In the 1990s a series of well publicised cases, in which critically ill patients were moved large distances in order to gain access to intensive care facilities, led to the recognition that the provision of intensive care services in the UK was characterised by unacceptable variations in organisation and delivery, quantity, funding, and effectiveness. It was appreciated that the ad hoc development of the discipline of intensive care medicine—following its origins in the polio epidemics of the 1950s—was responsible in part for this unhappy state of affairs. However, it was also apparent that there had been years of relative underfunding of intensive care units (ICUs) in the UK compared with other developed societies. The provision of ICU beds in the UK has historically been one of the smallest in the industrialised world. Only 2.6% of hospital beds were designated for intensive care before 2001 compared with averages of 3.3% and 5–7% in Europe and North America, respectively.¹ Furthermore, in the UK the practice of intensive care medicine was led principally by clinicians with anaesthesia as their base speciality, who were being asked increasingly to provide multiple services across numerous hospital departments ranging from pain relief to supporting day case, high throughput surgery. Many of these issues were recognised in the Audit Commission report of 1999.²

By the end of the last decade, many pressure groups and professional bodies within the medical and allied professions—most notably the Intensive Care Society—together with central government recognised that a new multidisciplinary approach to the delivery of critical care services across acute hospitals was desirable. Consequently, in April 1999 the Department of Health appointed a …