south wales critical care network 3b annual report 201… · care network. critical care networks...

South Wales

Critical Care

Network

Annual Report 2011/12

Introduction from the Chair of the Network

S O U T H W A L E S C R I T I C A L C A R E N E T W O R K

It gives me great pleasure to introduce this, my first Annual Report, as Chair of the South Wales Critical

Care Network.

Critical Care Networks were set up in 2007 following guidance from the Welsh Assembly Government in WHC (2005) 076 ‘Clinical Networks’, and the South Wales Critical Care Network was established in 2010 with the merger of the existing Mid and West Wales

Critical Care Network and the South East Wales Critical Care Network.

The South Wales Critical Care Network aims to build upon the excellent work done by these networks.

The aim of the South Wales Critical Care Network is to improve the safety, quality and efficiency of critical care in South Wales by enabling

units to collaborate in the achievement of mutual improvement.

Achievements

It is important to acknowledge that, without the support and cooperation of staff in critical care units throughout South Wales during the last 18 months, this section would be very brief. The success of the

Network is dependent on the ongoing work and efforts of the staff in the critical care units and much of our work goes into establishing and maintaining good working relationships with critical care staff.

The Network has achieved much during 2011/12, including:

8 training courses in transfer of the critically ill adult delivered

Continued participation in the All-Wales transfer of the critically ill

audit

Development of a number of care pathways through the Network’s Service Improvement Groups

Hosting of a successful winter conference on pandemic flu

Delivery of the majority of the critical care quality requirements

All critical care units in South Wales are submitting performance data to the National Audit and Research Centre (ICNARC).

Introduction from the Chair of the Network


It also gives me great pleasure to congratulate Glangwili Hospital on the opening of a “state of the art” new critical unit. (above)

I hope that you find this report useful and informative. If you want any further information, or you have any questions please do not hesitate to

contact one of the Network Mangers by email: [email protected] or [email protected]

In summary, thank you all for your continuing hard work and support and I look forward to working with you all in the coming year to further develop critical care services for the people of South Wales.

Andrew Goodall

South Wales Critical Care Network Chairman

It has been heartening for me to receive the first ever report for South

Wales from (ICNARC), at the Network Board. It is reassuring to have

concrete evidence of how well critical care units in South Wales perform

compared to the rest of the UK.

mailto:[email protected]

mailto:[email protected]

Introduction from one of our clinical leads


A couple of weeks ago I found myself, along with another 120 managers and clinicians, in a football stadium playing with plasticine. My group’s task was to make a 3 D model representing the future of health promotion and prevention. This was my first experience of Together for Health – a wide ranging exercise to plan healthcare for the next 5 – 10 years.

The South Wales Plan, the National Clinical Forum, ‘engagement events’ everywhere you look: the signs are all there – we’re heading for a major

NHS reorganisation.

The projections didn’t look good even before the banking crisis and double dip recession. How are we going to cope with the expectations of our aging population?

Critical care comes up a lot in this discussion, but probably not as much

as it should do. We represent a very expensive bottleneck in all acute services. Without careful planning and adequate resources in critical care, the whole secondary care model being developed won’t work.

What is the model? In a nutshell: keep patients at home, not in hospital; move what services you can to the patient/community; concentrate specialist services to reduce duplication and improve expertise; develop new ways to deliver high quality, low cost care. It’s obvious from this

analysis that critical care is stretched between being widely-distributed (needed in every acute hospital) to being centralised in large regional centres.

This is one of the main issues your Network team has been working on: providing advice that will hopefully improve the quality of care as this model is developed.

We’ve also made good progress in improving the ‘here and now’ in terms of developing clinical guidelines via the Service Improvement Groups - I’d like to thank all those that have contributed to these meetings.

Please let us know if we can help with any of your local problems. Even if I can’t solve your problem, at least I can represent it in an attractive

arrangement of fuzzy felt, straws and feathers – it’s not all about plasticine you know.

Some information about the Network


About the Network

The Network has a Board that sets the overall agenda and monitors progress and performance. It is chaired by Andrew Goodall, Chief

Executive of Aneurin Bevan LHB. There are a number of sub-groups that carry out work set by the Board. These include

Purpose of Networks

Critical Care Networks were established in Wales with the aim of bringing together different organisations to improve the care of the critically ill patient. By working across traditional, organisational boundaries, Networks can link professionals involved in every aspect of the patient’s journey, to ensure delivery of consistently high quality care.

