Hospitals told to increase critical care bed numbers within weeks

Exclusive: ‘There are no staff to pull into intensive care units’ this winter, critical care chief warns

Hospitals have been told to increase their critical care capacity for Covid patients to cope with a surge in demand this winter due to the omicron variant, The Independent can reveal.

Some areas of the country are already operating with just one per cent of beds available, as the new strain of the virus takes over from delta to become the dominant Covid variant.

NHS leaders have been told to prepare for an expected mid-January peak in Covid admissions, with the health service potentially having to implement its highest “black alert” level even earlier in the new year.

It comes as the UK’s chief medical officers increased the Covid alert level from 3 to 4, the second highest tier, with a warning that the omicron variant was “rapidly increasing risk to the public and healthcare services”.

Meanwhile, hospital directors have said they’ll be forced to confront “ethical dilemmas” and choose between prioritising beds for A&E patients and keeping them for people who have already been waiting too long for planned surgery.

The warnings come after the government’s scientific advisory group, Sage, said on Thursday that hospitalisations from the new Covid-19 variant could reach 1,000 per day by the end of the year, with the peak being potentially “several times this level”.

And on Saturday, government advisers warned that without further Covid restrictions, omicron could lead to a bigger wave than witnessed last winter, with potentially up to 75,000 deaths in England alone by the end of April.

Leaked NHS data has revealed that just one per cent of critical care beds were available on Friday in the Midlands, where pressures on intensive care appear to be the worst.

The region has reported lower Covid-19 vaccination rates compared to other areas, and around two-thirds of patients in its ICUs are unvaccinated.

Hospitals across the Midlands have been told to increase ICU capacity to 120 per cent of the normal level, though internal data has revealed that a number of areas are already operating at these levels. There are around 420 adult critical care beds across the Midlands, and hospital chiefs have been warned that 500 may be needed in the next few weeks.

Data seen by The Independent also showed that in London just five per cent of critical care beds were available this week, compared to six per cent in the northeast, seven per cent in the southwest, eight per cent in the southeast and east of England, and 10 per cent in the northwest.

Several senior sources said that hospitals across the country had been advised by the NHS to prepare for a peak in Covid-19 admissions in the second week of January, earlier than the peak experienced during the second pandemic wave last winter.

Sources have also said that discussions are being held over the alert level for the NHS, with predictions it is likely to have to move to level four – the highest level – by the first week in January.

One trust’s executive director warned that the NHS was on the brink of collapse.

Speaking to The Independent, the director said they had recently had a briefing with NHS England where directors had warned that “it’s all going to get worse in the new year, [and] we’re likely to go to level four major incident mode on 4 January”.

They added: “I don’t think there’s any more people can do, they’re just knackered. I think the NHS just might become overwhelmed. It may collapse.”

‘The perfect storm’

In an interview with The Independent, Nicki Credland, chair of the British Association of Critical Care Nurses, said some hospitals were already moving to “team nursing” in their intensive care units, and working at “surge ratios”, which means moving away from one-to-one nursing care – the recommended level of care.

She said the problems facing the NHS this winter are creating a “perfect storm”.

“There are no staff to pull into ICU as hospitals are already full of patients who need looking after. We’ve still got patients on medical and surgical wards, we’re still undertaking surgery.”

Ms Credland added: “Last year we had a significant amount of time where we were in full lockdown, so we kind of started at a better place, if that’s possible, going into winter. Whereas this time we’re starting at an even worse place, with reduced staffing because of sickness and mental health needs.”

She warned that the public have “absolutely no faith or trust in the government” at the moment, leading some to ignore Covid rules, which has the “knock-on effect” of increasing cases, and ultimately leads to increases in hospital admissions and deaths.

According to internal reports seen by The Independent, around seven per cent of staff in critical care units across the Midlands are clinicians who have been drawn from other NHS services, while 4 per cent of staff in ICUs in the southeast and east of England are those who’ve been redeployed from elsewhere.

