• Royal College of Surgeons recommends a review of critical care bed capacity
  • It follows two patient deaths as a result of delays receiving surgery
  • NHS England chief Simon Stevens was warned by coroners of future deaths risk

The Royal College of Surgeons has called on NHS England to carry out a review of critical care bed capacity after two patients died because of delays receiving surgery and poor referral practices between hospitals.

NHS England medical director Sir Bruce Keogh is expected to write to NHS trusts this week setting out their duties to accept patients needing emergency neurosurgery regardless of intensive care bed capacity.

His intervention follows the deaths of Mary Muldowney and Teresa Dennett, who both could have survived had they been treated sooner. Their deaths, highlighted by HSJ, prompted coroners in both cases to send warnings to NHS England chief executive Simon Stevens. Both said future deaths could occur if action wasn’t taken.

The Royal College of Surgeons told HSJ that some local STP plans recommended cutting beds further, and warned this could lead to patient safety risks.

Richard Kerr, a consultant neurosurgeon and Royal College of Surgeons council member said: “We strongly encourage NHS England to review bed capacity in the NHS, and not just critical care beds. While sustainability and transformation plans are a welcome initiative, a number are proposing to cut bed numbers further. Without realistic or fundable plans to create more capacity in the community this could, at best, result in a further significant rise in waiting times if not further risks to patients’ safety.”

He pointed to a study in 2014 which highlighted that England had four critical care beds per 100,000 people, far below the European average of 11.

“It is difficult to know what the national level of critical care bed shortages are as occupancy is counted at midnight on the last Thursday of the month, meaning we do not have the full picture throughout the week in our hospitals. However, with the current pressures on the NHS, we have heard from surgeons that bed availability is almost certainly getting worse in some hospitals. This isn’t just affecting patients requiring neurosurgery.”

Coroners raise concerns over critical care deaths

Mary Muldowney died in July last year after St George’s Hospital, Royal Sussex Hospital, and King’s College Hospital refused to take her as an emergency transfer from East Surrey Hospital where she has been admitted following a stroke requiring neurosurgery. Royal London eventually agreed to a transfer although it also had no free ICU beds. The coroner said Ms Muldowney would have survived if not for the delays.

Although the coroner said all three hospitals refused because they had no spare ICU beds, St George’s later told NHS England its refusal was a clinical decision. Sir Bruce Keogh accepted this was “at odds” with the inquest’s findings.

Teresa Dennett died from a stroke in February 2016 after Nottingham University Hospitals and Sheffield Teaching Hospital both refused to accept her transfer from nearby Kings Mill Hospital, run by Sherwood Forest Hospitals Trust. Nottingham refused because it had no free intensive care beds but Sheffield’s decision was made by a consultant who believed Ms Dennett should be treated at her local centre, despite the trust having eight spare ICU beds.

The Society for British Neurological Surgeons said in 2015 that patients should be admitted for surgery regardless of bed capacity. HSJ understands Sir Bruce Keogh’s letter to trusts this week will underline this responsibility under what is known as the “universal acceptance policy.”

Mr Kerr said the college was “saddened” by the deaths of Teresa Dennett and Mary Muldowney, adding: “There are important lessons that must be urgently learnt and we urge those trusts involved to set out clearly how they will prevent further deaths from lack of critical care bed capacity.”

NHS England declined to say whether or not it would undertake the review requested by the RCS.

A spokesman said: “Rather than cutting beds, there were also more adult and children’s critical care beds this January than a year ago, and at 84.6 per cent, bed occupancy is lower than in January last year.”

The Intensive Care Society recommends that critical care units should operate at a maximum of 70 per cent bed occupancy in order to manage peaks in demand.

The NHS England spokesman made no mention of Nottingham’s shortage of ICU beds in relation to Teresa Dennett’s death saying only: “One of the coroner’s reports makes clear there were in fact eight ICU beds available at the time in Sheffield where the patient could appropriately have been treated but the decision not to do so was made by a senior consultant neurosurgeon there.”

The spokesman added: “The formal response by St George’s Hospital to the other coroner’s report also makes clear that their hospital’s decision not to accept the patient was in fact taken on clinical grounds by the St George’s neurological team.”