Intensive care bed shortage 'causing deaths'

GLENDA COOPER

More than 3,000 deaths could be averted each year if Britain had the standards of intensive care found in the United States, doctors said yesterday.

While the US currently spends pounds 144 per head of population on intensive care, the United Kingdom spends only pounds 5.90. France (pounds 54), Japan (pounds 44) and New Zealand (pounds 26) are all bigger spenders than Britain, and doctors yesterday called for the number of intensive-care beds to be tripled.

For the last two and a half years South West Thames Regional Health Authority has been collecting data on more than 10,000 patients admitted to intensive care units (ITUs), including their clinical treatment and the subsequent outcome. This was compared with data on 20,000 patients in the US.

Presenting the findings at a press conference in London yesterday, Dr David Bennett, reader in intensive-care medicine at St George's Hospital Medical School in Tooting, south-west London, said that the patients in his survey had a severity-of-illness score that was about 10 per cent higher than their US counterparts. However, they spent about 10 per cent less time in ITUs and 15 per cent less in hospital.

Mortality rates were also 20 per cent higher than in the US. Dr Bennett estimated that 200 to 250 more people in his region died than would have done if they had been treated in America.

Between 1 and 2 per cent of hospital beds in Britain are for intensive care, compared with 5 per cent in Canada, Australia, the US and most of northern Europe.

Dr David Bahari, a former consultant in intensive care at Guy's Hospital in south London, who now works in St George's Hospital in New South Wales, Australia, told the conference: "We demonstrated that there were 2.2 ITU beds per 100,000 [population] in England compared with 5.3 beds per 100,000 in New South Wales. We are not talking about a small difference. We are talking about a 100 per cent or greater difference."

Last February, doctors carried out a major telephone survey of hospitals across the country. In the area within the M25 they found only eight available intensive-care beds. They concluded that, in the event of a major disaster, hospitals would be unable to cope.

A similar survey carried out last month found that although intensive- care beds have increased by 6 per cent since last February, the occupancy rate is still running at 90 per cent, which does not allow sufficient margin. Some hospitals are still having to refuse admission to critically ill patients.

Dr Bennett said a hospital in Birmingham had refused admission to 12 patients in three days: "Even if the number of beds was substantially increased, the specialist staff just aren't there ... Surveys which we carried out in January and November of this year confirm that units have had to close some of their beds due to the absence of trained intensive- care nursing staff."

He and Dr Bahari urged the Department of Health to instigate long-term planning for the number of intensive-care beds required and to introduce a training programme for doctors.

Dr William Sibbald, head of critical care medicine at the University of Western Ontario, warned at the conference: "People don't want to plan for tragedies. But you have a stake in this. There is a strong likelihood you will need an intensive care unit in the future. Making sure it's there is an important responsibility for us all."