This is in addition to those areas identified as surge capacity for critically ill patients as part of existing plans to double capacity when needed.

I want to express my thanks, not only to all our NHS colleagues who normally work within critical care, but also those staff who have retrained and being redeployed to work in critical care settings.

In addition, the National Institute for Health and Care Excellence (NICE) has published its COVID-19 rapid guideline for critical care in adults (NG159) to maximise the safety of patients who need critical care during the COVID-19 pandemic, while protecting staff from infection and also enabling services to make the best use of NHS resources.

Within Wales, the number of critical care beds is normally around 153. As at 3 April, there were 353 critical care or invasively ventilated beds. This number is increasing on a daily basis. Currently occupancy is around 48% with just over half the beds occupied with patients with confirmed COVID-19. There is significant variation in occupancy rates across Wales. Everything possible is being done to provide support to hospitals that are under the most pressure such as those in the Aneurin Bevan health board area.

Over the past few weeks we have undertaken work to clarify the number of ventilators currently available within NHS Wales – both the invasive and non-invasive types. An invasive ventilator is a machine that helps with breathing; a tube is placed in the mouth, nose or through a small cut in the throat (tracheostomy). Non-invasive ventilation (NIV) machines connect to a mask that covers the nose or face. These are used to support the lungs and make breathing easier.

Currently within NHS Wales, we already have 415 ventilators in Welsh hospitals which can provide invasive ventilation. There are a further 349 anaesthetic machines with ventilator capacity and 207 non-invasive ventilators.

An additional, 1,035 ventilators are also being procured by NHS Wales Shared Services Partnership and through UK arrangements. We expect Wales to receive a population-based share of UK procurement. This includes 385 invasive ventilators, 270 dual purpose (invasive or non-invasive machines) and 380 non-invasive machines. Work is continuing to procure machines which may help ease the burden on intensive care and help with patients’ breathing.

So far, 100 dual purpose machines have already been received and are being distributed. We are expecting a further 75 ventilators to be delivered by the start of this coming week, 40 invasive ventilators and 35 non-invasive ventilators.

I know you will all appreciate that we need more than just a ventilator to open an additional critical care bed in Wales. We also need to ensure there is sufficient staffing, medicines and other necessary equipment. Work is continuing at an incredible pace to bring all of these elements together to maximise the number of critical care or invasively ventilated beds in Wales.

I will keep you and the public regularly updated as this work progresses.

I urge you to: Stay at home. Protect our NHS. Save lives.