The role of a Critical Care Network as described in WHC(2006) 09 is “to support and advise its stakeholders on the implementation of the national quality requirements, to monitor service performance and use this information to inform the commissioning process”.

As there is no longer a commissioner/provider split in Wales the role of networks is more to inform LHBs’ service planning.

The South Wales Critical Care Network was formally established in November 2010 through the merger of the former mid and west Wales Critical Care Network and the South East Wales Critical Care Network.

Service Improvement Groups, Transfer Groups, Senior Nurse Forums,

Allied Health professionals group, and clinical topic groups as required

Network aims


Dave Hope Lead Clinician, Mid & West Wales

Jack Parry-Jones Lead Clinician, South East Wales

Ifor Evans Network Manager, Mid & West Wales

Zoe Goodacre Network Manager, South East Wales

Julia Jayne Network Information Analyst

Justine McCarthy Network Administrator

Jackie Rees Network Administrator

The Network’s overarching aims are to improve the safety, quality and efficiency of critical care in South Wales by enabling units to collaborate

in the achievement of mutual improvement.

The Network has the following 5 objectives:

1. Support Critical Care units to improve outcomes for their patients

2. Improve patient and family & partner experience of critical care

3. Support Health Boards to make best use of their critical care re-sources

4. Enable equitable access to tertiary critical care services, neuro critical care, cardiac critical care, burns critical care and respiratory centres

5. Ensure staff are appropriately skilled and supported to provide high-quality patient care

These have been translated into an annual work programme and this report will report progress with delivery of that programme.

The Network is staffed with a core team, which provides support to the

Critical Care units within the Network. The team is:

Our programme of work for 2011/12


The Network has a Service Improvement Group in both its South East

and Mid & West Region.

The Service Improvement Groups discuss clinical service improvements

needed to develop critical care services to meet the requirements of

NICE Guidelines, the Welsh Government’s Designed for Life Quality

Requirements for Critical Care and locally identified needs.

Work Programme

In 2011/12, the Network Board agreed a work programme with five

overarching themes that would guide the activity of the core team and

units within the Health Boards.

The work programme was created as a driver diagram (Appendix 1) to

make clear to all how the individual actions contributed to the

overarching themes and ensure that we weren’t engaging in work that

didn’t contribute to improvement in these agreed areas.

The Network core team developed draft objectives for the Network which

were then refined in consultation with units within the Health Boards and

agreed by the Board.

Much of the work in the programme has been done in the Network’s two

Service Improvement Groups (membership below).

Support Critical Care Units to Improve Outcomes for

Patients


Background

The first overarching aim of the Network is to improve patient outcomes.

The Network’s core team has worked with Health Boards in a number of

ways to achieve this in South

Wales.

The Network team attends the

Critical Care Delivery Groups in

each of the Health Boards to offer

management support, clinical

input and information to help

move units towards achievement of the Quality Requirements for Adult

Critical Care1.

During 2011/12, the Network has worked with

colleagues in North Wales to review the

Quality Requirements for Adult Critical Care.

Since their publication in 2006, practice has

moved on considerably, and there are areas

where progress has been difficult due to the

resources required.

The Quality Requirements are being reviewed

for relevance in the current clinical and

economic climate and will be shared with the

Welsh Government for discussion and

updating of the existing guidance.

Support Critical Care Units to Improve Outcomes for

Patients


During 2011/12, the South Wales Network has facilitated the development of a number of clinical pathways and referral guidelines, namely: Head Injury Cardiogenic shock Renal referrals (South East Wales only)

Pancreatitis Post cardiac arrest Acute respiratory distress syndrome Increasingly, South and Mid & West Regions are collaborating to develop

clinical services across the Network area. In addition, the South Wales Network has been working with North Wales colleagues on End of Life Criti-cal Care and on an ongoing basis on Transfer training.

North Wales has generously shared the work they’ve done on their post-cardiac arrest care bundle, and South Wales will share with the North any work that’s developed in the south. Throughout the year, South Wales has hosted 7 transfer training courses, which has seen 231 participants successfully complete their

Part A transfer training. During 2012/13, the Network Team will continue to work with the units and transfer faculty to ensure the training delivered is reviewed and kept up to date as practice develops. The Network has also been monitoring and evaluating performance and safety of critical care transfers using data collated in North Wales. This information is fed back regularly to Health Boards through the Critical Care teams and at the Board meetings.

