Shortage of critical care beds adds to delays for 2m operations

TWO million operations put off by Covid-19 face further delays due to a crisis over the availability of critical care beds which meet safety standards.

Dr Alison Pittard, dean of the Faculty of Intensive Care Medicine, told The

Sunday Telegraph preparations were urgent because front-line services had “fundamentally changed as a result of the pandemic”.

Since surge capacity was created in March, statistics from the Intensive Care National Audit & Research Centre consistently show that just 10 per cent of people who have died from Covid-19 were admitted to intensive care. At the peak of the crisis, figures from the NHS operational dashboard showed 40.9 per cent of acute beds were unoccupied, four times the normal number.

However, doctors warned those figures risked painting a misleading picture as hospitals begin taking other non-emergency surgeries in the coming weeks. Instead, they point to figures showing demand for critical beds increased 4 per cent year-on-year even before the pandemic began.

“The majority (of current spare beds) are extreme surge beds, which do meet GPICS 2 (Guidelines for the Provision of Intensive Care Services) standards, especially staffing,” tweeted Dr Chris Hingston, a critical care consultant at University Hospital of Wales’s Adult Critical Care Unit.

“This is fine for a pandemic. Wales remains woefully under-resourced in terms of funded critical care beds.”

The picture is further distorted as since lockdown, a greater proportion of over-80s have been dying in care homes than in hospital. Surge capacity in hospitals was created by spreading the same number of critical care staff across a larger number of beds.

“In February, a patient on a ventilator would have their own ICU nurse,” another doctor, speaking on condition of anonymity, told The Telegraph. “In the pandemic, the plan was to have each ICU nurse look after six. Staff with little or no ICU experience were brought in to fill in the gaps. Continuing in this manner to facilitate planned surgery would risk worse outcomes for the patients, and burnout for the staff.”

Dr Pittard echoed those observations. “The only way that critical care has managed the unprecedented demand during Covid is to dramatically change the way we work, including staffing ratios,” she said.

“Safety has been maintained by using the skills of non-critical care staff to provide care in a teams-based approach but, as normal NHS activity is restored, it will be necessary to return to more normal working practices.

“Current data shows that we remain above the normal recommended occupancy and, in order to support Covid and non-Covid activity, we will need an increase in critical care beds.”

The faculty said it “can’t really get into numbers” of how many more beds it needs. “What we can say is, it is possible that delivery of critical care has been fundamentally changed as a result of the pandemic, but short-term changes precipitated by the pandemic response cannot be assumed to be appropriate for an indefinite period without examination and analysis,” Dr Pittard added.

Overall, demand for critical care prior to the pandemic increased 4 per cent year-on-year, and the estimated two million operations delayed by the first-wave pandemic response “will create an additional, currently uncalculated medium-term critical care pressure”, the faculty said.

NHS England was contacted for comment.