• Intensive care chief says central data underestimates how full ICUs are
  • Faculty of Intensive Care Medicine boss warns of patient safety risks
  • Central data a “blunt tool” and can include empty beds shut by staffing shortages

Intensive care units are under far greater pressure than is reflected by NHS England’s official data with many trusts already recording 100 per cent bed occupancy, specialty leaders have warned.

The Faculty of Intensive Care Medicine told HSJ many ICUs were already full by mid-December despite NHSE’s winter daily situation reports stating an average 83 per cent fill rate across England’s adult critical care beds for the first two weeks of the reporting period.

The growing number of full units has led to an increasing number of non-clinical transfers, which come with greater patient safety risks, intensivists said. The FICM said this winter had been busier than last winter to date with little sign of a let up.

Dean of FICM Alison Pittard told HSJ the concerns raised by its members this winter echoed the findings of a report it published last year, which indicated “a quarter of units surveyed did not recognise their unit’s SitRep data”.

Dr Pittard said there were several reasons why the SitRep data may be “deceptive”, such as that it was “too blunt a tool” which did not represent the reality of pressure on the frontline. The central data may also “include beds that were empty but also unofficially closed due to lack of critical care nurses”.

She added: “The flow of patients through critical care is much more important than absolute occupancy…This gives a much better picture of the pressures on critical care and is possibly why there is the discrepancy between reported occupancy and what clinicians are seeing.

“The consequence this winter is that senior healthcare team members spend their time hunting beds in and outside of the ICU rather than caring for our patients.”

Senior intensivists from a number of units supported Dr Pittard’s argument (See box: Reports from the ICU front-line do not tally with picture given by central data).

The main drivers of pressures on ICUs are largely consistent with those for the rest of the system: rising acuity of patients, and a workforce shortage exacerbated by the pensions crisis.

NHSE did not comment about the accuracy of the daily data or address whether the daily data underestimated bed capacity.

An NHSE spokesman said: “These weekly data are submitted by hospitals themselves.”

The spokesman added the most recent bed occupancy monthly data, which goes through a more robust validation process than the daily data, “show there were more adult critical care beds open in October than in any of the same months this decade, and we also saw the second-lowest number of non-medical transfers”.

Reports from the ICU front-line do not tally with picture given by central data 

One senior figure from a unit in the North of England said: “Last week [mid-December] neurosurgical referrals were triaged and redirected to another centre due to lack of beds here. Unfortunately, this doesn’t appear on any formal data collection as the decision to transfer happened before they arrived at our hospital.”

Another unit in a large tertiary centre told HSJ: “The impact on us… has meant we have started cancelling operations.

“We have also had to pull staff from the [high dependency unit] to keep beds open on the ICU as we have had patients needing multiple organ support.

“This is partly due to staff sickness, despite flu jab uptake being really high, but mostly due to existing lack of staff. Other local centres are full so have been unable to take their own repatriation patients back, which means they have had to stay on our unit.”