Improve patient and family & partner experience of

Critical care


Improve patient and family & partner experience of critical care

During 2011/12, the Network worked with Health Boards to ensure consistent representation of patient, carer or lay representatives on Critical Care Delivery Groups. 3 out of the 5 critical care delivery groups now have patient, carer or lay representation.

It has proven more difficult to secure lay representation on existing Network groups as the nature of the work undertaken by the groups tends to be more technical in nature. The Board will reconsider the approach to engaging with lay representatives on more clinical issues.

Each unit has also agreed to use the Intensive Care Society questionnaire to obtain feedback from carers/relatives of patients who have been in intensive care.

All LHBs have undertaken patient/carer feedback exercises this year and

reported their activities to the Board. Where relevant, units have made changes in light of the feedback they have received.

Issue reported Action taken

Relatives unhappy with the décor of the room they have to stay in at Royal Glamorgan Hospital

Room completely decorated new pictures placed and new relative information boards established

Relatives unhappy that the relatives room is actually away from the unit

Office space completely rearranged to allow for a relatives room to be placed within the ITU.

Visitors said that more written information should be available

Information packs now provided on first visit & contents are also available in visitor’s sitting room. These include an information leaflet about our critical care unit, a pocket-sized card display-ing our phone number and visiting times and a booklet “Intensive care – A guide for patients and relatives”. An information board has been placed next to the entrance of the sitting room.

Patients complained about the noise levels Discussed at directorate, sisters and unit meetings. Cascaded to all staff. Monitoring 'Ear' purchased which changes colour depending on the noise level providing a visual aid to noise levels

Support Health Boards to make best use of their critical

care resources


In South East Wales, an

Equipment Standards group has

been set up for units to discuss the equipment they procure, the prices

they are charged and seek to standardise wherever possible. This has

led to savings in the Health Boards in South East Wales increased

bargaining power when entering into negotiations suppliers.

The Critical Care

Network budget is

principally used to fund

the staff who support

t h e u n i t s . T h e

remainder of the

money is used to run

the office, training and

education and travel.

The Critical Care’s

expenditure for the

year is shown in this

table.

1 Pay for a member of staff seconded to Powys Health Board was incorrectly charged to the Network

Budget 2 Sponsorship income was secured from a range of suppliers for educational events 3 Variance between budget and actual expenditure is accounted for by the fact that invoices for staff

salaries in Mid & West Region and North Wales are included here, having not yet been apportioned

to the correct budget lines.

Throughout 2011/12, the

Network has worked with the

Health Boards to provide

information and support to

ensure the best use of scarce

resources.

2011/12 2011/12 2011/12

BUDGET ACTUAL VARIANCE

INCOME

Powys LHB¹ 0 (9,740) (9,740)

Sponsorship² 1,000 (1,020) (20)

TOTAL INCOME 1,000 (10,760) (9,760)

PAY

Clinical Leads 47,546 36,239 12,466

Audit Clerk 7,600 12,468 4,868

Admin Assistant 5,954 4,833 (1,121)

Network Administrator 24,760 24,330 (430)

Network Information Analyst 24,652 22,131 (2,521)

Network Managers 130,748 113,655 (17,093)

TOTAL PAY EXPENDITURE 241,260 213,656 (27,604)

NON PAY

Total running costs³ 14,740 50,169 35,430

TOTAL 256,000 253,065 (1,934)

http://upload.wikimedia.org/wikipedia/commons/e/e3/UCIP.JPG

Minimise avoidable admissions to critical care


In 2011/12, the Network has worked on a number of objectives aimed at minimising avoidable admissions to critical care to ensure that best use is being made of the scarce critical care resource available. Care of the acutely ill in hospital

The Network has been supporting units to implement and monitor compliance with NICE Clinical Guideline 50 - Care of Acutely Ill Patients in Hospital (CG50). All hospitals in the Network are working on implementing NICE 50 through the Rapid Response to Acute Illness Learning Set (RRAILS) programme as part of the 1000 Lives + campaign.