‘Pressure valves are going’

On Thursday the NHS revealed that its waiting list for planned operations had reached an all time high of 6 million in October, up from 5.8 million in September.

Hospitals’ attempts to address their backlog of planned operations come as emergency services pressures have reached “dire” levels, according to the Royal College of Emergency Medicine, with a record number of patients waiting more than 12 hours in A&E in November. Meanwhile, more than 8,200 patients were left waiting for an hour in ambulances outside hospitals last week.

The chief executive of NHS Providers, Chris Hopson, told The Independent: “We are in a different position to pre-pandemic winters, when trusts were facing excessive demand and major strains, and scaling back elective care temporarily was sometimes part of the solution – we had the option of releasing that pressure valve in difficult circumstances.

“But we’re in a very different situation now. There are now so many patients who’ve been waiting, including for over one or two years, to have their elective treatment, that delaying elective treatment will not always be a viable option. 

“So, we’re now in a scenario where some of the pressure valves are going. Trusts are doing their best to offer care to all patients – but the stresses on the system are showing.”

The chief executive at one NHS trust said: “We are holding beds to operate on people, and in some cases putting additional pressure onto the emergency pathway to allow us to get through some really quite sick patients.”

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They said that staff were forced to choose whether to give “an ICU bed to somebody who’s got an aneurysm that could kill him at any minute, or bringing someone in from A&E? It creates some really difficult ethical dilemmas for the treating teams.”

One senior doctor working in the West Midlands said they had lost faith that the NHS would stay afloat this winter.

“I’m just sad, I’ve kind of lost all hope it’s going to be all right. Which is not why I went into medicine. I recently wanted a specialist nurse to work in my team, and the response from leaders was – you’ve got to prove things are horrific before you can.”

A leaked note to staff from Royal Bournemouth Hospital this week revealed that the trust had raised a “critical incident” for three days running due to pressures.

The note, seen by The Independent, told staff the trust’s situation was “very pressured,” with “very limited beds across the hospitals”.

It added that there had been a “significant issue of Covid outbreaks in the community”, which had limited its ability to discharge patients into care homes, and that the trust had been forced to cancel a “small number of operations”.

“I’ve lost all hope”

This week, the government’s Scientific Pandemic Influenza Group on Modelling warned that any significant wave of infections would spill over into hospitalisations, and that if estimates from South Africa were applicable to the UK, “there is the potential for a peak of infections much larger than that experienced in January 2021”.

Commenting on the modelling, Mr Hopson of NHS Providers said: “Reports that the new Covid variant, omicron, is spreading rapidly in the UK and could lead to major rises in hospital admissions are, obviously, worrying. 

“Trusts are understandably concerned when the NHS is experiencing the greatest pressure it has ever been under at this time of year, and is facing what is already becoming the most difficult winter in its history.”

He said that now, more than ever, it was important for the public to “play their part” by getting vaccinated and following the rules to curb transmission.

Boosters for over-30s are now open, with Health Secretary Sajid Javid urging people to “please come forward as quickly as possible to get boosted and help our country get ahead in this race with the variant.”

A spokesperson for the NHS in the Midlands said: “Hospitals across the region have well-established plans in place to manage increased demand. As part of these plans we have recommended local systems take a number of precautionary steps to ensure the ongoing safe care of all patients, including flexing critical care capacity as needed.”

NHS England Midlands said the region had set up an adult critical care transfer service last year to help trusts manage Covid-19 pressures on critical care, which had transferred 2,500 patients between its hospitals’ ICUs since April 2020.

A national NHS spokesperson said: “NHS services are facing sustained pressure, with staff contending with the highest number of 999 calls for any November on record, and the second busiest November for A&E.

“NHS staff have tried-and-tested plans in place to deal with increases in demand, and the best thing the public can do is get the evergreen offer of a vaccine and get the booster when eligible.”