2. To Approve the Minutes of the Last Meeting The minutes were agreed to be a true and accurate subject to the following amendment:-

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1 Minutes CIIG(17) 2 Critically Ill Implementation Group Wednesday 21 st June :00pm 4:30pm Caerdydd 1, Welsh Government Cathays Park, Cardiff Attendance Lead Mark Dickinson (Chair) - Director, Business Unit, NHS Wales Health Collaborative Tamas Szakmany - Lead Clinician, Wales Critical Care & Trauma Babu Muthuswamy - Critical Care Lead Clinician, AB UHB Stephen Monaghan - Public Health Wales Ifor Evans - Manager, Wales Critical Care & Trauma Dave Hope - Lead Clinician, Wales Critical Care & Trauma Simone Manning - Service Manager, ABMU Paul Temblett - Clinical Lead, ABMU Carole Jones - Senior Physiotherapist, C&V UHB Dale-Charlotte Moore - Critical Care Directorate Manager, C&V UHB Piroska Toth-Tarsoly - Critical Care Lead Clinician, CT UHB Hywel Roberts - Chair, Welsh Intensive Care Society Greg Ead - Project Manager, Wales Critical Care & Trauma Tom Archer - EMRTS Sue O Keeffe - Manager, Wales Critical Care & Trauma Ed Farley-Hills - Lead Clinician, Wales Critical Care & Trauma Caroline Lewis - Major Health Conditions, Welsh Government Olivia Shorrocks - Performance Manager, Welsh Government Chris Thorpe Greg LLoyd - - Consultant Anaesthetist, BC UHB Welsh Ambulance Service NHS Trust 1. Welcome, Introductions and Apologies for Absence Mark Dickinson welcomed members to the meeting and thanked them for their attendance. He formally introduced himself as the Director for the Business Unit, Wales Health Collaborative and invited members to do the same. Apologies Apologies for Absence were received from:- Carly Buckingham Maria Hobrok Jonathan Whelan Evan Moore Navros Masani Tim Jones Ceri Battle Steve Moore Jonathan Goodfellow Zoe Goodacre Richard Jones Abigail Harris Andrew Griffiths Richard Self 2. To Approve the Minutes of the Last Meeting The minutes were agreed to be a true and accurate subject to the following amendment:- Item 8 Transfer of Children Who Are Critically Ill

2 BM informed the group that in devising the Aneurin Bevan University Health Board plan, he had been in contact with PICU clinicians in Great Ormond Street Hospital Foundation Trust and explained to the group that Bristol is one of the 3 SHAs in England that admits a majority of their sick children to adult critical care.there are examples elsewhere in England of patients being stabilised and maintained in other areas of the hospital safely and effectively. 3. Matters Arising not on the Agenda 1 Further update on OHCA pathway required at next meeting On agenda 2 Ensure that all UHBs Delivery Plans had a clear policy and process for caring for critically- ill children 3 Circulate a copy of the draft OHCA plan to the group 4 Identify appropriate forums through which issues raised around the draft guideline on care of patients with devastating brain injury in Critical Care Item will be taken to the SIG and All Wales MD s. 5 Update the scorecard data template for local reporting Template completed and circulated. 6 Submit local progress made against Delivery Plans Partially completed. 7 Collate local progress made against Delivery Plans in to a summary report Partially completed. 8 Write to Medical Director s seeking assurance for CCIG that plans for the transfer of children who are critically ill had been agreed locally Letter drafted, check with Steve Moore whether letter has been sent. 9 Share details of funded projects to the CCIG for information 10 Propose dates for Peer Review visits and ask Health Boards to propose themselves for visits on a first come first served basis Next peer review agreed with ABUHB in September BCUHB peer review is currently under discussion and has gone to Board for agreement. 11 Share the outline document for Capacity and Workforce with CCIG SOK agreed to review the outline Capacity and Workforce document and bring to the next meeting for comment/information. 12 Write to Chief Executives asking them to review membership of the CCIG for their organisations in light of the revised TOR Ongoing 13 Update the CCIG on progress made on improving DTOCS On agenda FOR DECISION 4. Critically Ill Implementation Group Role and Function