New charts for recording patients’ vital observations have been introduced throughout Wales and training in their correct use is ongoing. Each Health Board has a policy for responding to patients whose condition is deteriorating on wards and each is working to ensure that the handover from critical care to wards complies with the CG50 guidance. Each Health Board also provides update reports on

progress to each Network Board meeting. In Aneurin Bevan and Cwm Taf Health Boards, the Rapid Response to Acutely Ill patients Learning Set (RRAILS) has been driven by members of the Outreach teams,

helping to better identify and care for patients whose condition is worsening & avert critical care admission where appropriate.

In 2011. ABM University Health Board introduced a comprehensive outreach team

to cover their 4 units. As part of the early development of the team’s role, outreach nurses have been working with wards to cascade the use of NEWS scoring, SBAR briefings and the Sepsis six care bundle.

Support Health Boards to make best use of their critical

care resources

Minimise avoidable admissions to critical care


All units are working on implementing NICE Clinical Guideline 83—Post-Critical Care follow-up. Units provide update reports on progress to each Network Board meeting. ABM Health Board clinicians are devising a rehabilitation passport and work is being shared across Mid and West Wales.

Admission & discharge policies

Following discussion, the Mid and West Wales

Service Improvement Group decided it was not appropriate to agree a consistent admission and discharge policy across South Wales due to the different levels of support available on the wards in each hospital. Instead, each LHB in the South Wales Network has been asked to review their admission and discharge policies.

Increase Organ Donation

The Network reviewed critical care capacity in re-sponse to a request by the chair of the Welsh Organ Donation Implementation Group in April 2011. The Network indicated that the number of operations that are cancelled due to the lack of a critical care bed, the number of non-clinical transfers that take place and

the number of patients that are discharged prematurely from ITUs showed insufficient capacity in the system.

The Network highlighted ethical issues related to admission of patients purely for organ retrieval if the unit was full. In collaboration with the North Wales Network, our clinicians drew attention to the lack of capacity in critical care in Wales and the impact this might have on the

number of organs that can be collected, irrespective of the system of consent for organ donation in Wales.

Last Days of Life

Through 2011/12, the Network has worked in collaboration with clinicians across Wales to create a care pathway for patients in Critical Care at the end of their lives.

The pathway is nearly complete, and clinicians in the Critical Care Units across Wales will be consulted during summer 2012.

Ensure staff are appropriately skilled and supported to

provide high-quality patient care


Agree core competencies for nursing staff in Wales

Initially, the SE Wales Senior Nurse Forum worked on this and produced “Draft outline competencies for critical care nurses working in Wales”. This provided a framework for the establishment of local competencies. Responses to consultation on this document called for the addition of actual competencies.

In the meantime, C h e s h i r e a n d Merseyside Critical Care Network were working with Skills for Health to produce National

O c c u p a t i o n a l Standards (NOS) for critical care nurses.

A proposal to adopt these NOS in Wales was put to the Welsh Nurse Executives and they

agreed to adopt them. However, once launched, it became apparent that there were quality issues with a couple of the NOS and so adoption was suspended.

Currently the Critical Care Networks National Nurse Leads Group England, Wales and Northern Ireland is developing core competencies for critical care nurses. The Network Manager for M&W Wales and a nurse consultant from UHW have attended these meetings and consideration is to be given as to whether to adopt these competencies in Wales on completion.

Hold Quarterly Service Improvement Group meetings

Both M&W Wales and SE Wales hold quarterly Service Improvement Groups. These groups adopt/adapt care pathways and guidelines for

clinical conditions for local implementation. The groups are now consid-ering how best to facilitate the implementation of these guidelines/pathways such as through the Critical Care Delivery Groups.

Ensure staff are appropriately skilled and supported to

provide high-quality patient care


Support Senior Nurse Forum

There is a Senior Nurse Forum in M&W Wales and one in SE Wales. These meet quarterly to consider nursing issues and to agree ways to improve patient care. Consideration was given to merging the two groups but the groups decided against it.

It is hoped to hold an Annual All-Wales Senior Nurse forum once a year.

Share good practice information across Wales to support service improvements in critical care

The Network held a joint conference with North Wales Critical Care Network in September

2011, focusing on planning for influenza and winter pressures. A number of excellent speakers

were secured to talk on the day, and as a result of the afternoon workshops, updated guidelines on the use of Personal Protective Equipment during influenza outbreaks were agreed.

In addition, the Network has distributed 3 newsletters across South

Wales this year, spreading the word about meetings, developments and the day-to-day activities of the team.

