Doctors warn intensive care units still face months of extra pressure

Hospitals across the UK opened more than 2,250 extra intensive care beds to cope with the demand from coronavirus patients during the last 12 months – the equivalent of 140 new intensive care units.

In a new report, the Intensive Care Society (ICS) warned pressure on hospitals could last for many more months with makeshift beds for critical care patients having to stay open, hampering efforts to restart more routine services.

The ICS said that 20,675 patients had been admitted to intensive care in England, Wales and Northern Ireland by 5 February. It said patients had a median length of stay in the first wave of 12 days, a lot longer than normal with 2,251 extra beds occupied in January 2021 compared to last year.

The ICS warned thousands of extra staff drafted in to look after critical care patients would be needed for months to come and this was despite staffing levels been stretched to dangerous levels.

It also warned of the impact on staff saying a recent study had shown one in five nurses working in ICU reported thoughts of self-harm after the first wave and 45 per cent of clinicians had self-reported symptoms of post-traumatic stress disorder.

“Continued pandemic and increased winter activity coupled with re-deploying staff back to theatres risks ICUs continuing to operate at well above 100 per cent occupancy, relative to baseline, with stretched staffing ratios, for months and years to come. An urgent service review and investment for temporary and permanent staff is therefore indicated,” it said.

“The existing intensive care workforce, including those who have supported from other specialties, will become more fatigued and stressed, with the risk of long term psychological harm and mental health concerns if time is not included for them to take their leave opportunities and recuperate.”

The report comes on the eve of the latest waiting times data from the NHS showing the huge backlog in routine operations, with numbers of people waiting more than a year expected to be significantly more than 200,000.

The report said local prioritisation committees needed to be set up to decide which patients were more urgent than others for surgery – raising the prospect some patients could end up waiting far longer than others.

It detailed a phased recovery that needed to be adopted by hospitals as the threat from the virus and the demand for critical care beds drops.

Dr Steve Mathieu, a critical care consultant and author of the report, said: “Intensive Care Units and staff have been under immense pressure now for a year. Staff are tired, working outside of usual staffing standards with little or no time to rest and recuperate and we are seriously concerned about the reports showing the impact on staff wellbeing.

“We can take some solace in the fact that we are starting to see the slow decrease in the demand on ICUs. However, there is still a lot of regional variation, and many staff are still caring for up to three times the number of patients they normally expect to at this time of year, even during the busiest winter periods.”

He said the equivalent of a 141 extra 16-bed ICU units had been opened up by the NHS in the past 12 months and this did not include the care of Covid-19 patients on respiratory and general medical wards.

He warned the roadmap for ICU recovery “will take many months, if not years and it’s clear the ICU landscape will look very different on the other side.

“We need to get the right balance to ensure patients continue to be well cared for, those needing life changing operations have them done a timely manner and staff are able to recuperate and receive the psychological support that will be needed following this pandemic," Dr Mathieu said.

“This will all inevitably need investment and a nationally co-ordinated approach.”