• Consultants at University Hospitals Birmingham Foundation Trust have been told the trust’s priority is ITU “at expense of dropping all activities”
  • Medics warned they may have to “demonstrate their activity” as trust makes plea for additional ITU staff

A medical leader at England’s largest acute trust has warned fellow doctors that its ‘priority is now [intensive care] at [the] expense of dropping all activities’, and suggested that some are avoiding critical care work.

An internal email sent by the divisional medical director of critical care at University Hospitals Birmingham to medical consultants this week said: “I don’t need to remind all about the covid situation. The headline is that we are continuing to ramp [up] and have exceeded our ITU capacity. To give you an idea, ITU beds are now four stacked in [a] space of two. Nursing staff are having to look after complex very demanding critically ill patients, with a ratio of 1:3 unlike the standard 1:1…

“The trusts’ priority is now ITU at expense of dropping all activities. We cannot let patients die because we can’t admit them to ITU. We must utilise all DCC [direct clinical care time] and SPA [supporting professional activity] (the latter has been cancelled) and ensure that all who are not on the ward or attending urgent cases are rostered to attend ITU. Ward demands should be met by junior floor staffing which is in operation already.”

He said all medical consulants’ time “need[s] to be accounted for. Redeployment does not mean you are necessarily expected to do medical ITU but to form part of the bedside team to assist in tasks that we are all capable of delivering.”

He said some specialities were “delivering on this but this has to be delivered by all of us” and added: “We are reaching the point whereby consultants may have to hand in returns to demonstrate their activity.” 

The medical director said there had been “anecdotal” incidents of junior doctors being left to pick up work after consultant ward rounds were done, which he said must stop.

According to the email, medics have been told to work on a four day on, four day off rota and to “dispense all other staff to help ITU”.

Commenting on the email, one medic, speaking anonymously, told HSJ: “All of us work flat out to keep services going. People are voluntarily cancelling their leave… This email shows first hand the degree of disarray. I am astounded by the fact they did very little to prepare ICU and the hospitals.”

The medical director’s email comes as the trust had 194 patients in intensive care today, higher than its April peak of 171, according to internal figures obtained by HSJ.

ITU capacity figures submitted earlier this month to NHS England by the trust showed the number of beds it could “super surge” to — effectively its maximum capacity — was 250.

Yesterday the trust was forced to send a separate email seeking medical staff to cover critical care shifts as it was short of around 50 staff, HSJ has been told. 

As the trust’s ITU pressures have grown, several senior medics have said it has cancelled urgent operations, including priority two cancer patients, who require treatment within four weeks or risk deteriorating.

However, earlier this week NHS England told trusts they should give equal priority to urgent cancer treatment as they do covid-19 patients.

University Hospitals Birmingham did not respond to HSJ’ questions and said it will not provide commentary on ”internal operational emails.” 

This story was updated at 9:54 with response from UHBFT.