The M&W Wales and the SE Wales web sites have been merged to form the South Wales Critical Care network Web site. www.wales.nhs.uk/southwalescriticalcarenetwork. The Network is now on Twitter, and those interested in the Network’s activities can follow @SWCCN. Through

Twitter, connections have been made across the globe to promote our work and collaborate on joint projects.

If you have any ideas about how we can better work for

you, we want to hear from you. Please contact us either through Twitter, or email us.

http://www.wales.nhs.uk/southwalescriticalcarenetwork

http://www.wales.nhs.uk/southwalescriticalcarenetwork

Our Critical Care Units


The South

Wales Critical

Care Network

covers a large

geographical

area, taking in

some of the

most densely &

sparsely

populated

places in

Wales.

Our 13 units

serve a

population of

nearly 2.5

million people,

some of whom

have the

highest rates of

social

depravation in

the UK.

Our units see ?# patients per year and work hard to provide a service

that is clinically excellent and sensitive to patient needs. The following

pages set out some key developments in our units in 2011/12.



Abertawe Bro Morgannwg University Health Board

Aneurin Bevan Health Board

The support and commitment of all our staff has allowed us to continue to maintain and promote quality, and drive the service forward, in what

has been a challenging environment.

There have been 3 new consultant appointments this year in the Royal Gwent Hospital with Dr Jonathan Whelan, Dr Teresa Evans and Dr Eloise Dawe having now joined the team. We are also currently advertising for a further two consultants. This year will see Dr Steve Dumont leave critical care after 20 years service to the specialty

Referrals to the Outreach Service continue to increase demonstrating the success of the service. Referrals have also increased due to the impact of other initiatives, such as the introduction of NEWS as part of the 1,000 Lives + Campaign. The Health Board was the first to introduce NEWS across its wards and its introduction was fully supported through the hard work and commitment of the Outreach Service.

Patient diaries continue to go from strength to strength. They have now been successfully introduced to critical care in Nevill Hall Hospital,



through successful collaboration between the units in the Royal Gwent and Nevill Hall Hospital.

Sister Mandy Hale and Sister Tracey Rich presented at the Florence Nightingale Conference in London in March 2011. In April 2011 the team had an article on patient diaries published in the journal ‘Nursing Management’. The team are now working on a PhD with the University of Glamorgan.

In October 2011 the Critical Care Unit at the Royal Gwent Hospital commenced Transforming Care followed by the Critical Care Unit at Nevill Hall Hospital in January 2012. The units are in the minority of critical care units to have done so.

Score - to - door - The Nevill Hall Hospital Outreach education team in collaboration with 1000 Lives + have recently acted as a pilot site for the

collaborative audit score-to-door to test a benchmarking tool for the process of emergency admissions to the ICU. The results were recently presented in Llandrindod Wells where their hard work was praised. This audit tool will soon be rolled out to the Royal Gwent Hospital Outreach team.

The Health Board has expressed its gratitude to Critical Care staff for the hard work and high calibre of our staff, helping us achieve and grow

during a particularly challenging year.



Cardiff and Vale University Health Board

Throughout 2011, the Critical Care Directorate in Cardiff & Vale has made significant progress towards its goal of becoming an internationally recognised centre of clinical excellence.

Achievements in research are particularly noteworthy; the Directorate's research team has established successful collaborations with researchers

both nationally and in Northern Europe, Canada and Australasia.

Currently the Directorate is running multiple studies, six of which have been included in the UK Clinical Research Network (UKCRN) portfolio.

Teaching and training has remained very strong during 2011, with the senior permanent staff contributing to teaching activities both nationally

and internationally.

Notable accomplishments include the presentation by our undergraduates of Critical Care service evaluation at the European Society of Intensive Care Medicine's annual international meeting and multiple publications by our medical staff in high quality medical journals.

Collaboration with Laerdal has facilitated simulation training for both doctors and nurses within the Directorate by the provision of a high fidelity teaching mannequin, enhancing both the technical and non-technical skills of staff including team working and good communication.

Quality and Safety remained at the heart of Critical Care service delivery during 2011. Significant achievements included a refurbishment of our patient quiet room (sponsored by John Lewis) providing a better environment in which to hold sensitive conversations with families.

We also introduced a new routine blood testing schedule for our patients; which will reduce the incidence of iatrogenic anaemia and save the Health Board approximately £59,000 per year.

