Critical Capacity

During the last two weeks of February 2018 as a short length research project, the FICM ran a survey of its membership to understand the complex picture behind the UK’s current critical care bed capacity. From a series of local workforce engagements and censuses, FICM has regularly had the issue of bed capacity raised as a concern for both the continuing quality care of patients and the wellbeing of the clinicians who look after them.

Figures have been routinely collected in England for some years, but it is commonly felt by ICM doctors, that this does not give an accurate reflection of the day-to-day pressures felt on the majority of High Dependency Units (HDUs) and Intensive Care Units (ICUs).
386 responses were received, accounting for approximately 20% of ICM consultants. As there are around 210 units in the UK, this is likely to cover a large number of units. The Faculty liaised with the Guardian and released this data as an exclusive to them for publication on 7 March 2018.

Key messages

  • 3/5 of units do not have a full critical care nursing complement.
  • Of those affected, the vast majority considered that bed capacity was inevitably impacted leading to cancelled operations. Quality of care and even patient safety might be impacted.
  • 2/5 of units have to close beds due to staffing shortages on at least a weekly basis. Only 14% of units did not have to close beds.
  • 4/5 of units had to transfer patients due to lack of beds. With 21% units doing this at least monthly.
  • The bed fill rate for Northern Ireland and Wales was estimated to be at least 95%. Scotland was 84%. NHS England data put the critical care bed capacity rate at 87%, but a number of units responded to express doubt that the rate entered for their Trusts was a true reflection of their real capacity.

While I am very concerned with some of the results of this survey, unfortunately none will come as a surprise to the healthcare professionals who manage these challenges on a day-to-day basis. No intensive care doctor is willing to compromise on patient safety, but without specific interventions targeted towards alleviating system pressures, the strain on intensive care staff and resources will increase exponentially. Staff are doing an incredible job to keep patients safe with the resources available to them – it is the system that requires urgent critical care.

Dr Carl Waldmann
FICM Dean, 2018

The survey demonstrated that large numbers of units across the UK are either currently experiencing or moving towards a capacity crisis. Only a minority of units were not having to make difficult decisions to ensure that patients were able to receive the care they required.

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