3 Review Terms of Reference The group received a revised copy of the Critically Ill Implementation Group Terms of Reference for information. The group were asked to note, comment and agree the revised document. MD sought clarity around membership and how many organisational representatives would be required to ensure the group was quorate. The group agreed that there would need to be at least three Health Board representatives present to ensure quoracy. The group formally approved the revised TOR subject to the following amendment:- Deliverables amend Work Plan date to March. SOK Merger of Implementation Group and Wales Critical Care and Trauma Board It was noted that the last Board was not well attended and consisted of mostly the Core Team. Discussions took place amongst the team around how the could improve engagement from HBs and other organisations. It had been suggested that elements of the work of the Implementation Group overlap with the Board and that the two groups would benefit from merging. Therefore the group were asked to consider the proposals and agree the new structure set out, with suggested improvements. Following discussion the group formally agreed the merger of the Critical Care Board and Critical Care Implementation Group. 5. Annual Statement of Progress The group received a draft copy of the statement of progress setting out the work that has been done by the Implementation Group and Health Boards to achieve the priorities set out by the group in The group were asked to consider the statement, comment and agree the statement subject to any suggested amendments. MD requested that the paragraph on the establishment of the Major Trauma Centre and Trauma be removed from the document. IE It was also highlighted the PACU should be Royal Gwent not Glamorgan. The group formally agreed the statement for publication. The statement of progress along with the Delivery Plan will be sent to Dr Andrew Goodall, NHS Wales Chief Executive. /OS 6. Delivery Plan Priorities and Investment The group received an update on the Clinical Information System project from Greg Ead, Project Support Manager. He noted that CIS is at risk due to the delay in starting the procurement process for the project. This was due to a variety of reasons including the establishment of a Project Board and of a Senior Responsible Officer for the project, engagement from NWIS Procurement team and knowledge and experience gaps in the project team that remain unfilled. GE informed the group that Leanne Richards has recently been appointed as Senior Category Manager, IM&T, NWIS and has been assisting the team in taking the project forward. GE explained that a business case for the project needed to be submitted by the end of September 2017 for the project to continue. It was noted that the first Project Board was scheduled to take place on 4 July TS requested that Health Boards ensure the appropriate representatives are present at the meeting to ensure decisions can be made. agreed to contact Andrew Griffiths to assist in moving the project along. ALL

4 7. Delayed Transfers of Care Following the introduction of the DTOC measure in September 2014, OS noted that data generated indicates that improvements on DTOC have not been achieved in line with the target set by the Cabinet Secretary and Implementation Group. She noted that all Health Boards were asked to submit DTOC data on a monthly basis and currently this was not happening. OS asked the group if they found current measure useful and what actions should be taken to improve DTOCs. Following discussions the group felt that the current DTOC measure was the best way to report DTOCS. OS OS agreed to add the issues to Health Board performance meetings. FOR INFORMATION 8. General Provision of Intensive Care Services Standards for Small Hospitals Dr Chris Thorpe presented that there will soon be a updated/revised version of GPICS published. This will include standards for smaller hospitals as the current standards are unrealistic for many smaller rural hospitals. There was a short Q&A session including what the definition of a smaller hospital is this is as yet undefined. 9. Out of Hospital Cardiac Arrest Plan TS presented a copy of the completed Out of Hospital Cardiac Arrest Plan to the group for information. The plan was developed by the OHCA Subgroup of the Heart Conditions Implementation Group and provides guidance on recognising and treating OHCA patients. confirmed the plan was due to be published on 29 June 2017 and agreed to circulate the most recent document to the group for information. TS informed the group the Critical Care & Trauma has collaborated with the Wales Cardiac and developed a STEMI pathway as a result of a regulation 23 regarding a cardiac patient. He noted that a study using patients identified by WAST/EMRTS had been carried out and the results were due to be published next week. SOK noted that no north Wales colleagues sat on the Group and that communication regarding the phased approach of the OOHCA plan was poor. to liaise with Tracey Hill, SOK and TS to get a statement of the phased response to the implementation of the OOHCA circulated to colleagues. PT expressed concerns about the impact of centralising services; SOK offered to collate and complete the audit of impact using historical ICNARC data. SOK 10. Devastating Brain Injury The group received the final version of the All Wales DBI guidelines for information and members formally agreed the document. HR thanked those who contributed to the document and asked the group to disseminate the guidance with their Health Boards. The guidance will be published on the WICS website and it was agreed that Welsh Government would circulate the guidelines as a WHC and share with other relevant implementation groups. The agreed to share the document widely for implementation within Health Boards. HR requested that DBI guidelines be included on the next agenda to update and discuss how the guidelines have been received and implemented. ZG

5 11. Any Other Business Monetary Reporting informed the group that Welsh Government has introduced a new template for reporting monetary spend and agreed to circulate a copy of the new template to the group for information. reminded the group that the next report was due for submission in October Critical Care Plan informed the group that the priorities for 2017/18 would need to be discussed and agreed at the next Implementation Group meeting in September Date of the Next Meeting Tuesday 12 September :00pm 4:00pm Caerdydd 1, Welsh Government Offices, Cathays Park, Cardiff