In addition we also instigated a successful pilot of patient diaries, where

the diaries were well received by both patients and relatives. Following this pilot the follow up sessions with the patients and relatives have now been redesigned in order to screen for any psychological difficulties that

Cwm Taf Health Board

The performance of both Critical Care Units in Cwm Taf Health Board against the Quality Requirements has progressively improved.

In 2011/12, the LHB recruited two Consultant Anaesthetists with special

interest in critical care, one in each site and committed to work towards a dedicated intensive care consultant on-call rota.

It is expected the newly established Critical Care Delivery Group, chaired by the Chief Operating Officer will monitor progress of these standards.

A review of the outreach service on both sites shows that it has been working extremely well. The aims of the outreach service—to identify

deteriorating patients; facilitate timely admissions to critical care; avert unnecessary critical care admissions; supporting seamless transition back to ward care; and educating ward staff are being met.

As a result of the implementation of outreach on both sites, NEWS scoring has been implemented across the Health Board very successfully.

The follow up of patients with CVC lines in 2011 has seen a significant decrease in line infection occurring on the wards. In 2011/12, lines were



may be present (anxiety, depression or post trauma symptoms) which will require further liaison with the patients’ GP or other community

services.

We have implemented multidisciplinary rehabilitation weekly meeting where we screen all patients through a multidisciplinary discussion assessing their rehabilitation, psychological, physical and welfare needs of both the patients and their families.

We undertook a physiotherapy service evaluation of NICE Guidelines 83 which demonstrates we are meeting or working towards all identified criteria except post hospital follow up.

Overall our most notable achievement during 2011 was to successfully treat ever increasing numbers of critically ill and injured patients despite a very challenging financial environment.



been identified as a risk and 72% of the CVC lines were removed after outreach educating the medical teams of the risks.

Underpinning this is the need to identify patients with sepsis earlier was Sepsis 6. Implementation and introduction of sepsis bags to the wards across both sites was implemented in April to link in with NEWS scoring.

The units continue to participate in research and presented several posters at the European Society of Intensive Care Medicine in 2011. The Royal Glamorgan Hospital has been participating in the SPOT (light) and EuSOS studies, together with the Welsh Government-funded cellular and molecular investigations in sepsis study. Dr Szakmany was awarded one of the NISCHR Clinical Research Fellowships for three years from April 2011.

Hywel Dda Health Board

A number of key developments have taken place in Hywel Dda Health Board during 2011/12. Most notably, two new critical care wards were opened in Glangwili Hospital, Carmarthen. Each bed space can now be used flexibly to

accommodate level 2 or 3 patients and there is space to expand capacity temporarily in response to a major incident or pandemic.

The Glangwili units are now using the CareVue system at bedsides for monitoring and recording patient contact. At Bronglais, all critical care monitoring and transfer monitoring systems have been upgraded and improved. Bronglais & Withybush Hospitals now have standardised PCA (PCAM) pumps with Withybush Hospital and are introducing a standardised 2mg/ml morphine protocol. Over the course of the year, the Health Board’s admissions & discharge

documentation has been updated to ensure compliance with the NICE standards 50 (Care of the Acutely Ill in Hospital) and 83 (Rehabilitation after Critical Care.



In collaboration with Swansea University, Bronglais, Glangwili and Withybush Hospitals have developed an accredited course, Rapid Response to acute and management of critical illness (RRAMCI) to be commenced in April 2012. This is to address standardisation of a recognised critical care nursing. Once operational, the course will be run in 3 sites.

Bronglais has noted an increased demand for critical care from medicine this year. To accommodate the additional demand, bed capacity bas been increased to 3 level 3 beds or 5 level 2 beds.

The Network Team would like to thank all the staff

in our Critical Care Units for their hard work,

dedication and support in the past year. It’s your

commitment that makes the Network.

South Wales Critical Care Network / Rhwydwaith Gofal Critigol De Cymru

c/o Aneurin Bevan Local Health Board / d/o Bwrdd Iechyd Lleol Aneurin Bevan

Room 7 / Ystafell 7

The Cabin / Y Caban

Llanfrechfa Grange / Faenor Llanfrechfa

Cwmbran / Cwmbran

NP44 8YN

01633 623782

www.wales.nhs.uk/southwalescriticalcarenetwork

@swccn

south wales critical care network 3b annual report 201… · care network. critical care networks...

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