Where are the 17 ICU bedsyou promised, Minister Donnelly?
Critical care nurses are overstretched – and on one dismal January day there were just three ICU beds available… in the whole country
SEVENTEEN critical-care beds promised by Health Minister Stephen Donnelly in budgets as far back as 2021 have still not been delivered, the Irish Mail on Sunday can reveal.
And overcrowded hospitals are unable to even use the current number of 323 ICU beds across the country due to a shortage of critical-care nurses.
A national average of just 286 criticalcare beds – intensive care and highdependency beds – were open and staffed in the first 20 days of 2023. For eight of the first 10 days in January, the number of patients in critical-care beds exceeded the total number of staffed beds, according to Health Service Executive (HSE) data. This means nurses had to care for more patients than the recommended ICU staffing ratio of one nurse per patient – a situation the HSE called ‘not ideal’.
The staffing issues currently impacting on hospitals’ critical-care capacity come as long-promised ICU beds have yet to materialise. In Budget 2021 – delivered the previous September during the height of the pandemic – Minister Donnelly promised 20 extra ICU beds would be delivered by the end of that year, which would have brought the number of critical-care beds at the time to 321.
The following year, the minister promised another 19 critical-care beds as part of a €10.5m investment announced in September 2021. These, combined with the earlier promised beds, would have brought the country’s ICU total to 340.
Mr Donnelly also promised a total of 446 ICU beds will eventually be provided as part of a ‘multi-year’ plan, but he did not
The HSE and Department of Health have both declined to give an explanation
give a deadline for their delivery. Despite the promises, none of the extra ICU beds promised were delivered by the end of 2021.
The HSE this week confirmed ‘a total of 23 critical-care beds were delivered in 2022, bringing the total to 323 criticalcare beds at the end of 2022’. This means hospitals are still short 17 ICU beds from what was promised in Budget 2021 and Budget 2022. The HSE said 20 more critical-care beds ‘are profiled for delivery this year’, which would bring the total to 343 by the end of this year.
Despite repeated requests for clarity in recent weeks, the HSE or the Department of Health have both declined to give an explanation for why the promised critical-care beds have not been delivered.
They also did not give a time-frame for when Minister Donnelly’s promise of 446 ICU beds will be achieved.
In response to queries about the underdelivered ICU beds, a HSE spokesman said, ‘I understand the Department of Health is going to be responding to you’.
Yet a spokesman for Mr Donnelly’s department said the queries were ‘operational and should be answered by the HSE’.
When asked when the minister’s promise of 446 ICU beds would be delivered, the spokesman would only say, ‘The Strategic Plan for Critical Care was brought to Government in December 2020. This sets out two phases of capacity expansion to plan, which will help to ensure readiness of the health system for response to the ongoing Covid-19 pandemic and support the ambitious longterm strategic goal of increasing overall critical-care capacity to 446 beds, fully addressing the critical-care recommendations of the Health Service Capacity Review.’
In a statement to the MoS, a HSE spokesman said: ‘The HSE is delivering on a multi-year plan for additional critical-care capacity, which includes a focus on workforce planning to ensure a supply of staff for the planned increased critical-care capacity.
‘In 2023, a further 20 critical-care beds are profiled for delivery. This will increase the total number of funded available critical-care beds to 343 by the end of 2023.
‘Phase 2 involves the development of new build capacity at a number of sites, which are subject to infrastructural development and planning processes.
‘The HSE is an employer of choice and offers significant opportunities for staff development and career progression. The retention of all health and social care workers remains a key pillar on the resourcing strategy for the HSE, coupled with ambitious international recruitment to close the resourcing gap.’ An analysis of the HSE’s Covid-19 daily operations updates confirms there was a daily average of 286 critical-care beds open and staffed in January up to Friday.
While this sometimes proved to be sufficient, in eight of the first 10 days of the month the number of patients in critical care was greater than the number of beds that were opened and staffed.
The HSE said: ‘This is explained by a unit having to take more patients than they are ideally staffed for.’
A spokesman added: ‘Most patients admitted to ICU are so sick they will die if they don’t receive life-saving treatment in ICU, therefore units have to take them, even if this impacts on staffing levels.
‘A unit may be staffed for 10 patients, but need to admit an 11th
‘A nurse may have to look after two patients instead of one to save a life’
patient because of clinical need. A nurse may have to look after two patients instead of one in order to save the patient’s life. The nurse in charge will allocate staffing in the most efficient way to ensure the least complex patients are assigned to the nurse who is looking after two patients.’
The spokesman acknowledged this situation ‘is not ideal’, but stressed, ‘Obviously, we have to provide life-saving care to all patients who need it.’
While the situation has improved since the beginning of January, the number of ICU beds available for emergencies has been as low as three in the whole country, on January 4.
A spokeswoman for the Irish Nurses
and Midwives Organisation (INMO) said: ‘Appropriate levels of staffing in high dependency areas is vital to making sure patients get the best possible care. When new beds are planned we need to make sure the correct staffing numbers and the right patient-to-staff ratios are planned alongside them.
‘Staffing shortages mean worse outcomes for patients across all areas of care, but it also has a significant impact on our long-term ability to keep trained staff in the health service.
‘If we don’t make an effort to make working conditions bearable for staff, we’re going to see the current problems persist.’