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Intense pressures on critical care units may now be easing across the country, but that’s not the case for everyone, as HSJ analysis shows.

NHS England data has revealed that at one in four English hospital trusts, the number of critically ill patients actually grew over the past week.

Adult critical care occupancy is still very high in most areas and 10 trusts still have at least double the number of patients, whether covid or non covid, than they would normally have space for.

At 31 trusts, the number of critically ill patients climbed between 2 and 9 February.

The good news is that, at 81 trusts, critical care pressures have dropped in the last week. At nine trusts, the number of patients remained static.

But it highlights the workloads that intensive care teams are still facing weeks after the third covid peak was reached.

Nationally, critical care occupancy fell by 5 per cent in the last week, according to NHS sitrep data.

But five of the seven NHS regions still have 150 per cent or more of last year’s critical care patients – with occupancy still more than double in the East of England and London.

An emergency of their own

January is generally a tricky time for emergency departments in England’s acute trusts.

The moment the thermometer drops below zero, clinicians are confronted by advancing ranks of patients with snapped wrists and fractured necks of femur. An assortment of respiratory viruses including flu plus the dreaded norovirus rip through wards.

Covid is a distressing addition to the mix. There are the obvious implications of each trust now having to deal with hundreds of patients with a new brand of respiratory virus. But there are also significant and intractable challenges that leave trusts even more congested than normal.

Trust’s general bed bases have been subdivided to accommodate covid-positive, covid-possible and covid-negative patients in separate areas. This limits the beds that are unoccupied and available for non-covid patients. Then there are the obligatory tests and pathways through ED for patients who pitch up or are brought in by ambulance, leading to more bottlenecks.

In this context, it is not surprising that trusts are struggling in the latest data release. There are three in January that managed to admit, discharge or transfer less than half the type-1 patients within the four-hour target.

Barking, Havering and Redbridge University Hospitals Trust has struggled with the accident and emergency access target for years. Its longstanding staffing and capacity problems have been dramatically exacerbated by covid and in January it only dealt with 39.5 per cent of patients inside the four-hour target.

The Hillingdon Hospitals Foundation Trust and West Hertfordshire Hospitals Trust also reported performance of less than 50 per cent for type-1 patients. The covid pressure is slowly abating – these figures show that the latest wave of the pandemic cannot recede fast enough.