The general population is ageing, with those requiring hospital admission older, sicker and generally more dependent. In 2010 the over-65 age group accounted for 10 million of the population in the UK, and by 2030 the number will be closer to 15.5 million. Emergency admissions for patients who have increasingly complex comorbidities requiring multidisciplinary and cross-speciality input are increasing. Meanwhile, greater emphasis has been placed on managing patients in their home environment for longer periods, meaning those who are admitted to hospital are sicker and require greater use of resources. Technological developments in healthcare means that treatments once thought too high a risk are now commonplace in hospitals.

With the increase in patient acuity it became evident that wards were not always able to cope effectively with the extra demands placed on them. Studies in the late 1990s identified that the deteriorating patient was not always recognised, and/or sufficient action was not taken prior to admission into the intensive care unit (ICU), adversely affecting patient outcome.

In 2000 the Department of Health¹ published its report, Comprehensive Critical Care