Health Minister gives ventilator update – and says Wales will follow NICE critical care guidelines

Minister for Health Vaughan Gething AM today issued a written statement detailing how Wales will follow critical care guidelines, as well as giving a detailed update on the numbers of critical care beds and ventilators.

The Minister explains how 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, that is in addition to those areas identified as surge capacity for critically ill patients as part of existing plans to double capacity when needed.

Within Wales, the number of critical care beds is normally around 153. As of April 3rd, there were 353 critical care or invasively ventilated beds. Currently occupancy is around 48% with just over half the beds occupied with patients with confirmed COVID-19. The Minister notes, “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.”

The statement explains work has taken place to ‘clarify the number of ventilators currently available within NHS Wales’, noting two main types an invasive and non-invasive ventilator. 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.

The Minister says, “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.”

The Minister has also given an update on the guidelines for critical care, with it now confirmed that the NICE system is being used in Wales. Over the last week we have asked questions of the the Health Minister, the First Minister and the Chief Exec of NHS Wales on this topic.

In today’s statement the Health Minister says “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.”

The now updated full guidance also includes the following diagram to support decision making, changed from a previous version. Earlier versions had caused concern, for example responding to the changes Mencap have said, “The revised guidance now makes clear that the clinical frailty scale should never be used to assess patients aged under 65, or patients of any age with stable long-term disabilities (for example cerebral palsy), learning disabilities or autism.”

On Thursday we asked Andrew Goodall , Chief Executive of NHS Wales, “A surgery in Maesteg wrote to patients with ‘significant life-limiting illnesses’ noting possible limited treatment if they had Covid-19. Is there a COVID-19 ethical decision making framework for Wales, and does it rule out defined age based decisions on care, and does it ensure that those with learning disabilities are not disadvantaged ?”

Mr Goodall paraphrased the question as wanting to know about concerns about letters and information that was passed to patients at the Maesteg surgery earlier this week, and about decision making around patients.

Mr Goodall answered, “I just wanted to say in response to that, that I was really concerned to see the nature of the correspondence that happened, and I wouldn’t wish to defend at all the manner in which that was done. I know the practice itself has apologised for that communication. It certainly wasn’t under any guidance from either the Health Board locally or from a Welsh Government perspective.

“I think what the coronavirus that makes us all reflect on however, is the importance of being able to talk to our families about what is happening around us at this stage and understanding what our own thoughts and needs are, as we all go through these very difficult circumstances.

“I hope that as we’re able to focus on ethical decision making and the nature of the demand into our system over the course of the next few weeks, that we will have people who’ve been able to think through their concerns and actually how they would wish us to respond on behalf of themselves and their families.”

On Friday we submitted a question to the First Minister, “As a 65 year old what are your personal thoughts about the NICE COVID-19 guidelines, and do you think your age or frailty should be a factor in deciding if you would benefit from critical care intervention?” however it was not put to him.

Today’s statement by the Health Minister wraps up by saying, “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.”