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NHS intensive care units sending patients elsewhere due to lack of beds

Posted on 8/03/2018 by

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Exclusive: Doctors say 80% of units sending patients to other hospitals amid chronic shortages

Patients whose lives are at risk are being turned away from their local hospitals because of a lack of intensive care beds, doctors who work in those units have revealed.

Four in five intensive care units (ICUs) are having to send patients to other hospitals as a result of chronic bed and staff shortages.

Units are so beleaguered that some may no longer be able to care properly for the NHS’s sickest patients, the leader of the intensive care speciality has warned.

Intensive care consultants have disclosed that patients are being transferred from one ICU to another for non-clinical reasons in 80% of hospitals, and in 21% of units that happens at least once a month.

Six in 10 (62%) ICUs cannot function normally because they are so short of nurses, according to a survey of ICU consultants by the Faculty of Intensive Care Medicine (FICM), their professional body, which has shared its findings with the Guardian.

It found that the 210 intensive care units across the UK were each on average short of 12 nurses, who play a vital role in caring for critically ill patients.

The doctors’ testimonies show that ICUs are under such strain that they are struggling to cope with the numbers of patients needing potentially life-saving care, such as after a car crash, heart attack, stroke or cancer operation. 

The units have recently come under even greater pressure from the spike in serious illness linked to the long, cold winter, especially with the worst flu outbreak since 2009-10 having led to 2,401 people being hospitalised because of the virus.

“These findings reveal a range of very serious concerns about widespread understaffing and lack of beds in intensive care across the NHS. The problems revealed by this survey of senior doctors should give ministers and NHS leaders serious cause for concern,” said Dr Carl Waldmann, the dean of the FICM.

“Especially at this time of year, when winter pressures exacerbate an already beleaguered system, critical care services come close to the absolute limit of their ability to provide good patient care. Without an open bed, which includes all the relevant critical care staff to safely manage that bed, intensive care units and high dependency units cannot admit patients.”

He added: “It is never ideal to transfer patients at their sickest, but for the relatives transfers can be a daunting prospect, not least because they then have to travel long distances to spend time with their loved one. This is an emotional drain for relatives at a time when they may already be at their most vulnerable.”

The survey of 386 (20%) of the 2,100 consultants working in ICUs found that planned operations were having to be cancelled as a result of ICU bed shortages. Patients who undergo high-risk surgery often need to be looked after in an ICU bed for several days after their procedure.

Other findings were:

• 62% of ICU doctors said their unit did not have a full complement of critical care nurses. Shortages were most acute in Wales and least in London.

• Beds in ICUs are being shut every day because of staff shortages. About 40% of units have to close a bed or beds at least once a week, doctors say.

• 79% of intensive care consultants think patients’ quality of care can suffer due to ICU understaffing.

• Two-thirds (68%) fear patients’ safety is being compromised by widespread nurse shortages.

• Nurse and bed shortages worsen staffing problems by increasing problems of recruitment and retention.

NHS figures due out on Thursday are expected to show that this winter the NHS has come under unprecedented strain, and that last month it faced even more intense pressure than in December and January.

The Department of Health and Social Care declined to comment directly about patients being turned away from ICUs and shortages of ICU nurses.

It said in a statement: “We currently have record numbers of staff working in the NHS, including over 900 more intensive care doctors since May 2010, but we know there is more to do to strengthen our workforce.

“That’s why we announced the biggest increase in training places for doctors and nurses in the history of the NHS, and are helping existing staff to improve work/life balance and work more flexibly – underlining our commitment to ensuring the NHS has the staff it needs, both now and in the future.”

NHS England said: “The facts are that in January 800 more critical care beds were open than seven years ago, occupancy rates were in line with previous years, and the number of non-clinical transfers was less than half of what it has been for the last few years.”

What intensive care doctors say

“We have a serious underprovision of ICU beds, resulting in frequent non-clinical transfers, overstretched nursing and medical staff, very difficult decisions regarding management of where to nurse patients and frequent cancellation of elective operations.” (Intensive care consultant in Kent, Surrey and Sussex)

“We have spent the majority of the last six weeks in ‘surge’ capacity mode with extra beds in the recovery area. Efficiency, safety and quality all suffer when we run at this level of workloads.” (East Midlands)

“We have been trying to engage the [hospital] trust in critical care expansion for more than 10 years. We have reached crisis point.” (North-west)

“We often have to use expensive agency nurses to keep our capacity of beds.” (Scotland)

“Elective surgery is cancelled nearly daily, which is a massive burden on patients and staff looking after them, both emotionally and physically.” (Kent, Surrey and Sussex)

“I am very concerned about bed capacity issues in this region. It is unsustainable. I can recall only a couple of occasions over the past six months that there was a physically empty bed when I came on shift.” (North-west)

Source: TheGuardian