The NHS’s network of intensive care units is “at its limits” because they are overwhelmed by staff shortages and the sheer number of patients needing life-or-death care, senior doctors are warning in an unprecedented intervention.
Intensive care units (ICUs) are becoming so full that patient safety is increasingly at risk because life-saving operations – including heart, abdominal and neurosurgery – are having to be delayed, the leaders of the specialist doctors who staff the units have told the Guardian.
“Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels,” said Dr Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM).
“It is important that bed occupancy rates do not exceed 85% in order to ensure there is capacity for emergencies. The reality is that many units are quickly reaching 100% capacity whenever there is excessive hospital activity,” he added.
The Guardian can reveal that, in a stark example of the growing problems, Hull and East Yorkshire Hospitals NHS trust last week ran out of intensive care beds at its two hospitals and was struggling to provide normal care to the many patients needing treatment for life-or-death conditions.
In a letter to its nurses, it said: “The critical care units have been working under considerable and sustained pressure. This is as a direct consequence of both the high number of patients requiring critical care support, and the intensity of each patient’s needs. This is in excess of the established number of level 3 [intensive care] equivalent beds on both hospital sites.”
Dr Liam Brennan, the president of the Royal College of Anaesthetists, voiced similar concerns. “In order to care for acutely unwell patients, surgery is being postponed because of lack of ITU [intensive therapy unit] beds. The combination of inadequate staffing levels in intensive care units together with a shortage of high-dependency beds is having a very real impact on patients, which are needing to have critical surgery such as major abdominal or chest surgery, or neurosurgery, delayed for their own safety,” he said.
“I’ve had reports from anaesthetists and intensive care specialists across the country of 100% occupancy rates in intensive care units and of major surgical cases, including cardiac cases which are potentially life threatening, being cancelled because the beds required for the post-operative care are needed for other critically ill patients,” Brennan added.
Steve Jessop, the trust’s nurse director, added that as a result, “at this time the service is currently unable to deliver critical care services to the high number of patients that require treatment resulting in: cancellation of life-saving operations for patients requiring critical care support, including neurosurgery, cardiothoracic surgery, vascular surgery and cancer operations.
“Currently the critical care units are caring for patients which are significantly above the number of patients we are resourced to care for.” Jessop offered nurses increased pay for working extra shifts to help relieve the pressure in its critical care units in Hull and Cottingham in east Yorkshire.
Doctors working in intensive care have told the Guardian how ICU bed shortages have become even more acute during the NHS’s “winter crisis” and forced patients needing life-or-death treatment in an ICU to wait many hours before getting a bed. One told how a patient with sepsis, the blood infection that kills an estimated 44,000 people a year, had to wait more than 12 hours in A&E for an ICU bed to become free. Another patient, an elderly man who was known to be dying after a cardiac arrest, ended up passing away in an A&E unit rather than in a side room in the hospital’s ICU as doctors hoped because it was so full.
Waldmann and Brennan also fear that patient safety is at risk as a result of ICUs becoming overloaded. “Multidisciplinary teams have maintained patient safety, but in future years this may increasingly come at the expense of quality of care,” said Waldmann.
The disclosure that ICUs are under such intense strain challenges both Theresa May’s recent insistence that the unprecedented problems seen in hospitals are in line with normal winter pressures and the claim by the health secretary, Jeremy Hunt, that the NHS is “performing well”. Copious official data shows that hospitals, GP surgeries and ambulance services, under the heaviest pressures on record, are routinely breaching NHS-wide targets for seeing and treating patients fast enough.
NHS-wide shortages of specialist doctors and nurses means ICU beds often lie unused because there are no staff to care for patients, added Brennan. One in three of the 220 ICUs across the UK have a vacancy for at least one consultant, according to new survey data collected by the FICM. “Bed capacity figures still do not give a true reflection of the situation on the ground. A number of seemingly empty beds have to remain empty as there are not sufficient doctors and nurses in place to support them,” said Waldmann.
Jonathan Ashworth, the shadow health secretary, said: “Reports that intensive care is at capacity and without adequate staffing should set alarms bells ringing in Downing Street, but instead we have a prime minister utterly lacking in her response to the NHS crisis.
“The truth is problems are getting worse and more widespread than in previous years with even life-saving cardiac, abdominal or neurosurgery operations being cancelled. Theresa May needs to get a grip of the crisis and explain what action she’s going to take to make sure that hospitals can get in place the number of staff they need to keep patients safe.”
NHS England denied there were any serious problems. “At this time of year it’s not unusual for specialist intensive care units to become busy, but tracking data on occupancy rates show hospitals have teams in place to ensure the right care is available. This can include moving patients to other hospitals or bringing in extra staff where necessary,” said a spokeswoman.
NHS intensive care "at its limits" because of staff shortages
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