2000-2009

What was happening

From 2000 to 2009, UK critical care services were reshaped. Care moved beyond isolated ICUs towards a coordinated system across hospitals. Nurses also began to take a more active role in national policy, service design, and leadership.

A major driver of this shift was the Comprehensive Critical Care review (2000). It changed how care was organised and delivered:

• It introduced a whole system model, moving care beyond the ICU into a coordinated hospital-wide approach
• It established level-based care, grouping patients by acuity rather than location
• It led to the development of outreach teams, supporting early intervention on wards
• It supported the growth of critical care networks, improving access and coordination
• It contributed to increased capacity, with a significant rise in critical care beds
• It strengthened the role of nurses and multidisciplinary teams in both practice and service design

BACCN Milestones

• In 2001, BACCN became an incorporated charitable company, strengthening governance:
  https://register-of-charities.charitycommission.gov.uk/en/charity-search/-/charity-details/4004593/charity-overview?_uk_gov_ccew_onereg_charitydetails_web_portlet_CharityDetailsPortlet_organisationNumber=4004593
• It gained formal charity registration in 2002:
  https://register-of-charities.charitycommission.gov.uk/en/charity-search/-/charity-details/4004593/full-print
• BACCN increased its involvement in consultations and national working groups
• It expanded position statements and professional guidance
• It contributed to national workforce and care planning, including Department of Health work on nursing input (2001)
• The organisation updated its logo in 2007 as part of a wider rebrand

Key policy and service developments

• The Comprehensive Critical Care review (2000) set the direction for reform:
  https://webarchive.nationalarchives.gov.uk/ukgwa/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf
• Care levels were reclassified to reflect patient acuity and improve data use
• Critical Care Outreach Services were introduced to support earlier intervention outside ICU
• The NHS Modernisation Agency defined workforce roles (2002):
  https://www.ghpscot.org.uk/documents/CriticalCareDoH.pdf
• Critical care networks developed across the UK
• CC3N was established in 2003, followed by the National Outreach Forum in 2004
• Quality Critical Care: Beyond Comprehensive Critical Care (2005) strengthened expectations:
  https://webarchive.nationalarchives.gov.uk/ukgwa/20061031183641/http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4121049&chk=C2CJv3
• NCEPOD’s An Acute Problem (2005) highlighted gaps in acute care:
  https://www.ncepod.org.uk/2005aap.html
• The World Federation of Critical Care Nurses was established in 2001, with BACCN involvement:
  https://wfccn.org/about-us/
• Later developments included the national framework for advanced practitioners (2008) and formal definitions of care levels (2009)
• NICE guidance on rehabilitation after critical illness (2009) shaped recovery pathways:
  https://www.nice.org.uk/guidance/cg83

Key BACCN publications

• Nurse-to-patient ratios (1999):
  https://www.baccn.org/static/uploads/resources/BACCNNursePatientsRatios2000.pdf
• Healthcare assistant roles (2003):
  https://onlinelibrary.wiley.com/doi/10.1046/j.1478-5153.2003.00001.x
• Restraint use in adult critical care (2004):
  https://www.baccn.org/static/uploads/resources/BACCNRestraint2004.pdf
  https://onlinelibrary.wiley.com/doi/10.1111/j.1362-1017.2004.00074.x
• Prescribing in critical care (2009):
  https://www.baccn.org/static/uploads/resources/BACCNPrescibingInCritCare.pdf
• Joint staffing standards with CC3N and RCN (2009):
  https://www.baccn.org/static/uploads/resources/BACCN_Staffing_Standards.pdf

Wider publications and developments shaping practice

• Intensive Care Nursing: A Framework for Practice (2000):
  http://ndl.ethernet.edu.et/bitstream/123456789/64901/1/3.pdf
• WHO Europe Critical Care Nursing Curriculum (2003)
• Growth of paediatric critical care standards, networks, and PICANet (2003)
• Increased research activity, including the TracMan study (2004 to 2011)
• ICU Steps was established in 2005, with BACCN support from 2007: Home - ICUsteps

What changed in practice

• Outreach teams extended care beyond ICU, supporting “critical care without walls”
• Advanced and specialist nursing roles increased
• Multidisciplinary working became more structured
• Capacity expanded, with critical care beds in England rising by over 40 percent between 2000 and 2006

Decade summary

This decade marked a clear move to a coordinated, system-wide model of care. The 2000 review set that direction, and the changes that followed reshaped practice, workforce, and service delivery. BACCN became a recognised voice in national policy and professional standards.

Mo Coombs received an MBE in 2004, reflecting the growing national impact of critical care nursing.