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I’d like to tell you a story of a crisis in critical care beds. When patients were being shipped across the country, and crucial operations cancelled. Its not a tale of 2020 (though I could easily tell that too), but of the 1990s. The ICU beds crisis often made the papers.
In 1999 we had 2240 critical care beds in England & Wales. The Audit Commission found that this was woefully inadequate – A damning report “Critical to Success”, showed wide variations in outcomes & frequent transfers of patients due to lack of beds
http://news.bbc.co.uk/1/hi/health/486473.stm
http://news.bbc.co.uk/1/hi/health/486473.stm
To the credit of the Department of Health, it produced an action plan “Comprehensive Critical Care” and promised a 30% increase in critical care beds in the 2000 NHS Plan
https://webarchive.nationalarchives.gov.uk/20121014090959/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf
https://webarchive.nationalarchives.gov.uk/20121014090959/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf
“Comprehensive Critical Care” wasn’t just about beds, but also delivery of care – extending critical care to the whole hospital through ‘outreach’ and ‘rapid response’ teams, and ensuring that nursing, medical and allied professional staff in ICU were appropriately trained.
Compared to the rest of Europe, the UK had the lowest proportion of ICU beds relative to total hospital bed numbers (indeed we still do)
Did they deliver? Yes – critical care beds went from 2240 to 3128 in 2003 (40% expansion), this expansion continued to 3500 by 2011 (12% vs 2003). Did it work? Yes – mortality fell by 13.4%, & routine transfers between hospitals for lack of beds dropped https://www.bmj.com/content/339/bmj.b4353
We know that delays in admission to ICU cost lives - which is why running ICUs at full capacity is a bad idea https://dx.doi.org/10.1007%2Fs00134-018-5148-2
And so now we find ourselves in 2021, ICU beds have expanded in the past decade – but so has demand (aging population, highly invasive surgery, ability to save previously unsalvageable patients). But COVID has temporarily reversed so much progress.
The return of non-specialist delivered critical care, the dilution of nursing ratios and routine transfer of patients across the country, delayed admissions. Hospitals rightly warning of compromised ability to deliver high-quality critical care.
This sadly means lives will be lost, because we don’t do those things for fun but because we know its what makes the difference. We’re trying our best in the face of an overwhelming onslaught of cases.
To get us out of the 1999-shaped hole (and be in no doubt, this is considerably worse than 1999), we need everyone to do their bit. Stay at home, socially distance, wear a mask, get vaccinated and don’t create or spread misinformation.
