• Midlands told it must double its critical care capacity from this week
  • National commissioner said to achieve surge trusts would have to dilute critical care staffing ratios beyond current 1:2 guideline
  • Midlands critical care units may need to support pressures in London and South East, NHSE said

NHS England has told hospitals in the Midlands to further dilute their staffing ratios so critical care capacity can be doubled, HSJ has learned.

In a letter sent on 9 January to the boards of all trusts in the region, national leaders said they needed to “dilute nursing ratios beyond the current ask of 1:2” to achieve the significant increase in capacity.

In November, all trusts in England were told they could dilute staffing ratios in critical care from the standard one nurse to one patient ratio, to one nurse to two patients.

Informal reports from around the country suggest some trusts have already had to move beyond these ratios.

The letter said trusts had already been asked to surge capacity to 150 per cent of the normal baseline on 6 January, and were expected to be at 175 per cent today. But it said some units were still not achieving this and the region was “transferring patients to other regions.”

It added: “In addition to this, you need to have well developed plans in place that can be rapidly activated to surge to 200 per cent of baseline, which may need to be enacted in the coming days.

“As a region, we will be expected to potentially support the decompression of units in other areas, primarily in London and the South East over the coming days and weeks.”

It comes a few days after HSJ reported internal data suggesting demand for critical care units in the Midlands would greatly exceed capacity within two weeks.

As of last week, Good Hope Hospital in Birmingham was already working at 200 per cent of its normal baseline, while seven hospitals had declared CRITCON 3 - the second highest alert level for critical care.

HSJ asked NHS England whether there would need to be full scale cancellations of elective care to support the increased ITU capacity. 

A spokesman for the NHS in the Midlands said“To prepare for the increasing demand for NHS services, trusts have been asked to expand surge critical care on an anticipatory basis, while making provision for the wellbeing of staff working in a very demanding environment. All trusts will continue to prioritise urgent cancer operations and emergency surgery.”